%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e33591 %T Regulatory Frameworks for Clinical Trial Data Sharing: Scoping Review %A Gudi,Nachiket %A Kamath,Prashanthi %A Chakraborty,Trishnika %A Jacob,Anil G %A Parsekar,Shradha S %A Sarbadhikari,Suptendra Nath %A John,Oommen %+ The George Institute for Global Health, University of New South Wales, 308-309, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi, 110025, India, 91 114158809193, ojohn@georgeinstitute.org.in %K clinical trial %K data sharing %K policy %K scoping review %D 2022 %7 4.5.2022 %9 Review %J J Med Internet Res %G English %X Background: Although well recognized for its scientific value, data sharing from clinical trials remains limited. Steps toward harmonization and standardization are increasing in various pockets of the global scientific community. This issue has gained salience during the COVID-19 pandemic. Even for agencies willing to share data, data exclusivity practices complicate matters; strict regulations by funders affect this even further. Finally, many low- and middle-income countries (LMICs) have weaker institutional mechanisms. This complex of factors hampers research and rapid response during public health emergencies. This drew our attention to the need for a review of the regulatory landscape governing clinical trial data sharing. Objective: This review seeks to identify regulatory frameworks and policies that govern clinical trial data sharing and explore key elements of data-sharing mechanisms as outlined in existing regulatory documents. Following from, and based on, this empirical analysis of gaps in existing policy frameworks, we aimed to suggest focal areas for policy interventions on a systematic basis to facilitate clinical trial data sharing. Methods: We followed the JBI scoping review approach. Our review covered electronic databases and relevant gray literature through a targeted web search. We included records (all publication types, except for conference abstracts) available in English that describe clinical trial data–sharing policies, guidelines, or standard operating procedures. Data extraction was performed independently by 2 authors, and findings were summarized using a narrative synthesis approach. Results: We identified 4 articles and 13 policy documents; none originated from LMICs. Most (11/17, 65%) of the clinical trial agencies mandated a data-sharing agreement; 47% (8/17) of these policies required informed consent by trial participants; and 71% (12/17) outlined requirements for a data-sharing proposal review committee. Data-sharing policies have, a priori, milestone-based timelines when clinical trial data can be shared. We classify clinical trial agencies as following either controlled- or open-access data-sharing models. Incentives to promote data sharing and distinctions between mandated requirements and supportive requirements for informed consent during the data-sharing process remain gray areas, needing explication. To augment participant privacy and confidentiality, a neutral institutional mechanism to oversee dissemination of information from the appropriate data sets and more policy interventions led by LMICs to facilitate data sharing are strongly recommended. Conclusions: Our review outlines the immediate need for developing a pragmatic data-sharing mechanism that aims to improve research and innovations as well as facilitate cross-border collaborations. Although a one-policy-fits-all approach would not account for regional and subnational legislation, we suggest that a focus on key elements of data-sharing mechanisms can be used to inform the development of flexible yet comprehensive data-sharing policies so that institutional mechanisms rather than disparate efforts guide data generation, which is the foundation of all scientific endeavor. %M 35507397 %R 10.2196/33591 %U https://www.jmir.org/2022/5/e33591 %U https://doi.org/10.2196/33591 %U http://www.ncbi.nlm.nih.gov/pubmed/35507397 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e30405 %T Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review %A Kariotis,Timothy Charles %A Prictor,Megan %A Chang,Shanton %A Gray,Kathleen %+ School of Computing and Information Systems, University of Melbourne, The University of Melbourne, Parkville, 3052, Australia, 61 0488300223, Timothy.kariotis@unimelb.edu.au %K electronic health records %K psychiatry %K mental health %K electronic medical records %K health informatics %K mental illness %K scoping review %K clinical decision support %D 2022 %7 4.5.2022 %9 Review %J J Med Internet Res %G English %X Background: The adoption of electronic health records (EHRs) and electronic medical records (EMRs) has been slow in the mental health context, partly because of concerns regarding the collection of sensitive information, the standardization of mental health data, and the risk of negatively affecting therapeutic relationships. However, EHRs and EMRs are increasingly viewed as critical to improving information practices such as the documentation, use, and sharing of information and, more broadly, the quality of care provided. Objective: This paper aims to undertake a scoping review to explore the impact of EHRs on information practices in mental health contexts and also explore how sensitive information, data standardization, and therapeutic relationships are managed when using EHRs in mental health contexts. Methods: We considered a scoping review to be the most appropriate method for this review because of the relatively recent uptake of EHRs in mental health contexts. A comprehensive search of electronic databases was conducted with no date restrictions for articles that described the use of EHRs, EMRs, or associated systems in the mental health context. One of the authors reviewed all full texts, with 2 other authors each screening half of the full-text articles. The fourth author mediated the disagreements. Data regarding study characteristics were charted. A narrative and thematic synthesis approach was taken to analyze the included studies’ results and address the research questions. Results: The final review included 40 articles. The included studies were highly heterogeneous with a variety of study designs, objectives, and settings. Several themes and subthemes were identified that explored the impact of EHRs on information practices in the mental health context. EHRs improved the amount of information documented compared with paper. However, mental health–related information was regularly missing from EHRs, especially sensitive information. EHRs introduced more standardized and formalized documentation practices that raised issues because of the focus on narrative information in the mental health context. EHRs were found to disrupt information workflows in the mental health context, especially when they did not include appropriate templates or care plans. Usability issues also contributed to workflow concerns. Managing the documentation of sensitive information in EHRs was problematic; clinicians sometimes watered down sensitive information or chose to keep it in separate records. Concerningly, the included studies rarely involved service user perspectives. Furthermore, many studies provided limited information on the functionality or technical specifications of the EHR being used. Conclusions: We identified several areas in which work is needed to ensure that EHRs benefit clinicians and service users in the mental health context. As EHRs are increasingly considered critical for modern health systems, health care decision-makers should consider how EHRs can better reflect the complexity and sensitivity of information practices and workflows in the mental health context. %M 35507393 %R 10.2196/30405 %U https://www.jmir.org/2022/5/e30405 %U https://doi.org/10.2196/30405 %U http://www.ncbi.nlm.nih.gov/pubmed/35507393 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e26015 %T eHealth Tools That Assess and Track Health and Well-being in Children and Young People: Systematic Review %A Stewart,Elizabeth %A Milton,Alyssa %A Yee,Hannah Frances %A Song,Michael Jae %A Roberts,Anna %A Davenport,Tracey %A Hickie,Ian %+ Brain and Mind Centre, The University of Sydney, 94-100 Mallett Street Camperdown, Sydney, 2050, Australia, 61 0404060549, lizziestewart@gmail.com %K eHealth %K children %K young people %K health %K technology %K mobile phone %D 2022 %7 12.5.2022 %9 Review %J J Med Internet Res %G English %X Background: eHealth tools that assess and track health outcomes in children or young people are an emerging type of technology that has the potential to reform health service delivery and facilitate integrated, interdisciplinary care. Objective: The aim of this review is to summarize eHealth tools that have assessed and tracked health in children or young people to provide greater clarity around the populations and settings in which they have been used, characteristics of digital devices (eg, health domains, respondents, presence of tracking, and connection to care), primary outcomes, and risks and challenges of implementation. Methods: A search was conducted in PsycINFO, PubMed or MEDLINE, and Embase in April 2020. Studies were included if they evaluated a digital device whose primary purpose was to assess and track health, focused on children or young people (birth to the age of 24 years), reported original research, and were published in peer-reviewed journals in English. Results: A total of 39 papers were included in this review. The sample sizes ranged from 7 to 149,329 participants (median 163, mean 5155). More studies were conducted in urban (18/39, 46%) regions than in rural (3/39, 8%) regions or a combination of urban and rural areas (8/39, 21%). Devices were implemented in three main settings: outpatient health clinics (12/39, 31%), hospitals (14/39, 36%), community outreach (10/39, 26%), or a combination of these settings (3/39, 8%). Mental and general health were the most common health domains assessed, with a single study assessing multiple health domains. Just under half of the devices tracked children’s health over time (16/39, 41%), and two-thirds (25/39, 64%) connected children or young people to clinical care. It was more common for information to be collected from a single informant (ie, the child or young person, trained health worker, clinician, and parent or caregiver) than from multiple informants. The health of children or young people was assessed as a primary or secondary outcome in 36% (14/39) of studies; however, only 3% (1/39) of studies assessed whether using the digital tool improved the health of users. Most papers reported early phase research (formative or process evaluations), with fewer outcome evaluations and only 3 randomized controlled trials. Identified challenges or risks were related to accessibility, clinical utility and safety, uptake, data quality, user interface or design aspects of the device, language proficiency or literacy, sociocultural barriers, and privacy or confidentiality concerns; ways to address these barriers were not thoroughly explored. Conclusions: eHealth tools that assess and track health in children or young people have the potential to enhance health service delivery; however, a strong evidence base validating the clinical utility, efficacy, and safety of tools is lacking, and more thorough investigation is needed to address the risks and challenges of using these emerging technologies in clinical care. At present, there is greater potential for the tools to facilitate multi-informant, multidomain assessments and longitudinally track health over time and room for further implementation in rural or remote regions and community settings around the world. %M 35550285 %R 10.2196/26015 %U https://www.jmir.org/2022/5/e26015 %U https://doi.org/10.2196/26015 %U http://www.ncbi.nlm.nih.gov/pubmed/35550285 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e33380 %T Use of Robots in Critical Care: Systematic Review %A Teng,Rachel %A Ding,Yichen %A See,Kay Choong %+ Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore, 65 6772 3737, yichending@u.nus.edu %K COVID-19 %K intensive care %K high dependency %K telepresence %K intubation %D 2022 %7 16.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The recent focus on the critical setting, especially with the COVID-19 pandemic, has highlighted the need for minimizing contact-based care and increasing robotic use. Robotics is a rising field in the context of health care, and we sought to evaluate the use of robots in critical care settings. Objective: Although robotic presence is prevalent in the surgical setting, its role in critical care has not been well established. We aimed to examine the uses and limitations of robots for patients who are critically ill. Methods: This systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Embase, IEEE Xplore, and ACM Library were searched from their inception to December 23, 2021. Included studies involved patients requiring critical care, both in intensive care units or high-dependency units, or settings that required critical care procedures (eg, intubation and cardiopulmonary resuscitation). Randomized trials and observational studies were included. Results: A total of 33 studies were included. The greatest application of robots in the intensive care unit was in the field of telepresence, whereby robots proved advantageous in providing a reduced response time, earlier intervention, and lower mortality rates. Challenges of telepresence included regulatory and financial barriers. In therapy and stroke rehabilitation, robots achieved superior clinical outcomes safely. Robotic use in patient evaluation and assessment was mainly through ultrasound evaluation, obtaining satisfactory to superior results with the added benefits of remote assessment, time savings, and increased efficiency. Robots in drug dispensing and delivery increased efficiency and generated cost savings. All the robots had technological limitations and hidden costs. Conclusions: Overall, our results show that robotic use in critical care settings is a beneficial, effective, and well-received intervention that delivers significant benefits to patients, staff, and hospitals. Looking ahead, it is necessary to form strong ethical and legislative frameworks and overcome various regulatory and financial barriers. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021234162; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=234162 %M 35576567 %R 10.2196/33380 %U https://www.jmir.org/2022/5/e33380 %U https://doi.org/10.2196/33380 %U http://www.ncbi.nlm.nih.gov/pubmed/35576567 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e35371 %T Factors Influencing Adherence to mHealth Apps for Prevention or Management of Noncommunicable Diseases: Systematic Review %A Jakob,Robert %A Harperink,Samira %A Rudolf,Aaron Maria %A Fleisch,Elgar %A Haug,Severin %A Mair,Jacqueline Louise %A Salamanca-Sanabria,Alicia %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Professur Informationsmanagement, WEV G 217, Weinbergstr. 56/58, Zurich, 8092, Switzerland, 41 44 632 53 57, rjakob@ethz.ch %K intended use %K adherence %K engagement %K attrition %K retention %K mHealth %K eHealth %K digital health intervention %K noncommunicable disease %K NCD %K mobile phone %D 2022 %7 25.5.2022 %9 Review %J J Med Internet Res %G English %X Background: Mobile health (mHealth) apps show vast potential in supporting patients and health care systems with the increasing prevalence and economic costs of noncommunicable diseases (NCDs) worldwide. However, despite the availability of evidence-based mHealth apps, a substantial proportion of users do not adhere to them as intended and may consequently not receive treatment. Therefore, understanding the factors that act as barriers to or facilitators of adherence is a fundamental concern in preventing intervention dropouts and increasing the effectiveness of digital health interventions. Objective: This review aimed to help stakeholders develop more effective digital health interventions by identifying factors influencing the continued use of mHealth apps targeting NCDs. We further derived quantified adherence scores for various health domains to validate the qualitative findings and explore adherence benchmarks. Methods: A comprehensive systematic literature search (January 2007 to December 2020) was conducted on MEDLINE, Embase, Web of Science, Scopus, and ACM Digital Library. Data on intended use, actual use, and factors influencing adherence were extracted. Intervention-related and patient-related factors with a positive or negative influence on adherence are presented separately for the health domains of NCD self-management, mental health, substance use, nutrition, physical activity, weight loss, multicomponent lifestyle interventions, mindfulness, and other NCDs. Quantified adherence measures, calculated as the ratio between the estimated intended use and actual use, were derived for each study and compared with the qualitative findings. Results: The literature search yielded 2862 potentially relevant articles, of which 99 (3.46%) were included as part of the inclusion criteria. A total of 4 intervention-related factors indicated positive effects on adherence across all health domains: personalization or tailoring of the content of mHealth apps to the individual needs of the user, reminders in the form of individualized push notifications, user-friendly and technically stable app design, and personal support complementary to the digital intervention. Social and gamification features were also identified as drivers of app adherence across several health domains. A wide variety of patient-related factors such as user characteristics or recruitment channels further affects adherence. The derived adherence scores of the included mHealth apps averaged 56.0% (SD 24.4%). Conclusions: This study contributes to the scarce scientific evidence on factors that positively or negatively influence adherence to mHealth apps and is the first to quantitatively compare adherence relative to the intended use of various health domains. As underlying studies mostly have a pilot character with short study durations, research on factors influencing adherence to mHealth apps is still limited. To facilitate future research on mHealth app adherence, researchers should clearly outline and justify the app’s intended use; report objective data on actual use relative to the intended use; and, ideally, provide long-term use and retention data. %M 35612886 %R 10.2196/35371 %U https://www.jmir.org/2022/5/e35371 %U https://doi.org/10.2196/35371 %U http://www.ncbi.nlm.nih.gov/pubmed/35612886 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34451 %T Findings and Guidelines on Provider Technology, Fatigue, and Well-being: Scoping Review %A Hilty,Donald M %A Armstrong,Christina M %A Smout,Shelby A %A Crawford,Allison %A Maheu,Marlene M %A Drude,Kenneth P %A Chan,Steven %A Yellowlees,Peter M %A Krupinski,Elizabeth A %+ Department of Psychiatry & Behavioral Sciences, University of California Davis School of Medicine, 2230 Stockton Boulevard, Sacramento, CA, 95817, United States, 1 626 375 7857, donh032612@gmail.com %K burnout %K screen fatigue %K technology fatigue %K well-being %K videoconferencing %K Zoom fatigue %K mobile phone %D 2022 %7 25.5.2022 %9 Review %J J Med Internet Res %G English %X Background: Video and other technologies are reshaping the delivery of health care, yet barriers related to workflow and possible provider fatigue suggest that a thorough evaluation is needed for quality and process improvement. Objective: This scoping review explored the relationship among technology, fatigue, and health care to improve the conditions for providers. Methods: A 6-stage scoping review of literature (from 10 databases) published from 2000 to 2020 that focused on technology, health care, and fatigue was conducted. Technologies included synchronous video, telephone, informatics systems, asynchronous wearable sensors, and mobile health devices for health care in 4 concept areas related to provider experience: behavioral, cognitive, emotional, and physical impact; workplace at the individual, clinic, hospital, and system or organizational levels; well-being, burnout, and stress; and perceptions regarding technology. Qualitative content, discourse, and framework analyses were used to thematically analyze data for developing a spectrum of health to risk of fatigue to manifestations of burnout. Results: Of the 4221 potential literature references, 202 (4.79%) were duplicates, and our review of the titles and abstracts of 4019 (95.21%) found that 3837 (90.9%) were irrelevant. A full-text review of 182 studies revealed that 12 (6.6%) studies met all the criteria related to technology, health care, and fatigue, and these studied the behavioral, emotional, cognitive, and physical impact of workflow at the individual, hospital, and system or organizational levels. Video and electronic health record use has been associated with physical eye fatigue; neck pain; stress; tiredness; and behavioral impacts related to additional effort owing to barriers, trouble with engagement, emotional wear and tear and exhaustion, cognitive inattention, effort, expecting problems, multitasking and workload, and emotional experiences (eg, anger, irritability, stress, and concern about well-being). An additional 14 studies that evaluated behavioral, emotional, and cognitive impacts without focusing on fatigue found high user ratings on data quality, accuracy, and processing but low satisfaction with clerical tasks, the effort required in work, and interruptions costing time, resulting in more errors, stress, and frustration. Our qualitative analysis suggests a spectrum from health to risk and provides an outline of organizational approaches to human factors and technology in health care. Business, occupational health, human factors, and well-being literature have not studied technology fatigue and burnout; however, their findings help contextualize technology-based fatigue to suggest guidelines. Few studies were found to contextually evaluate differences according to health professions and practice contexts. Conclusions: Health care systems need to evaluate the impact of technology in accordance with the Quadruple Aim to support providers’ well-being and prevent workload burden, fatigue, and burnout. Implementation and effectiveness approaches and a multilevel approach with objective measures for clinical, human factors, training, professional development, and administrative workflow are suggested. This requires institutional strategies and competencies to integrate health care quality, technology and well-being outcomes. %M 35612880 %R 10.2196/34451 %U https://www.jmir.org/2022/5/e34451 %U https://doi.org/10.2196/34451 %U http://www.ncbi.nlm.nih.gov/pubmed/35612880 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37356 %T Comparison of the ACASI Mode to Other Survey Modes in Sexual Behavior Surveys in Asia and Sub-Saharan Africa: Systematic Literature Review %A Phoo,Nang Nge Nge %A Lobo,Roanna %A Vujcich,Daniel %A Reid,Alison %+ School of Population Health, Curtin University, Kent Street, Bentley WA, Perth, 6102, Australia, 61 0414954410, nangngenge.phoo@curtin.edu.au %K ACASI %K survey mode %K sexual behaviors %K HIV %K STI %K hepatitis %K blood-borne virus %K Asia %K sub-Saharan Africa %K review %D 2022 %7 31.5.2022 %9 Review %J J Med Internet Res %G English %X Background: Reliable data about sexual behaviors is fundamental in the prevention and control of HIV, hepatitis, and other sexually transmitted infections. Generally, sexual behaviors are regarded as a sociocultural taboo in Africa and Asia, and this results in biased sexual behavior survey data due to social desirability. Various modes of survey delivery, including audio computer-assisted self-interviews (ACASIs), have been investigated to improve data quality. Objective: This study aimed to review studies that compared the ACASI mode to other survey modes in sexual behavior surveys in Asia and sub-Saharan Africa to ascertain the impact of survey mode on responses to sexual behavior questions. Methods: A systematic literature review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The review protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews). Six databases were searched. Results: A total of 21 papers were included. The face-to-face interview (FTFI) mode was the survey mode most frequently compared to the ACASI mode. Among the most commonly reported outcome variable groups, ACASI participants were more likely to report sexual behaviors, such as “forced sex,” “multiple partners,” “transactional sex,” and “ever had sex,” as compared to FTFI participants. In addition to the survey mode effect, other factors were found to have had an impact on data quality, for example, participant characteristics, social norms, study design, and data collection setting. Conclusions: Use of ACASIs for administering sexual behavior surveys among populations in Asia and sub-Saharan Africa demonstrated higher reports for some sexual behaviors than the use of FTFIs. More studies that compare the ACASI mode to other survey modes would improve our understanding of the usefulness of ACASIs in sexual behavior surveys in these regions. %M 35639465 %R 10.2196/37356 %U https://www.jmir.org/2022/5/e37356 %U https://doi.org/10.2196/37356 %U http://www.ncbi.nlm.nih.gov/pubmed/35639465 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e38513 %T Through the Narrative Looking Glass: Commentary on “Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review” %A Weir,Charlene %+ Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste 140, Salt Lake City, UT, 84108-3514, United States, 1 801 541 9462, charlene.weir@utah.edu %K electronic health records %K psychiatry %K mental health %K electronic medical records %K health informatics %K mental illness %K scoping review %K clinical decision support %D 2022 %7 4.5.2022 %9 Commentary %J J Med Internet Res %G English %X The authors of “Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review” have effectively brought to our attention the failure of the electronic health record (EHR) to represent the human context. Because mental health or behavioral disorders (and functional status in general) emerge from an interaction between the individual’s characteristics and the social context, it is essentially a failure to represent the human context. The assessment and treatment of these disorders must reflect how the person lives, their degree of social connectedness, their personal motivation, and their cultural background. This type of information is best communicated both through narrative and in collaboration with other providers and the patient—largely because human social memory is organized around situation models and natural episodes. Neither functionality is currently available in most EHRs. Narrative communication is effective for several reasons: (1) it supports the communication of goals between providers; (2) it allows the author to express their belief in others’ perspectives (theory of mind), for example, those who will be reading these notes; and (3) it supports the incorporation of the patient’s personal perspective. The failure of the EHR to support mental health information data and information practices is, therefore, essentially a failure to support the basic communication functions necessary for the narrative. The authors have rightly noted the problems of the EHR in this domain, but perhaps they did not completely link the problems to the lack of functionality to support narrative communication. Suggestions for adding design elements are discussed. %M 35507399 %R 10.2196/38513 %U https://www.jmir.org/2022/5/e38513 %U https://doi.org/10.2196/38513 %U http://www.ncbi.nlm.nih.gov/pubmed/35507399 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e32845 %T Improving Research Patient Data Repositories From a Health Data Industry Viewpoint %A Tang,Chunlei %A Ma,Jing %A Zhou,Li %A Plasek,Joseph %A He,Yuqing %A Xiong,Yun %A Zhu,Yangyong %A Huang,Yajun %A Bates,David %+ Brigham and Women’s Hospital, Harvard Medical School, 1620 Tremont Street, BS-3, Brigham and Women’s Hospital, Boston, MA, 02115, United States, 1 857 366 7211, towne.tang@gmail.com %K data science %K big data %K data mining %K data warehousing %K information storage and retrieval %D 2022 %7 11.5.2022 %9 Viewpoint %J J Med Internet Res %G English %X Organizational, administrative, and educational challenges in establishing and sustaining biomedical data science infrastructures lead to the inefficient use of Research Patient Data Repositories (RPDRs). The challenges, including but not limited to deployment, sustainability, cost optimization, collaboration, governance, security, rapid response, reliability, stability, scalability, and convenience, restrict each other and may not be naturally alleviated through traditional hardware upgrades or protocol enhancements. This article attempts to borrow data science thinking and practices in the business realm, which we call the data industry viewpoint, to improve RPDRs. %M 35544299 %R 10.2196/32845 %U https://www.jmir.org/2022/5/e32845 %U https://doi.org/10.2196/32845 %U http://www.ncbi.nlm.nih.gov/pubmed/35544299 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e35951 %T Measuring Health-Related Quality of Life With Multimodal Data: Viewpoint %A Clay,Ieuan %A Cormack,Francesca %A Fedor,Szymon %A Foschini,Luca %A Gentile,Giovanni %A van Hoof,Chris %A Kumar,Priya %A Lipsmeier,Florian %A Sano,Akane %A Smarr,Benjamin %A Vandendriessche,Benjamin %A De Luca,Valeria %+ Novartis Institutes for Biomedical Research, Fabrikstrasse 2, Basel, 4056, Switzerland, 41 79 540 3272, valeria.de_luca@novartis.com %K digital measures %K quality of life %K machine learning %K digital health %K digital product %K digital wellness %K digital therapeutics %K digital therapy %K multimodal technology %K drug development %K care delivery %K data integration %D 2022 %7 26.5.2022 %9 Viewpoint %J J Med Internet Res %G English %X The ability to objectively measure aspects of performance and behavior is a fundamental pillar of digital health, enabling digital wellness products, decentralized trial concepts, evidence generation, digital therapeutics, and more. Emerging multimodal technologies capable of measuring several modalities simultaneously and efforts to integrate inputs across several sources are further expanding the limits of what digital measures can assess. Experts from the field of digital health were convened as part of a multi-stakeholder workshop to examine the progress of multimodal digital measures in two key areas: detection of disease and the measurement of meaningful aspects of health relevant to the quality of life. Here we present a meeting report, summarizing key discussion points, relevant literature, and finally a vision for the immediate future, including how multimodal measures can provide value to stakeholders across drug development and care delivery, as well as three key areas where headway will need to be made if we are to continue to build on the encouraging progress so far: collaboration and data sharing, removal of barriers to data integration, and alignment around robust modular evaluation of new measurement capabilities. %M 35617003 %R 10.2196/35951 %U https://www.jmir.org/2022/5/e35951 %U https://doi.org/10.2196/35951 %U http://www.ncbi.nlm.nih.gov/pubmed/35617003 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e28911 %T Digital Transformation of Face-To-Face Focus Group Methodology: Engaging a Globally Dispersed Audience to Manage Institutional Change at the World Health Organization %A Gamhewage,Gaya %A Mahmoud,Mohamed Essam %A Tokar,Anna %A Attias,Melissa %A Mylonas,Christos %A Canna,Sara %A Utunen,Heini %+ World Health Organization, Av Appia 20, Genève, 1211, Switzerland, 41 794755563, gamhewageg@who.int %K qualitative research %K digitalization %K WHO %K World Health Organization %K FGDs %K focus group discussions %D 2022 %7 26.5.2022 %9 Viewpoint %J J Med Internet Res %G English %X Focus group discussions (FGDs) are widely used to obtain qualitative data from purposely selected groups of people. This paper describes how the Learning and Capacity Development (LCD) unit of the World Health Organization (WHO) Health Emergencies Programme (WHE) digitalized FGDs to engage with WHO staff from around the world, to listen, share, and collect their feedback in the development of a WHO learning framework. The impact of the COVID-19 pandemic and the introduction of local lockdowns and travel restrictions resulted in the wide use of digital platforms, such as Zoom, for employee communications and collaboration capable of reaching employees wherever they are working. The LCD/WHE team drew upon the experience of WHO colleagues from human resources, country, and regional offices to set up and hold FGDs in 6 languages with participants from all WHO regions. Building on the findings of a 2019 WHO staff survey, which was part of a comprehensive, organization-wide career development initiative, the digitalized FGDs allowed for the exchange of substantive feedback, novel ideas, and alignment, connecting across different geographies, disciplines, and levels of seniority. As a result, FGDs can be successfully conducted online, but it is essential to remove barriers to participation by adopting a multilingual and flexible approach in multinational and international organizations such as the WHO. %M 35617007 %R 10.2196/28911 %U https://www.jmir.org/2022/5/e28911 %U https://doi.org/10.2196/28911 %U http://www.ncbi.nlm.nih.gov/pubmed/35617007 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e28354 %T Types of Errors Hiding in Google Scholar Data %A Sauvayre,Romy %+ Polytech Clermont, Clermont Auvergne INP, 2 avenue Blaise Pascal, TSA 60 026, Aubière, 63178, France, 33 473405545, romy.sauvayre@uca.fr %K reference accuracy %K database reliability %K false positives %K academic publication %K research evaluation %K scientometrics %K citation analysis %D 2022 %7 27.5.2022 %9 Viewpoint %J J Med Internet Res %G English %X Google Scholar (GS) is a free tool that may be used by researchers to analyze citations; find appropriate literature; or evaluate the quality of an author or a contender for tenure, promotion, a faculty position, funding, or research grants. GS has become a major bibliographic and citation database. For assessing the literature, databases, such as PubMed, PsycINFO, Scopus, and Web of Science, can be used in place of GS because they are more reliable. The aim of this study was to examine the accuracy of citation data collected from GS and provide a comprehensive description of the errors and miscounts identified. For this purpose, 281 documents that cited 2 specific works were retrieved via Publish or Perish software (PoP) and were examined. This work studied the false-positive issue inherent in the analysis of neuroimaging data. The results revealed an unprecedented error rate, with 279 of 281 (99.3%) examined references containing at least one error. Nonacademic documents tended to contain more errors than academic publications (U=5117.0; P<.001). This viewpoint article, based on a case study examining GS data accuracy, shows that GS data not only fail to be accurate but also potentially expose researchers, who would use these data without verification, to substantial biases in their analyses and results. Further work must be conducted to assess the consequences of using GS data extracted by PoP. %M 35622395 %R 10.2196/28354 %U https://www.jmir.org/2022/5/e28354 %U https://doi.org/10.2196/28354 %U http://www.ncbi.nlm.nih.gov/pubmed/35622395 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e30073 %T Delivering Mindfulness-Based Interventions for Insomnia, Pain, and Dysfunctional Eating Through a Text Messaging App: Three Randomized Controlled Trials Investigating the Effectiveness and Mediating Mechanisms %A Li,Amanda CM %A Wong,Keith KL %A Chio,Floria HN %A Mak,Winnie WS %A Poon,Loretta WH %+ Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, Hong Kong, 852 39436577, wwsmak@psy.cuhk.edu.hk %K text messaging %K mindfulness %K insomnia %K pain %K dysregulated eating %K mHealth %K mental health %K SMS %K distress %K intervention %K outcome %K mobile interventions %D 2022 %7 3.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Although text messaging has the potential to be the core intervention modality, it is often used as an adjunct only. To improve health and alleviate the distress related to insomnia, pain, and dysregulated eating of people living in urban areas, text messaging–based mindfulness-based interventions were designed and evaluated in 3 randomized controlled trials. Objective: This study investigated the effectiveness and mediating mechanisms of text messaging–based mindfulness-based interventions for people with distress related to insomnia, pain, or dysregulated eating. Methods: In these trials, 333, 235, and 351 participants were recruited online and randomized to intervention and wait-list control conditions for insomnia, pain, and dysregulated eating, respectively. Participants experienced 21 days of intervention through WhatsApp Messenger. Participants completed pre-, post-, 1-month follow-up, and 3-month follow-up self-report questionnaires online. The retention rates at postmeasurements were 83.2% (139/167), 77.1% (91/118), and 72.9% (129/177) for intervention groups of insomnia, pain, and dysregulated eating, respectively. Participants’ queries were answered by a study technician. Primary outcomes included insomnia severity, presleep arousal, pain intensity, pain acceptance, and eating behaviors. Secondary outcomes included mindfulness, depression, anxiety, mental well-being, and functional impairments. Mindfulness, dysfunctional beliefs and attitudes about sleep, pain catastrophizing, and reactivity to food cues were hypothesized to mediate the relationship between the intervention and outcomes. Results: For all 3 studies, the intervention groups showed significant improvement on most outcomes at 1-month follow-up compared to their respective wait-list control groups; some primary outcomes (eg, insomnia, pain, dysregulated eating indicators) and secondary outcomes (eg, depression, anxiety symptoms) were sustained at 3-month follow-up. Medium-to-large effect sizes were found at postassessments in most outcomes in all studies. In the intervention for insomnia, mediation analyses showed that dysfunctional beliefs and attitudes about sleep mediated the effect of the intervention on all primary outcomes and most secondary outcomes at both 1-month and 3-month follow-ups, whereas mindfulness mediated the intervention effect on presleep arousal at 1-month and 3-month follow-ups. In the intervention for pain, pain catastrophizing mediated the effect of intervention on pain intensity and functioning at both 1-month and 3-month follow-ups, whereas mindfulness only mediated the effect of intervention on anxiety and depressive symptoms. In the intervention for dysregulated eating, power of food mediated the effect of intervention on both uncontrolled and emotional eating at both 1-month and 3-month follow-ups and mindfulness was found to mediate the effect on depressive symptoms at both 1-month and 3-month follow-ups. Conclusions: These 3 studies converged and provided empirical evidence that mindfulness-based interventions delivered through text messaging are effective in improving distress related to sleep, pain, and dysregulated eating. Text messaging has the potential to be a core intervention modality to improve various common health outcomes for people living a fast-paced lifestyle. Trial Registration: Clinical Research and Biostatistics Clinical Trials Registry CUHK_CCRB00559; https://tinyurl.com/24rkwarz %M 35503653 %R 10.2196/30073 %U https://www.jmir.org/2022/5/e30073 %U https://doi.org/10.2196/30073 %U http://www.ncbi.nlm.nih.gov/pubmed/35503653 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e29787 %T The Effects of a Web-Based Tool for Parents of Children With Juvenile Idiopathic Arthritis: Randomized Controlled Trial %A Mulligan,Kathleen %A Hirani,Shashivadan P %A Harris,Sally %A Taylor,Jo %A Wedderburn,Lucy R %A Newman,Stanton %A , %+ Centre for Health Services Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, United Kingdom, 44 020 7040 3090, Stanton.Newman.1@city.ac.uk %K parenting stress %K juvenile idiopathic arthritis %K web-based intervention %K randomized controlled trial %K parenting %K pediatrics %K arthritis %K RCT %K rheumatology %K children %K youth %K web-based tool %K mobile phone %D 2022 %7 12.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Juvenile idiopathic arthritis (JIA) is a group of autoinflammatory diseases that cause pain and disability if not controlled by treatment. Parenting a child with JIA is stressful for parents, who express concerns about their child’s treatment and may experience anxiety and powerlessness concerning their child’s illness. Parenting stress is greater in parents of children with chronic illness than in those with healthy children and is related to poorer psychological adjustment in both parents and children. It is therefore important to develop interventions to support parents. This paper reports the evaluation of a web-based tool that provides information and practical skills to help increase parents’ confidence in managing their child’s illness and reduce parenting stress. Objective: The aim of this study is to evaluate the benefits of a web-based tool (WebParC) for parents of children with recently diagnosed JIA. Methods: A multicentered randomized controlled trial was conducted at pediatric rheumatology centers in England. We recruited parents of children aged ≤12 years who had been diagnosed with JIA within the previous 6 months. They were randomized to the intervention (WebParC access plus standard care) or the control (standard care alone) and followed up 4 months and 12 months after randomization. Where both parents participated, they were randomized by household to the same trial arm. The WebParC intervention consists of information about JIA and its treatment plus a toolkit, based on cognitive behavioral therapy, to help parents develop skills to manage JIA-related issues. The primary outcome was the self-report Pediatric Inventory for Parents measure of illness-related parenting stress. The secondary outcomes were parental mood, self-efficacy, coping, effectiveness of participation in their child’s health care, satisfaction with health care, and child’s health-related quality of life. Results: A total of 203 households comprising 220 parents were randomized to the intervention (100/203, 49.3%) or control (103/203, 50.7%) arm. Follow-up assessments were completed by 65.5% (133/203) of the households at 4 months (intervention 60/100, 60%, and control 73/103, 70.9%) and 61.1% (124/203) of the households at 12 months (intervention 58/100, 58%, and control 66/103, 64.1%). A main effect of the trial arm was found on the Pediatric Inventory for Parents: the intervention participants reported less frequency (subscales communication F1,120627=5.37; P=.02, and role function F1,27203=5.40; P=.02) and difficulty (subscales communication F1,2237=7.43; P=.006, medical care F1,2907=4.04; P=.04, and role function F1,821=4.37, P=.04) regarding illness-related stressful events than the control participants. Conclusions: The WebParC website for parents of children with JIA reduced illness-related parenting stress. This web-based intervention offers a feasible preventive approach for parents of children with JIA and potentially could be adapted and evaluated for parents of children with other chronic illnesses. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 13159730; http://www.isrctn.com/ISRCTN13159730 %M 35551065 %R 10.2196/29787 %U https://www.jmir.org/2022/5/e29787 %U https://doi.org/10.2196/29787 %U http://www.ncbi.nlm.nih.gov/pubmed/35551065 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34853 %T A Gamified Personalized Normative Feedback App to Reduce Drinking Among Sexual Minority Women: Randomized Controlled Trial and Feasibility Study %A Boyle,Sarah C %A LaBrie,Joseph W %A Trager,Bradley M %A Costine,Lauren D %+ HeadsUp Labs, Department of Psychology, Loyola Marymount University, 1 LMU Drive, Suite 3787, Los Angeles, CA, 90045, United States, 1 310 568 6681, sarah.boyle@lmu.edu %K sexual minority women %K alcohol %K intervention %K social norms %K gamification %K mobile phone %K smartphone %D 2022 %7 13.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexual minority women disproportionately engage in heavy drinking and shoulder the burden of alcohol dependence. Although several intensive interventions are being developed to meet the needs of treatment-seeking sexual minority women, there remains a lack of preventive interventions to reduce drinking and its consequences among women not yet motivated to reduce their alcohol consumption. Objective: We aimed to examine the feasibility and efficacy of reducing alcohol-related risks via personalized normative feedback (PNF) on alcohol use and coping delivered within LezParlay, a social media–inspired digital competition designed to challenge negative stereotypes about lesbian, bisexual, and queer (LBQ)–identified sexual minority women. Methods: Feasibility was assessed by examining engagement with LezParlay outside the context of an incentivized research study, assessing the characteristics of the LBQ women taking part, and examining the competition’s ability to derive risk-reducing actual norms as well as levels of acceptability and perceived benefits reported by participants. Intervention efficacy was examined by randomizing a subsample of 499 LBQ alcohol consumers (ie, drinkers) already taking part in the competition to receive sexual identity–specific PNF on alcohol use and coping, alcohol use only, or control topics over only 2 rounds of play. Changes in alcohol use and negative consequences were examined 2 and 4 months after the delivery of treatment PNF. Results: A total of 2667 diverse LBQ women played ≥1 round of LezParlay. The competition attracted large numbers of moderate and heavy drinkers; however, risk-reducing actual norms could still be derived from competition rounds and featured in PNF. Efficacy results revealed that drinkers who received PNF on alcohol use and both alcohol use and coping had similar reductions in their weekly drinks (P=.003; P<.001), peak drinks (P<.001; P<.001), and negative consequences (P<.001; P<.001) relative to those who received PNF on control topics at the 2-month follow-up. However, at the 4-month follow-up, reductions in alcohol consumption outcomes faded among those who received alcohol PNF only (weekly: P=.06; peak: P=.11), whereas they remained relatively robust among those who received PNF on both alcohol use and coping (weekly: P=.02; peak: P=.03). Finally, participants found the competition highly acceptable and psychologically beneficial as a whole. Conclusions: The LezParlay competition was found to be a feasible and efficacious means of reducing alcohol-related risks in this population. Our findings demonstrate the utility of correcting sexual identity–specific drinking and coping norms to reduce alcohol-related risks among LBQ women and suggest that this approach may also prove fruitful in other stigmatized health disparity populations. To engage these populations in the real world and expand the psychological benefits associated with PNF, our findings also point to packaging PNF within a broader, culturally tailored competition designed to challenge negative group stereotypes. Trial Registration: ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478 International Registered Report Identifier (IRRID): RR2-10.2196/24647 %M 35559854 %R 10.2196/34853 %U https://www.jmir.org/2022/5/e34853 %U https://doi.org/10.2196/34853 %U http://www.ncbi.nlm.nih.gov/pubmed/35559854 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e35771 %T Telephone and Web-Based Delivery of Healthy Eating and Active Living Interventions for Parents of Children Aged 2 to 6 Years: Mixed Methods Process Evaluation of the Time for Healthy Habits Translation Trial %A Hammersley,Megan L %A Wyse,Rebecca J %A Jones,Rachel A %A Okely,Anthony D %A Wolfenden,Luke %A Eckermann,Simon %A Xu,Joe %A Green,Amanda %A Stacey,Fiona %A Yoong,Sze Lin %A Jackson,Jacklyn %A Innes-Hughes,Christine %A Li,Vincy %A Rissel,Chris %+ Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Northfields Ave, Wollongong, 2522, Australia, 61 242215670, mhammers@uow.edu.au %K dietary intake %K physical activity %K screen time %K sleep %K movement behaviors %K online %K internet %K telephone %K mobile phone %D 2022 %7 26.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Few translational trials have provided detailed reports of process evaluation results. Objective: This study reported on findings from a mixed methods process evaluation of a large translational trial comparing 2 remotely delivered healthy eating and active living interventions with an active control, targeting parents of young children. Methods: Mixed methods process evaluation data were collected as part of a 3-arm, partially randomized preference trial targeting parents of children aged 2 to 6 years from New South Wales, Australia. Recruitment strategies were assessed through the participant baseline questionnaire and a questionnaire completed by the health promotion staff involved in recruitment. Data on participants’ intervention preferences were collected at baseline and after the intervention. Intervention acceptability and demographic data were collected via a postintervention questionnaire (approximately 3 months after baseline), which was supplemented by qualitative participant interviews. Implementation data on intervention fidelity and withdrawal were also recorded. Differences in intervention acceptability, fidelity, and withdrawal rates between telephone and web-based interventions and between randomized and nonrandomized participants were analyzed. The significance level was set at P<.05 for all tests. The interview content was analyzed, key themes were drawn from participant responses, and findings were described narratively. Results: Data were collected from 458 participants in the baseline survey and 144 (31.4%) participants in the 3-month postintervention survey. A total of 30 participants completed the qualitative interviews. A total of 6 health promotion staff members participated in the survey on recruitment strategies. Most participants were recruited from Early Childhood Education and Care services. There was a broad reach of the study; however, better take-up rates were observed in regional and rural areas compared with metropolitan areas. Parents with a university education were overrepresented. Most participants preferred the web-based medium of delivery at baseline. There was high acceptability of the web-based and telephone interventions. Participants found the healthy eating content to be the most useful component of the modules (web-based) and calls (telephone). They regarded text (web-based) or verbal (telephone) information as the most useful component. A high proportion of participants completed the telephone intervention compared with the web-based intervention; however, more participants actively withdrew from the telephone intervention. Conclusions: This is one of the first studies to comprehensively report on process evaluation data from a translation trial, which demonstrated high acceptability of all interventions but a strong participant preference for the web-based intervention. This detailed process evaluation is critical to inform further implementation and be considered alongside the effectiveness outcomes. %M 35616994 %R 10.2196/35771 %U https://www.jmir.org/2022/5/e35771 %U https://doi.org/10.2196/35771 %U http://www.ncbi.nlm.nih.gov/pubmed/35616994 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e32723 %T Disparity and Factors Associated With Internet Health Information Seeking Among US Adults Living With Diabetes Mellitus: Cross-sectional Study %A Eke,Ransome %A Jannat,Khadiza Tul %A Yang,Xin Thomas %A Parton,Jason M %+ Department of Community Medicine, Mercer University School of Medicine, 1633 1st Ave, Columbus, GA, 31901, United States, 1 7062235235, eke_r@mercer.edu %K diabetes %K internet %K information seeking %K adults living with diabetes %K predictors %K racial disparity %K Health Information National Trends Survey %K race %K ethnicity %K chronic conditions %K self-management %K internet health information %K mobile phone %D 2022 %7 30.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Many patients with chronic medical conditions search the internet to obtain medical advice and health information to improve their health condition and quality of life. Diabetes is a common chronic disease that disproportionately affects different race and ethnicity groups in the United States. In the existing literature on the popularity of internet health information seeking among persons with a chronic medical condition, there are limited data on US adults living with diabetes. Objective: This study aims to examine the factors associated with internet health information seeking among US adults living with diabetes and whether there is a disparity in internet health information seeking stratified by race and ethnicity. Methods: We conducted a cross-sectional study using the Health Information National Trends Survey data from 2017 to 2020. We selected our study sample based on respondents’ reports on whether they were told they had diabetes, and our primary outcome was internet health information–seeking behavior. We used 2 multivariable logistic regression models to examine the effects of sociodemographic factors and other covariates on the internet health information–seeking behavior of adults with diabetes. Jackknife replicate weights were used to provide bias-corrected variance estimates. Results: Our study sample included 2903 adults who self-reported that they had diabetes. In total, 60.08% (1744/2903) were non-Hispanic White individuals, 46.88% (1336/2850) were men, and 64% (1812/2831) had some college or graduate education. The prevalence of internet health information seeking in this population was 64.49% (1872/2903), and the main factors associated with internet health information seeking included education level (some college vs less than high school: odds ratio [OR] 1.42, 95% CI 1.44-1.88; and college graduate or higher vs less than high school: OR 2.50, 95% CI 1.79-3.50), age (age group ≥65 years vs age group 18-44 years: OR 0.46, 95% CI 0.34-0.63), and household income level (P<.001). In addition, we found significant differences in the effects of predictors stratified by race. Conclusions: The findings from this study suggest that internet health information seeking is common among US adults living with diabetes. Internet health information could influence the relationship between health care providers and adults living with diabetes and improve their self-management and quality of life. %M 35635741 %R 10.2196/32723 %U https://www.jmir.org/2022/5/e32723 %U https://doi.org/10.2196/32723 %U http://www.ncbi.nlm.nih.gov/pubmed/35635741 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37970 %T Comparison Between the 24-hour Holter Test and 72-hour Single-Lead Electrocardiogram Monitoring With an Adhesive Patch-Type Device for Atrial Fibrillation Detection: Prospective Cohort Study %A Kwon,Soonil %A Lee,So-Ryoung %A Choi,Eue-Keun %A Ahn,Hyo-Jeong %A Song,Hee-Seok %A Lee,Young-Shin %A Oh,Seil %A Lip,Gregory Y H %+ Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea, 82 2 2072 0688, choiek417@gmail.com %K atrial fibrillation %K diagnosis %K electrocardiogram %K wearable device %K health monitoring %K Holter %K cardiac %K arrhythmia %K electrocardiogram %K ECG %K EKG %K digital tool %K cardiology %K patient monitoring %K outpatient clinic %K cardiac health %K diagnostic %K patient %K clinician %K digital health %D 2022 %7 9.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: There is insufficient evidence for the use of single-lead electrocardiogram (ECG) monitoring with an adhesive patch-type device (APD) over an extended period compared to that of the 24-hour Holter test for atrial fibrillation (AF) detection. Objective: In this paper, we aimed to compare AF detection by the 24-hour Holter test and 72-hour single-lead ECG monitoring using an APD among patients with AF. Methods: This was a prospective, single-center cohort study. A total of 210 patients with AF with clinical indications for the Holter test at cardiology outpatient clinics were enrolled in the study. The study participants were equipped with both the Holter device and APD for the first 24 hours. Subsequently, only the APD continued ECG monitoring for an additional 48 hours. AF detection during the first 24 hours was compared between the two devices. The diagnostic benefits of extended monitoring using the APD were evaluated. Results: A total of 200 patients (mean age 60 years; n=141, 70.5% male; and n=59, 29.5% female) completed 72-hour ECG monitoring with the APD. During the first 24 hours, both monitoring methods detected AF in the same 40/200 (20%) patients (including 20 patients each with paroxysmal and persistent AF). Compared to the 24-hour Holter test, the APD increased the AF detection rate by 1.5-fold (58/200; 29%) and 1.6-fold (64/200; 32%) with 48- and 72-hour monitoring, respectively. With the APD, the number of newly discovered patients with paroxysmal AF was 20/44 (45.5%), 18/44 (40.9%), and 6/44 (13.6%) at 24-, 48-, and 72-hour monitoring, respectively. Compared with 24-hour Holter monitoring, 72-hour monitoring with the APD increased the detection rate of paroxysmal AF by 2.2-fold (44/20). Conclusions: Compared to the 24-hour Holter test, AF detection could be improved with 72-hour single-lead ECG monitoring with the APD. %M 35532989 %R 10.2196/37970 %U https://www.jmir.org/2022/5/e37970 %U https://doi.org/10.2196/37970 %U http://www.ncbi.nlm.nih.gov/pubmed/35532989 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e31797 %T The Influence of Perceived Social Presence on the Willingness to Communicate in Mobile Medical Consultations: Experimental Study %A Chen,Lijuan %A Zhang,Danyang %A Hou,Mutian %+ Department of Journalism and Communication, School of Media and Communication, Shanghai Jiao Tong University, 800 Dongchuan Rd, Shanghai, 200240, China, 86 138 6752 9369, zdytiffany@163.com %K mobile medical consultation %K mobile medical service %K perceived social presence %K willingness to communicate about health %K COVID-19 %D 2022 %7 11.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: With the rise of online health care service, there is growing discussion on the relationship between physicians and patients online, yet few researchers have paid attention to patients’ perception of social presence, especially its influence on their willingness to communicate (WTC). Objective: The goal of the research is to investigate the influence of perceived social presence (PSP) on WTC in mobile medical consultations. Methods: Participants living in Yunnan province during the period of middle to high risk of COVID-19 infection were recruited via the internet. They were assigned randomly into 2 groups interacting with a virtual physician presenting high and low levels of social presence and then asked to complete a questionnaire. Based on the theoretical framework, the study puts forward a model evaluating the relationships among participants’ PSP, communication apprehension (CA), self-perceived communication competence (SPCC), and willingness to communicate about health (WTCH) in the computer-mediated communication between virtual physicians and patients. Results: In total 206 (106 in group 1 and 100 in group 2) valid samples were gathered (from 276 log-ins) and 88.8% (183/206) of them were aged 18 to 44 years, which approximately resembles the age distribution of the main population engaging in online medical consultation in China. Independent t test shows that there is significant difference between the PSP of the 2 groups (P=.04), indicating a successful manipulation of social presence. The total effect of PSP on WTCH is 0.56 (P<.001), among which 74.4% is direct effect (P<.001). Among the indirect effects between PSP and WTCH, the mediating effect of SPCC accounts for 68.8% (P<.001) and the sequential mediating effect of CA→SPCC accounts for 19.2% (P<.001), while the mediating effect of CA alone is not significant (P=.08). Conclusions: This study provides a comprehensible model, demonstrating that PSP is an important antecedent of WTCH, and the sequential mediating effect of CA and SPCC found in this study also proves that in the environment of online mobile medical services, CA cannot affect communication directly. The findings will provide some practical inspiration for the popularization of online medical service, especially for the promotion of online physician-patient communication. %M 35544293 %R 10.2196/31797 %U https://www.jmir.org/2022/5/e31797 %U https://doi.org/10.2196/31797 %U http://www.ncbi.nlm.nih.gov/pubmed/35544293 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e30907 %T Screening Depressive Symptoms and Incident Major Depressive Disorder Among Chinese Community Residents Using a Mobile App–Based Integrated Mental Health Care Model: Cohort Study %A Zhang,Huimin %A Liao,Yuhua %A Han,Xue %A Fan,Beifang %A Liu,Yifeng %A Lui,Leanna M W %A Lee,Yena %A Subramaniapillai,Mehala %A Li,Lingjiang %A Guo,Lan %A Lu,Ciyong %A McIntyre,Roger S %+ Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, No.74, Zhongshan 2nd, Guangzhou, 510080, China, 86 020 87332477, luciyong@mail.sysu.edu.cn %K screening %K depressive symptoms %K incident major depressive disorder %K Chinese community residents %K electronic-based integrated mental health care model %D 2022 %7 20.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is associated with significant morbidity and human capital costs globally. Early screening for depressive symptoms and timely depressive disorder case identification and intervention may improve health outcomes and cost-effectiveness among affected individuals. China’s public and academic communities have reached a consensus on the need to improve access to early screening, diagnosis, and treatment of depression. Objective: This study aims to estimate the screening prevalence and associated factors of subthreshold depressive symptoms among Chinese residents enrolled in the cohort study using a mobile app–based integrated mental health care model and investigate the 12-month incidence rate and related factors of major depressive disorder (MDD) among those with subthreshold depressive symptoms. Methods: Data were drawn from the Depression Cohort in China (DCC) study. A total of 4243 community residents aged 18 to 64 years living in Nanshan district, Shenzhen city, in Guangdong province, China, were encouraged to participate in the DCC study when visiting the participating primary health care centers, and 4066 (95.83%) residents who met the DCC study criteria were screened for subthreshold depressive symptoms using the Patient Health Questionnaire-9 at baseline. Of the 4066 screened residents, 3168 (77.91%) with subthreshold depressive symptoms were referred to hospitals to receive a psychiatric diagnosis of MDD within 12 months. Sleep duration, anxiety symptoms, well-being, insomnia symptoms, and resilience were also investigated. The diagnosis of MDD was provided by trained psychiatrists using the Mini-International Neuropsychiatric Interview. Univariate and multivariate logistic regression models were performed to explore the potential factors related to subthreshold depressive symptoms at baseline, and Cox proportional hazards models were performed to explore the potential factors related to incident MDD. Results: Anxiety symptoms (adjusted odds ratio [AOR] 1.63, 95% CI 1.42-1.87) and insomnia symptoms (AOR 1.13, 95% CI 1.05-1.22) were associated with an increased risk of subthreshold depressive symptoms, whereas well-being (AOR 0.93, 95% CI 0.87-0.99) was negatively associated with depressive symptoms. During the follow-up period, the 12-month incidence rate of MDD among participants with subthreshold depressive symptoms was 5.97% (189/3168). After incorporating all significant variables from the univariate analyses, the multivariate Cox proportional hazards model reported that a history of comorbidities (adjusted hazard ratio [AHR] 1.49, 95% CI 1.04-2.14) and anxiety symptoms (AHR 1.13, 95% CI 1.09-1.17) were independently associated with an increased risk of incident MDD. The 5-item World Health Organization Well-Being Index was associated with a decreased risk of incident MDD (AHR 0.90, 95% CI 0.86-0.94). Conclusions: Elevated anxiety symptoms and unfavorable general well-being were significantly associated with subthreshold depressive symptoms and incident MDD among Chinese residents in Shenzhen. Early screening for subthreshold depressive symptoms and related factors may be helpful for identifying populations at high risk of incident MDD. %M 35594137 %R 10.2196/30907 %U https://www.jmir.org/2022/5/e30907 %U https://doi.org/10.2196/30907 %U http://www.ncbi.nlm.nih.gov/pubmed/35594137 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e28063 %T The Use of Social Media as a Persuasive Platform to Facilitate Nutrition and Health Behavior Change in Young Adults: Web-Based Conversation Study %A Friedman,Vanessa J %A Wright,Cassandra J C %A Molenaar,Annika %A McCaffrey,Tracy %A Brennan,Linda %A Lim,Megan S C %+ Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia, 61 85062403, megan.lim@burnet.edu.au %K young adults %K nutrition %K physical activity %K mental health %K social media %K qualitative methods %K health promotion %D 2022 %7 18.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, suboptimal dietary choices are a leading cause of noncommunicable diseases. Evidence for effective interventions to address these behaviors, particularly in young adults, is limited. Given the substantial time young adults spend in using social media, there is interest in understanding the current and potential role of these platforms in shaping dietary behavior. Objective: This study aims to explore the influence of social media on young adults’ dietary behaviors. Methods: We recruited 234 young adults aged 18-24 years and living in Australia, using market and social research panels. We applied a digital ethnography approach to collect data from web-based conversations in a series of forums, where participants responded to different health-themed questions related to health behavior change and persuasion on social media. We conducted a qualitative thematic analysis. Results: Participants described how social media influenced their decisions to change their health behaviors. Access to social support and health information through web-based communities was juxtaposed with exposure to highly persuasive fast-food advertisements. Some participants expressed that exposure to web-based health-focused content induced feelings of guilt about their behavior, which was more prominent among women. Fast-food advertisements were discussed as a contributor to poor health behaviors and indicated as a major barrier to change. Conclusions: Young adults reported that social media is highly persuasive toward dietary behavior through different pathways of social influence. This suggests that social norms on the web are an important aspect of changing young adults’ health behaviors. The commercialization of social media also encourages poor health behaviors, largely through fast-food advertisements. Future social media–delivered dietary interventions should acknowledge the social and environmental factors that challenge the ability of young adults to make individual health behavior improvements. Care should also be taken to ensure that future interventions do not further elicit guilt in a way that contributes to poor mental health within this community. %M 35583920 %R 10.2196/28063 %U https://www.jmir.org/2022/5/e28063 %U https://doi.org/10.2196/28063 %U http://www.ncbi.nlm.nih.gov/pubmed/35583920 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37519 %T Characterization of False or Misleading Fluoride Content on Instagram: Infodemiology Study %A Lotto,Matheus %A Sá Menezes,Tamires %A Zakir Hussain,Irfhana %A Tsao,Shu-Feng %A Ahmad Butt,Zahid %A P Morita,Plinio %A Cruvinel,Thiago %+ Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Alameda Dr Octávio Pinheiro Brisolla, 9-75, Vila Universitária, Bauru, 17012-901, Brazil, 55 14 3235 8318, thiagocruvinel@fob.usp.br %K eHealth %K fluorides %K infodemiology %K information seeking behavior %K internet %K misinformation %K social media %K infoveillance %K health outcome %K dental caries %K health information %K dental health %D 2022 %7 19.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Online false or misleading oral health–related content has been propagated on social media to deceive people against fluoride’s economic and health benefits to prevent dental caries. Objective: The aim of this study was to characterize the false or misleading fluoride-related content on Instagram. Methods: A total of 3863 posts ranked by users’ total interaction and published between August 2016 and August 2021 were retrieved by CrowdTangle, of which 641 were screened to obtain 500 final posts. Subsequently, two independent investigators analyzed posts qualitatively to define their authors’ interests, profile characteristics, content type, and sentiment. Latent Dirichlet allocation analysis topic modeling was then applied to find salient terms and topics related to false or misleading content, and their similarity was calculated through an intertopic distance map. Data were evaluated by descriptive analysis, the Mann-Whitney U test, the Cramer V test, and multiple logistic regression models. Results: Most of the posts were categorized as misinformation and political misinformation. The overperforming score was positively associated with older messages (odds ratio [OR]=3.293, P<.001) and professional/political misinformation (OR=1.944, P=.05). In this context, time from publication, negative/neutral sentiment, author’s profile linked to business/dental office/news agency, and social and political interests were related to the increment of performance of messages. Although political misinformation with negative/neutral sentiments was typically published by regular users, misinformation was linked to positive commercial posts. Overall messages focused on improving oral health habits, side effects, dentifrice containing natural ingredients, and fluoride-free products propaganda. Conclusions: False or misleading fluoride-related content found on Instagram was predominantly produced by regular users motivated by social, psychological, and/or financial interests. However, higher engagement and spreading metrics were associated with political misinformation. Most of the posts were related to the toxicity of fluoridated water and products frequently motivated by financial interests. %M 35588055 %R 10.2196/37519 %U https://www.jmir.org/2022/5/e37519 %U https://doi.org/10.2196/37519 %U http://www.ncbi.nlm.nih.gov/pubmed/35588055 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e35557 %T Patient Activeness During Online Medical Consultation in China: Multilevel Analysis %A Cao,Bolin %A Huang,Wensen %A Chao,Naipeng %A Yang,Guang %A Luo,Ningzheng %+ School of Media and Communication, Shenzhen University, L7 Building, South Campus, Number 3688, Nanhai Avenue, Nanshan Area, Shenzhen, 518000, China, 86 17717428439, wshuang19@szu.edu.cn %K patient %K physician %K online medical consultation %K patient activeness %D 2022 %7 27.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Online medical consultation is an important complementary approach to offline health care services. It not only increases patients’ accessibility to medical care, but also encourages patients to actively participate in consultation, which can result in higher shared decision making, patient satisfaction, and treatment adherence. Objective: This study aims to explore multilevel factors that influence patient activeness in online medical consultations. Methods: A data set comprising 40,505 patients from 300 physicians in 10 specialties was included for multilevel analysis. Patient activeness score (PAS) was calculated based on the frequency and the proportion of patient discourses to the total frequency of doctor-patient interactions. Intraclass correlation coefficients were calculated to identify between-group variations, and the final multilevel regression model included patient- and physician-level factors. Results: Patients were not equally active in online medical consultations, with PASs varying from 0 to 125.73. Patient characteristics, consultation behavioral attributes, and physician professional characteristics constitute 3 dimensions that are associated with patient activeness. Specifically, young and female patients participated more actively. Patients’ waiting times online (β=–.17; P<.001) for physician responses were negatively correlated with activeness, whereas patients’ initiation of conversation (β=.83; P<.001) and patient consultation cost (β=.52; P<.001) in online medical consultation were positively correlated. Physicians’ online consultation volumes (β=–.10; P=.01) were negatively associated with patient activeness, whereas physician online consultation fee (β=.03; P=.01) was positively associated. The interaction effects between patient- and physician-level factors were also identified. Conclusions: Patient activeness in online medical consultation requires more scholarly attention. Patient activeness is likely to be enhanced by reducing patients’ waiting times and encouraging patients’ initiation of conversation in online medical consultation. The findings have practical implications for patient-centered care and the improvement of online medical consultation services. %M 35622403 %R 10.2196/35557 %U https://www.jmir.org/2022/5/e35557 %U https://doi.org/10.2196/35557 %U http://www.ncbi.nlm.nih.gov/pubmed/35622403 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e33507 %T A Teleconsultation Device, Consult Station, for Remote Primary Care: Multisite Prospective Cohort Study %A Falgarone,Géraldine %A Bousquet,Guilhem %A Wilmet,Arnaud %A Brizio,Albert %A Faure,Valérie %A Guillouet,Celestin %A Baudino,Franck %A Roque,Isabelle %A Mayol,Samuel %A Pamoukdjian,Frederic %+ Unité de Médecine Ambulatoire, Hôpital Avicenne, Assistance Publique–Hôpitaux de Paris, 125 Rue de Stalingrad, Bobigny, 93009, France, 33 148026870, g.falgarone@aphp.fr %K telemedicine booth %K primary care %K cost-benefit %K absenteeism from work %K health care system %K telemedicine %K consultation %K remote medical consultation %K proof-of-concept %K general practice %D 2022 %7 17.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine technology is a growing field, especially in the context of the COVID-19 pandemic. Consult Station (Health for Development) is the first telemedicine device enabling completely remote medical consultations, including the concurrent collection of clinical parameters and videos. Objective: Our aim was to collect data on the multisite urban and suburban implementation of the Consult Station for primary care and assess its contribution to health care pathways in areas with a low density of medical services. Methods: In a proof-of-concept multisite prospective cohort study, 2134 consecutive patients had teleconsultations. Consultation characteristics were analyzed from both the patient and practitioner perspective. Results: In this study, the main users of Consult Station were younger women consulting for low-severity seasonal infections. Interestingly, hypertension, diabetes, and preventive medical consultations were almost absent, while they accounted for almost 50% of consultations with a general practitioner (GP). We showed that for all regions where the Consult Station was implemented, the number of consultations increased as GP density decreased. The study of practitioner characteristics showed GPs from metropolitan areas are motivated to work with this device remotely, with a high level of technology acceptability. Conclusions: The multisite implementation of Consult Station booths is suitable for primary care and could also address the challenge of “medical deserts.” In addition, further studies should be performed to evaluate the possible contribution of Consult Station booths to limiting work absenteeism. %M 35254263 %R 10.2196/33507 %U https://www.jmir.org/2022/5/e33507 %U https://doi.org/10.2196/33507 %U http://www.ncbi.nlm.nih.gov/pubmed/35254263 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e36431 %T Online Video Teletherapy Treatment of Obsessive-Compulsive Disorder Using Exposure and Response Prevention: Clinical Outcomes From a Retrospective Longitudinal Observational Study %A Feusner,Jamie D %A Farrell,Nicholas R %A Kreyling,Jeremy %A McGrath,Patrick B %A Rhode,Andreas %A Faneuff,Ted %A Lonsway,Stephanie %A Mohideen,Reza %A Jurich,John E %A Trusky,Larry %A Smith,Stephen M %+ NOCD Inc, 225 N Michigan, Suite 1430, Chicago, IL, 60601, United States, 1 323 868 7211, jamie@nocdhelp.com %K digital behavioral health %K cognitive-behavioral therapy %K CBT %K exposure and ritual prevention %K ERP %K EX/RP %K digital health %K telehealth %K cognitive therapy %K obsessive compulsive disorder %K OCD %K clinical outcomes %K teletherapy %K remote therapy %K telemedicine %K obsessive compulsive %K symptom %K comorbid symptom %K comorbidity %K comorbidities %K video therapy %K virtual therapy %K clinical outcome %K patient outcome %K online therapy %K mobile health %K mHealth %K app based %K health app %K technology assisted %K messaging %D 2022 %7 19.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Exposure and response prevention, a type of cognitive-behavioral therapy, is an effective first-line treatment for obsessive-compulsive disorder (OCD). Despite extensive evidence of the efficacy of exposure and response prevention (ERP) from clinical studies and in real-world samples, it is still underused as a treatment. This is likely due to the limits to access to care that include the availability of adequately trained therapists, as well as geographical location, time, and cost barriers. To address these, NOCD created a digital behavioral health treatment for OCD using ERP delivered via video teletherapy and with technology-assisted elements including app-based therapy tools and between-session therapist messaging. Objective: We examined treatment outcomes in a large naturalistic sample of 3552 adults with a primary OCD diagnosis who received NOCD treatment. Methods: The treatment model consisted of twice-weekly, live, face-to-face video teletherapy ERP for 3 weeks, followed by 6 weeks of once-weekly brief video teletherapy check-ins for 30 minutes. Assessments were conducted at baseline, at midpoint after completion of 3 weeks of twice-weekly sessions, and at the end of 6 weeks of brief check-ins (endpoint). Longitudinal assessments were also obtained at 3, 6, 9, and 12 months after endpoint. Results: Treatment resulted in clinically and statistically significant improvements, with a 43.4% mean reduction in obsessive-compulsive symptoms (g=1.0; 95% CI 0.93 to 1.03) and a 62.9% response rate. Treatment also resulted in a 44.2% mean reduction in depression, a 47.8% mean reduction in anxiety, and a 37.3% mean reduction in stress symptoms. Quality of life improved by a mean of 22.7%. Reduction in OCD symptoms and response rates were similar for those with mild, moderate, or severe symptoms. The mean duration of treatment was 11.5 (SD 4.0) weeks, and the mean total therapist time was 10.6 (SD 1.1) hours. Improvements were maintained at 3, 6, 9, and 12 months. Conclusions: In this sample, representing the largest reported treated cohort of patients with OCD to date, video teletherapy treatment demonstrated effectiveness in reducing obsessive-compulsive and comorbid symptoms and improved quality of life. Further, it achieved meaningful results in less than half the total therapist time compared with standard once-weekly outpatient treatment, an efficiency that represents substantial monetary and time savings. The effect size was large and similar to studies of in-person ERP. This technology-assisted remote treatment is readily accessible for patients, offering an advancement in the field in the dissemination of effective evidence-based care for OCD. %M 35587365 %R 10.2196/36431 %U https://www.jmir.org/2022/5/e36431 %U https://doi.org/10.2196/36431 %U http://www.ncbi.nlm.nih.gov/pubmed/35587365 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e32002 %T How We Can Reap the Full Benefit of Teleconsultations: Economic Evaluation Combined With a Performance Evaluation Through a Discrete-Event Simulation %A Huguet,Marius %A Sarazin,Marianne %A Perrier,Lionel %A Augusto,Vincent %+ Mines Saint-Etienne, Univ Clermont Auvergne, CNRS, UMR 6158 LIMOS, Centre CIS, 158 Cours Fauriel, Allée 1, F-42023 Saint-Étienne, 42000, France, 33 0633989861, marius.huguet@gmail.com %K telemedicine %K telehealth %K teleconsultation %K discrete-event simulation %K economic evaluation %K propensity score matching %D 2022 %7 20.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, the rapid development of information and communications technology enabled by innovations in videoconferencing solutions and the emergence of connected medical devices has contributed to expanding the scope of application and expediting the development of telemedicine. Objective: This study evaluates the use of teleconsultations (TCs) for specialist consultations at hospitals in terms of costs, resource consumption, and patient travel time. The key feature of our evaluation framework is the combination of an economic evaluation through a cost analysis and a performance evaluation through a discrete-event simulation (DES) approach. Methods: Three data sets were used to obtain detailed information on the characteristics of patients, characteristics of patients’ residential locations, and usage of telehealth stations. A total of 532 patients who received at least one TC and 18,559 patients who received solely physical consultations (CSs) were included in the initial sample. The TC patients were recruited during a 7-month period (ie, 2020 data) versus 19 months for the CS patients (ie, 2019 and 2020 data). A propensity score matching procedure was applied in the economic evaluation. To identify the best scenarios for reaping the full benefits of TCs, various scenarios depicting different population types and deployment strategies were explored in the DES model. Associated break-even levels were calculated. Results: The results of the cost evaluation reveal a higher cost for the TC group, mainly induced by higher volumes of (tele)consultations per patient and the substantial initial investment required for TC equipment. On average, the total cost per patient over 298 days of follow-up was €356.37 (US $392) per TC patient and €305.18 (US $336) per CS patient. However, the incremental cost of TCs was not statistically significant: €356.37 – €305.18 = €51.19 or US $392 – US $336 = US $56 (95% CI –35.99 to 114.25; P=.18). Sensitivity analysis suggested heterogeneous economic profitability levels within subpopulations and based on the intensity of use of TC solutions. In fact, the DES model results show that TCs could be a cost-saving strategy in some cases, depending on population characteristics, the amortization speed of telehealth equipment, and the locations of telehealth stations. Conclusions: The use of TCs has the potential to lead to a major organizational change in the health care system in the near future. Nevertheless, TC performance is strongly related to the context and deployment strategy involved. %M 35594065 %R 10.2196/32002 %U https://www.jmir.org/2022/5/e32002 %U https://doi.org/10.2196/32002 %U http://www.ncbi.nlm.nih.gov/pubmed/35594065 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e33505 %T Health Care Professionals’ Experiences of Web-Based Symptom Checkers for Triage: Cross-sectional Survey Study %A Kujala,Sari %A Hörhammer,Iiris %+ Department of Computer Science, Aalto University, PO Box 15400, Espoo, FI-00076, Finland, 358 503862768, sari.kujala@aalto.fi %K adoption %K symptom checker %K triage %K health care professional %K survey %K online health %K digital health %K health organizations %K health care %D 2022 %7 5.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based symptom checkers are promising tools that provide help to patients seeking guidance on health problems. Many health organizations have started using them to enhance triage. Patients use the symptom checker to report their symptoms online and submit the report to the health care center through the system. Health care professionals (registered nurse, practical nurse, general physician, physiotherapist, etc) receive patient inquiries with urgency rating, decide on actions to be taken, and communicate these to the patients. The success of the adoption, however, depends on whether the tools can efficiently support health care professionals’ workflow and achieve their support. Objective: This study explores the factors influencing health care professionals’ support for a web-based symptom checker for triage. Methods: Data were collected through a web-based survey of 639 health care professionals using either of the two most used web-based symptom checkers in the Finnish public primary care. Linear regression models were fitted to study the associations between the study variables and health care professionals’ support for the symptom checkers. In addition, the health care professionals’ comments collected via survey were qualitatively analyzed to elicit additional insights about the benefits and challenges of the clinical use of symptom checkers. Results: Results show that the perceived beneficial influence of the symptom checkers on health care professionals’ work and the perceived usability of the tools were positively associated with professionals’ support. The perceived benefits to patients and organizational support for use were positively associated, and threat to professionals’ autonomy was negatively associated with health care professionals’ support. These associations were, however, not independent of other factors included in the models. The influences on professionals’ work were both positive and negative; the tools streamlined work by providing preliminary information on patients and reduced the number of phone calls, but they also created extra work as the professionals needed to call patients and ask clarifying questions. Managing time between the use of symptom checkers and other tasks was also challenging. Meanwhile, according to health care professionals’ experience, the symptom checkers benefited patients as they received help quickly with a lower threshold for care. Conclusions: The efficient use of symptom checkers for triage requires usable solutions that support health care professionals’ work. High-quality information about the patients’ conditions and an efficient way of communicating with patients are needed. Using a new eHealth tool also requires that health organizations and teams reorganize their workflows and work distributions to support clinical processes. %M 35511254 %R 10.2196/33505 %U https://www.jmir.org/2022/5/e33505 %U https://doi.org/10.2196/33505 %U http://www.ncbi.nlm.nih.gov/pubmed/35511254 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e36943 %T Promised and Lottery Airtime Incentives to Improve Interactive Voice Response Survey Participation Among Adults in Bangladesh and Uganda: Randomized Controlled Trial %A Gibson,Dustin Garrett %A Kibria,Gulam Muhammed Al %A Pariyo,George William %A Ahmed,Saifuddin %A Ali,Joseph %A Labrique,Alain Bernard %A Khan,Iqbal Ansary %A Rutebemberwa,Elizeus %A Flora,Meerjady Sabrina %A Hyder,Adnan Ali %+ Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E8650, Baltimore, MD, 21205, United States, 1 443 287 8763, dgibso28@jhu.edu %K mobile phone survey %K interactive voice response survey %K survey %K interactive voice response %K non-communicable disease %K surveillance %K airtime incentive %K response rate %K cooperation rate %K communicable disease %K Uganda %K Bangladesh %K low income %K middle income %K LMIC %K Africa %K incentive %K RCT %K randomized controlled trial %K lottery %K cooperation %K participation %D 2022 %7 9.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Increased mobile phone penetration allows the interviewing of respondents using interactive voice response surveys in low- and middle-income countries. However, there has been little investigation of the best type of incentive to obtain data from a representative sample in these countries. Objective: We assessed the effect of different airtime incentives options on cooperation and response rates of an interactive voice response survey in Bangladesh and Uganda. Methods: The open-label randomized controlled trial had three arms: (1) no incentive (control), (2) promised airtime incentive of 50 Bangladeshi Taka (US $0.60; 1 BDT is approximately equivalent to US $0.012) or 5000 Ugandan Shilling (US $1.35; 1 UGX is approximately equivalent to US $0.00028), and (3) lottery incentive (500 BDT and 100,000 UGX), in which the odds of winning were 1:20. Fully automated random-digit dialing was used to sample eligible participants aged ≥18 years. The risk ratios (RRs) with 95% confidence intervals for primary outcomes of response and cooperation rates were obtained using log-binomial regression. Results: Between June 14 and July 14, 2017, a total of 546,746 phone calls were made in Bangladesh, with 1165 complete interviews being conducted. Between March 26 and April 22, 2017, a total of 178,572 phone calls were made in Uganda, with 1248 complete interviews being conducted. Cooperation rates were significantly higher for the promised incentive (Bangladesh: 39.3%; RR 1.38, 95% CI 1.24-1.55, P<.001; Uganda: 59.9%; RR 1.47, 95% CI 1.33-1.62, P<.001) and the lottery incentive arms (Bangladesh: 36.6%; RR 1.28, 95% CI 1.15-1.45, P<.001; Uganda: 54.6%; RR 1.34, 95% CI 1.21-1.48, P<.001) than those for the control arm (Bangladesh: 28.4%; Uganda: 40.9%). Similarly, response rates were significantly higher for the promised incentive (Bangladesh: 26.5%%; RR 1.26, 95% CI 1.14-1.39, P<.001; Uganda: 41.2%; RR 1.27, 95% CI 1.16-1.39, P<.001) and lottery incentive arms (Bangladesh: 24.5%%; RR 1.17, 95% CI 1.06-1.29, P=.002; Uganda: 37.9%%; RR 1.17, 95% CI 1.06-1.29, P=.001) than those for the control arm (Bangladesh: 21.0%; Uganda: 32.4%). Conclusions: Promised or lottery airtime incentives improved survey participation and facilitated a large sample within a short period in 2 countries. Trial Registration: ClinicalTrials.gov NCT03773146; http://clinicaltrials.gov/ct2/show/NCT03773146 %M 35532997 %R 10.2196/36943 %U https://www.jmir.org/2022/5/e36943 %U https://doi.org/10.2196/36943 %U http://www.ncbi.nlm.nih.gov/pubmed/35532997 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34347 %T Self-administered Web-Based Tests of Executive Functioning and Perceptual Speed: Measurement Development Study With a Large Probability-Based Survey Panel %A Liu,Ying %A Schneider,Stefan %A Orriens,Bart %A Meijer,Erik %A Darling,Jill E %A Gutsche,Tania %A Gatz,Margaret %+ Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089, United States, 1 2138211850, liu.ying@usc.edu %K cognitive tests %K internet %K probability-based %K web-based %K executive function %K response speed %K self-administered test %K mobile phone %D 2022 %7 9.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive testing in large population surveys is frequently used to describe cognitive aging and determine the incidence rates, risk factors, and long-term trajectories of the development of cognitive impairment. As these surveys are increasingly administered on internet-based platforms, web-based and self-administered cognitive testing calls for close investigation. Objective: Web-based, self-administered versions of 2 age-sensitive cognitive tests, the Stop and Go Switching Task for executive functioning and the Figure Identification test for perceptual speed, were developed and administered to adult participants in the Understanding America Study. We examined differences in cognitive test scores across internet device types and the extent to which the scores were associated with self-reported distractions in everyday environments in which the participants took the tests. In addition, national norms were provided for the US population. Methods: Data were collected from a probability-based internet panel representative of the US adult population—the Understanding America Study. Participants with access to both a keyboard- and mouse-based device and a touch screen–based device were asked to complete the cognitive tests twice in a randomized order across device types, whereas participants with access to only 1 type of device were asked to complete the tests twice on the same device. At the end of each test, the participants answered questions about interruptions and potential distractions that occurred during the test. Results: Of the 7410 (Stop and Go) and 7216 (Figure Identification) participants who completed the device ownership survey, 6129 (82.71% for Stop and Go) and 6717 (93.08% for Figure Identification) participants completed the first session and correctly responded to at least 70% of the trials. On average, the standardized differences across device types were small, with the absolute value of Cohen d ranging from 0.05 (for the switch score in Stop and Go and the Figure Identification score) to 0.13 (for the nonswitch score in Stop and Go). Poorer cognitive performance was moderately associated with older age (the absolute value of r ranged from 0.32 to 0.61), and this relationship was comparable across device types (the absolute value of Cohen q ranged from 0.01 to 0.17). Approximately 12.72% (779/6123 for Stop and Go) and 12.32% (828/6721 for Figure Identification) of participants were interrupted during the test. Interruptions predicted poorer cognitive performance (P<.01 for all scores). Specific distractions (eg, watching television and listening to music) were inconsistently related to cognitive performance. National norms, calculated as weighted average scores using sampling weights, suggested poorer cognitive performance as age increased. Conclusions: Cognitive scores assessed by self-administered web-based tests were sensitive to age differences in cognitive performance and were comparable across the keyboard- and touch screen–based internet devices. Distraction in everyday environments, especially when interrupted during the test, may result in a nontrivial bias in cognitive testing. %M 35532966 %R 10.2196/34347 %U https://www.jmir.org/2022/5/e34347 %U https://doi.org/10.2196/34347 %U http://www.ncbi.nlm.nih.gov/pubmed/35532966 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e33291 %T Access to and Use of Internet and Social Media by Low-Morbidity Stroke Survivors Participating in a National Web-Based Secondary Stroke Prevention Trial: Cross-sectional Survey %A Clancy,Brigid %A Bonevski,Billie %A English,Coralie %A Baker,Amanda L %A Turner,Alyna %A Magin,Parker %A Pollack,Michael %A Callister,Robin %A Guillaumier,Ashleigh %+ The University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 0432599892, brigid.clancy@newcastle.edu.au %K stroke %K stroke survivor %K recurrent stroke %K digital health %K social media %K internet use %K eHealth %K information-seeking behavior %K web-based %K mobile phone %D 2022 %7 30.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth applications for stroke are a growing area of research that has yielded promising results. However, little is known about how stroke survivors engage with the internet, social media, and other digital technologies on a day-to-day basis. Objective: This study had three main objectives: to describe the type, frequency, and purpose of technology use among a cohort of low-morbidity stroke survivors; to investigate associations between social media use and participant factors, including sociodemographics, physical function, and independence in activities of daily living; and to investigate associations between stroke-related health risk factors and the use of the internet to search for health and medical information. Methods: This study is a secondary analysis of data obtained during a national randomized controlled trial—Prevent 2nd Stroke. The participants were stroke survivors recruited from 2 Australian stroke registries who completed 2 telephone-administered surveys to collect data on demographics and stroke characteristics; health risk factors (diet quality, physical activity, blood pressure medication, alcohol intake, anxiety and depression, and smoking status); physical functioning; independence in activities of daily living; and questions about what technology they had access to, how often they used it, and for what purposes. Participants were eligible if they had no more than a moderate level of disability (modified Rankin score ≤3) and had access to the internet. Multivariable logistic regression was used to assess the associations between social media use and sociodemographics, physical function, and independence in activities of daily living as well as associations between stroke-related health risk factors and the use of the internet to search for health and medical information. Results: Data from 354 participants were included in the analysis. Approximately 79.1% (280/354) of participants used the internet at least daily, 40.8% (118/289) accessed social media on their phone or tablet daily, and 46.4% (134/289) looked up health and medical information at least monthly. Women were 2.7 times more likely to use social media (adjusted odds ratio 2.65, 95% CI 1.51-4.72), and people aged >75 years were significantly less likely to use social media compared with those aged <55 years (adjusted odds ratio 0.17, 95% CI 0.07-0.44). Health risk factors were not found to be associated with searching for health- or medical-related information. Conclusions: The internet appears to be a viable platform to engage with stroke survivors who may not be high-morbidity to conduct research and provide information and health interventions. This is important given that they are at high risk of recurrent stroke regardless of their level of disability. Exploring the technology use behaviors and the possibility of eHealth among survivors who experience higher levels of morbidity or disability because of their stroke is an area of research that warrants further study. %M 35635754 %R 10.2196/33291 %U https://www.jmir.org/2022/5/e33291 %U https://doi.org/10.2196/33291 %U http://www.ncbi.nlm.nih.gov/pubmed/35635754 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e36799 %T Self-efficacy and Use of Digital Health Care and Social Welfare Services Among Incarcerated People: Cross-sectional Survey Study %A Rantanen,Teemu %A Järveläinen,Eeva %A Leppälahti,Teppo %+ Laurea University of Applied Sciences, Ratatie 22, Vantaa, 01300, Finland, 358 408306149, teemu.rantanen@laurea.fi %K digital inclusion %K digital exclusion %K digital divide %K digitalization in prisons %K incarcerated people %D 2022 %7 31.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The digitization of health care and social welfare services creates many opportunities for the rehabilitation of incarcerated people and their preparation for release from prison. A range of digital platforms and technology solutions have been developed that offer multiple opportunities to handle private matters either by video conference, email, or some other digital format during imprisonment. However, incarcerated people have limited access to digital health care and social welfare services, and face challenges related to shortcomings in their digital skills and self-efficacy. Objective: This article assessed the significance of incarcerated people’s self-efficacy in terms of their sense of control over the use of digital health care and social welfare services. Methods: A cross-sectional study was conducted using a questionnaire. Research data were collected from 11 prisons in different parts of Finland, and a total of 225 incarcerated people responded to the survey. Statistical analyses were conducted using the Pearson product-moment correlation coefficient, 2-tailed t test, linear regression analysis, and Hayes bootstrapping method. Results: The results showed the significance of both general and internet-specific self-efficacy, which appear to be more important for the use of digital health care and social welfare services than factors related to a person’s socioeconomic background or sentence. Age was negatively correlated with perceived control over the use of digital health care and social welfare services. Furthermore, the study emphasized the importance of support from family and friends, as well as prison employees. Conclusions: The digitalization of prisons offers many opportunities, but special consideration should be given to how the digitization of health care and social welfare services responds to the needs of incarcerated people in terms of their integration into society and the prevention of recidivism. During imprisonment, attention should be paid to strengthening the digital skills of incarcerated people, with support provided by prison employees. In addition to providing guidance on the use of individual digital services, the study recommends strengthening the general digital skills of incarcerated people, as well as developing their life management skills. %M 35639446 %R 10.2196/36799 %U https://www.jmir.org/2022/5/e36799 %U https://doi.org/10.2196/36799 %U http://www.ncbi.nlm.nih.gov/pubmed/35639446 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e32922 %T Web-Based Independent Versus Laboratory-Based Stop-Signal Task Performance: Within-Subjects Counterbalanced Comparison Study %A Poulton,Antoinette %A Chen,Li Peng Evelyn %A Dali,Gezelle %A Fox,Michael %A Hester,Robert %+ Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville, 3010, Australia, 61 3 8344 6377, antoinette.poulton@unimelb.edu.au %K Stop-Signal Task %K response inhibition %K inhibitory control %K online assessment %K web-based assessment %K cognition %D 2022 %7 30.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Considered a facet of behavioral impulsivity, response inhibition facilitates adaptive and goal-directed behavior. It is often assessed using the Stop-Signal Task (SST), which is presented on stand-alone computers under controlled laboratory conditions. Sample size may consequently be a function of cost or time and sample diversity constrained to those willing or able to attend the laboratory. Statistical power and generalizability of results might, in turn, be impacted. Such limitations may potentially be overcome via the implementation of web-based testing. Objective: The aim of this study was to investigate if there were differences between variables derived from a web-based SST when it was undertaken independently—that is, outside the laboratory, on any computer, and in the absence of researchers—versus when it was performed under laboratory conditions. Methods: We programmed a web-based SST in HTML and JavaScript and employed a counterbalanced design. A total of 166 individuals (mean age 19.72, SD 1.85, range 18-36 years; 146/166, 88% female) were recruited. Of them, 79 undertook the independent task prior to visiting the laboratory and 78 completed the independent task following their laboratory visit. The average time between SST testing was 3.72 (SD 2.86) days. Dependent samples and Bayesian paired samples t tests were used to examine differences between laboratory-based and independent SST variables. Correlational analyses were conducted on stop-signal reaction times (SSRT). Results: After exclusions, 123 participants (mean age 19.73, SD 1.97 years) completed the SST both in the laboratory and independently. While participants were less accurate on go trials and exhibited reduced inhibitory control when undertaking the independent—compared to the laboratory-based—SST, there was a positive association between the SSRT of each condition (r=.48; P<.001; 95% CI 0.33-0.61). Conclusions: Findings suggest a web-based SST, which participants undertake on any computer, at any location, and in the absence of the researcher, is a suitable measure of response inhibition. %M 35635745 %R 10.2196/32922 %U https://www.jmir.org/2022/5/e32922 %U https://doi.org/10.2196/32922 %U http://www.ncbi.nlm.nih.gov/pubmed/35635745 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37523 %T The Development and Evaluation of an e-Learning Course That Promotes Digital Health Literacy in School-age Children: Pre-Post Measurement Study %A König,Lars %A Marbach-Breitrück,Eugenia %A Engler,Anne %A Suhr,Ralf %+ Stiftung Gesundheitswissen, Friedrichstr 134, Berlin, 10117, Germany, 49 30419549262, lars.koenig@stiftung-gesundheitswissen.de %K digital education %K digital health literacy %K digital literacy %K e-learning %K health education %K health information %K health literacy %K learning material %K school %K school-age children %D 2022 %7 16.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Experts agree that the promotion of (digital) health literacy should be an integral part of the school curriculum. However, promoting (digital) health literacy within the German school system is difficult because (digital) health education is not a mandatory school subject in all the German states. Therefore, experts suggest that (digital) health literacy could be addressed as part of the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz). Objective: The goal of this study was to evaluate a newly developed e-learning course that was designed to improve (digital) health literacy in school-age children and concurrently to teach skills specified in the mandatory framework for digital education and digital literacy in schools. It was hypothesized that participants’ health literacy and digital health literacy levels would be higher after completing the e-learning course than they were before doing the course. Furthermore, it was hypothesized that after completing the e-learning course, participants’ subjective and objective knowledge in the domain of (digital) health literacy would be higher than it was before doing the course. Methods: The pre-post measurement study was conducted online. After participants (N=323) gave their informed consent to participate in the study, they provided demographic information and answered all measures (premeasurement). Following this, participants had 7 days to complete the e-learning course. After finishing the e-learning course, participants answered all the measures again (postmeasurement). Results: To test the hypotheses, Bayesian paired samples t tests (1-sided) were conducted. After completing the e-learning course, participants showed higher health literacy levels. Specifically, they showed higher competency levels in the domains of theoretical knowledge (Bayes factor [BF]–0=676,000; δ=–0.316), practical knowledge (BF–0=92,300; δ=–0.294), critical thinking (BF–0=7.42e+13; δ=–0.482), self-awareness (BF–0=11,500,000; δ=–0.345), and citizenship (BF–0=266,000; δ=–0.306). Furthermore, participants achieved higher digital health literacy levels. Specifically, they achieved higher competency levels in the domains of information searching (BF–0=2.339; δ=–0.135), evaluating reliability (BF–0=2.03e+11; δ=–0.434), and determining relevance (BF–0=316,000; δ=–0.308). Moreover, participants demonstrated higher subjective (BF–0=3.58e+82; δ=–1.515) and objective knowledge (BF–0=3.82e+97; δ=–1.758) in the domain of (digital) health literacy. Conclusions: The newly designed e-learning course provides an easy way for schools and teachers from all German states to integrate (digital) health literacy education into their school curriculums and lessons. The evaluated course is especially attractive because it was designed to improve (digital) health literacy and at the same time to teach skills specified in the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz). %M 35576572 %R 10.2196/37523 %U https://www.jmir.org/2022/5/e37523 %U https://doi.org/10.2196/37523 %U http://www.ncbi.nlm.nih.gov/pubmed/35576572 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e38508 %T A Short Intervention and an Interactive e-Learning Module to Motivate Medical and Dental Students to Enlist as First Responders: Implementation Study %A Taramarcaz,Victor %A Herren,Tara %A Golay,Eric %A Regard,Simon %A Martin-Achard,Sébastien %A Mach,Francois %A Schnetzler,Nicolas %A Ricci,Gaëtan %A Zamberg,Ido %A Larribau,Robert %A Niquille,Marc %A Suppan,Mélanie %A Schiffer,Eduardo %A Suppan,Laurent %+ Division of Emergency Medicine, 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, laurent.suppan@hcuge.ch %K basic life support %K cardiopulmonary resuscitation %K first responder %K undergraduate medical education %K out-of-hospital cardiac arrest %K medical education %K e-learning %K digital education %K medical student %K blended learning %D 2022 %7 18.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Prompt and proficient basic life support (BLS) maneuvers are essential to increasing the odds of survival after out-of-hospital cardiac arrest. However, significant time can elapse before the arrival of professional rescuers. To decrease these delays, many countries have developed first responder networks. These networks are composed of BLS-certified lay or professional rescuers who can be dispatched by emergency medical communication centers to take care of those who experience out-of-hospital cardiac arrest. Many systems are, however, limited by a relatively low number of active first responders, and first-year medical and dental students may represent an almost untapped pool of potential rescuers. On top of providing an enhanced BLS coverage to the population, this could also help medical students be better prepared to their future role as certified health care providers and address societal expectations regarding health care students. Objective: Our objective was to describe the impact of a short motivational intervention followed by a blended BLS course (e-learning and practice session) designed to motivate first-year medical and dental students to enlist as first responders. Methods: A short, web-based, motivational intervention presenting this project took place, and first-year University of Geneva, Faculty of Medicine students were provided with a link to the study platform. Those who agreed to participate were redirected to a demographic questionnaire before registering on the platform. The participants were then asked to answer a second questionnaire designed to determine their baseline knowledge prior to following an interactive e-learning module. Upon completion, a web-based booking form enabling them to register for a 1-hour practice session was displayed. These sessions were held by senior medical students who had been trained and certified as BLS instructors. The participants who attended these practice sessions were asked to answer a postcourse questionnaire before receiving the certificate enabling them to register as first responders. Results: Out of the 529 first-year students registered at University of Geneva, Faculty of Medicine on January 14, 2021, 190 (35.9%) initially agreed to participate. Moreover, 102 (19.3%) attended the practice sessions, and 48 (9.1%) had completed all training and enlisted as first responders on the dedicated platform, Save a Life, at 6 months (July 14, 2021). Postcourse confidence in resuscitation skills was associated with a higher likelihood of registering as first responder (P=.03). No association was found between prior BLS knowledge and the probability of registering to a practice session (P=.59), of obtaining a course completion certificate (P=.29), or of enlisting as first responder (P=.56). Conclusions: This study shows that a motivational intervention associated with a short BLS course can convince medical students to enlist as first responders. Further studies are needed to understand the rather low proportion of medical students finally registering as first responders. International Registered Report Identifier (IRRID): RR2-10.2196/24664 %M 35583927 %R 10.2196/38508 %U https://www.jmir.org/2022/5/e38508 %U https://doi.org/10.2196/38508 %U http://www.ncbi.nlm.nih.gov/pubmed/35583927 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37674 %T Exploring Online Peer Support Groups for Adults Experiencing Long COVID in the United Kingdom: Qualitative Interview Study %A Day,Hannah L S %+ Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 2079272700, hannah.day1@alumni.lshtm.ac.uk %K COVID-19 %K long COVID %K post-COVID-19 syndrome %K peer support %K online health communities %K self-help groups %K internet %K qualitative %K interview %K patient experience %K digital health %K digital peer support %K online health %D 2022 %7 20.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Long COVID is an emerging public health concern. A growing number of individuals are experiencing prolonged, multifaceted health challenges and accompanying social impacts after COVID-19 infections. Support services in the United Kingdom remain insufficient and fraught with complexity. Responding to persistent gaps in care, patients joined forces in online peer support groups. However, little is known about how these groups impact patients with long COVID and their lived experiences of the condition. Objective: The aim of this study is to explore the roles that online peer support groups take on and the impact they have on patients experiencing and recovering from long COVID in the United Kingdom. In doing so, this study aims to identify ways to inform future long COVID care, including online peer support and broader long COVID care structures. Methods: I conducted 11 semistructured interviews virtually on Zoom in July 2021. Participants had long COVID, were UK-based, and used long COVID online peer support groups. Topics discussed in interviews included what led participants to these groups, experiences within them, and feelings about the roles that the groups took on. I analyzed the results by manually conducting thematic analysis. Results: Long COVID online peer support groups had numerous roles, significantly impacting users. I identified 5 themes and 13 subthemes through thematic analysis. The identified themes were as follows: (1) filling professional care gaps, (2) societal awareness, (3) engagement behavior, (4) diversity, and (5) social connections. Given the void of professional support, those experiencing long COVID gained some benefit from these groups. However, participants emphasized notable concerns about the all-encompassing roles these groups embody and speculated over potential improvements. Conclusions: If used appropriately, online peer support groups could be immensely beneficial for patient well-being, beyond simply filling gaps in long COVID care. However, it appears many groups take on more than they can manage and become potentially harmful. Through prioritizing patient voices, long COVID care could be restructured to maximize peer support’s benefits within broader care structures. %M 35468083 %R 10.2196/37674 %U https://www.jmir.org/2022/5/e37674 %U https://doi.org/10.2196/37674 %U http://www.ncbi.nlm.nih.gov/pubmed/35468083 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e35981 %T Integration of an Intensive Care Unit Visualization Dashboard (i-Dashboard) as a Platform to Facilitate Multidisciplinary Rounds: Cluster-Randomized Controlled Trial %A Lai,Chao-Han %A Li,Kai-Wen %A Hu,Fang-Wen %A Su,Pei-Fang %A Hsu,I-Lin %A Huang,Min‑Hsin %A Huang,Yen‑Ta %A Liu,Ping-Yen %A Shen,Meng-Ru %+ Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, 704, Taiwan, 886 062353535 ext 5505, mrshen@mail.ncku.edu.tw %K Intensive care unit %K multidisciplinary round %K visualization dashboard %K large screen %K information management strategy %K electronic health record %K medical record %K digital health %K dashboard %K i-Dashboard %K electronic medical record %K information exchange %D 2022 %7 13.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background:  Multidisciplinary rounds (MDRs) are scheduled, patient-focused communication mechanisms among multidisciplinary providers in the intensive care unit (ICU). Objective: i-Dashboard is a custom-developed visualization dashboard that supports (1) key information retrieval and reorganization, (2) time-series data, and (3) display on large touch screens during MDRs. This study aimed to evaluate the performance, including the efficiency of prerounding data gathering, communication accuracy, and information exchange, and clinical satisfaction of integrating i-Dashboard as a platform to facilitate MDRs. Methods: A cluster-randomized controlled trial was performed in 2 surgical ICUs at a university hospital. Study participants included all multidisciplinary care team members. The performance and clinical satisfaction of i-Dashboard during MDRs were compared with those of the established electronic medical record (EMR) through direct observation and questionnaire surveys. Results: Between April 26 and July 18, 2021, a total of 78 and 91 MDRs were performed with the established EMR and i-Dashboard, respectively. For prerounding data gathering, the median time was 10.4 (IQR 9.1-11.8) and 4.6 (IQR 3.5-5.8) minutes using the established EMR and i-Dashboard (P<.001), respectively. During MDRs, data misrepresentations were significantly less frequent with i-Dashboard (median 0, IQR 0-0) than with the established EMR (4, IQR 3-5; P<.001). Further, effective recommendations were significantly more frequent with i-Dashboard than with the established EMR (P<.001). The questionnaire results revealed that participants favored using i-Dashboard in association with the enhancement of care plan development and team participation during MDRs. Conclusions:  i-Dashboard increases efficiency in data gathering. Displaying i-Dashboard on large touch screens in MDRs may enhance communication accuracy, information exchange, and clinical satisfaction. The design concepts of i-Dashboard may help develop visualization dashboards that are more applicable for ICU MDRs. Trial Registration: ClinicalTrials.gov NCT04845698; https://clinicaltrials.gov/ct2/show/NCT04845698 %M 35560107 %R 10.2196/35981 %U https://www.jmir.org/2022/5/e35981 %U https://doi.org/10.2196/35981 %U http://www.ncbi.nlm.nih.gov/pubmed/35560107 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e31231 %T Ethical Issues in Social Media Recruitment for Clinical Studies: Ethical Analysis and Framework %A Zimmermann,Bettina M %A Willem,Theresa %A Bredthauer,Carl Justus %A Buyx,Alena %+ Institute of History and Ethics in Medicine, School of Medicine, Technical University of Munich, Prinzregentenstraße 68, Munich, 81675, Germany, 49 17662315637, theresa.willem@tum.de %K social media %K clinical studies %K clinical trials %K ethics %K recruitment %D 2022 %7 3.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media recruitment for clinical studies holds the promise of being a cost-effective way of attracting traditionally marginalized populations and promoting patient engagement with researchers and a particular study. However, using social media for recruiting clinical study participants also poses a range of ethical issues. Objective: This study aims to provide a comprehensive overview of the ethical benefits and risks to be considered for social media recruitment in clinical studies and develop practical recommendations on how to implement these considerations. Methods: On the basis of established principles of clinical ethics and research ethics, we reviewed the conceptual and empirical literature for ethical benefits and challenges related to social media recruitment. From these, we derived a conceptual framework to evaluate the eligibility of social media use for recruitment for a specific clinical study. Results: We identified three eligibility criteria for social media recruitment for clinical studies: information and consent, risks for target groups, and recruitment effectiveness. These criteria can be used to evaluate the implementation of a social media recruitment strategy at its planning stage. We have discussed the practical implications of these criteria for researchers. Conclusions: The ethical challenges related to social media recruitment are context sensitive. Therefore, social media recruitment should be planned rigorously, taking into account the target group, the appropriateness of social media as a recruitment channel, and the resources available to execute the strategy. %M 35503247 %R 10.2196/31231 %U https://www.jmir.org/2022/5/e31231 %U https://doi.org/10.2196/31231 %U http://www.ncbi.nlm.nih.gov/pubmed/35503247 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37931 %T Distinguishing Admissions Specifically for COVID-19 From Incidental SARS-CoV-2 Admissions: National Retrospective Electronic Health Record Study %A Klann,Jeffrey G %A Strasser,Zachary H %A Hutch,Meghan R %A Kennedy,Chris J %A Marwaha,Jayson S %A Morris,Michele %A Samayamuthu,Malarkodi Jebathilagam %A Pfaff,Ashley C %A Estiri,Hossein %A South,Andrew M %A Weber,Griffin M %A Yuan,William %A Avillach,Paul %A Wagholikar,Kavishwar B %A Luo,Yuan %A , %A Omenn,Gilbert S %A Visweswaran,Shyam %A Holmes,John H %A Xia,Zongqi %A Brat,Gabriel A %A Murphy,Shawn N %+ Laboratory of Computer Science, Department of Medicine, Massachusetts General Hospital, 50 Staniford St, Suite 750, Boston, MA, 02114, United States, 1 6142822222, jeff.klann@mgh.harvard.edu %K COVID-19 %K medical informatics %K public health %K phenotype %K electronic health records %K clinical research informatics %K health data %K SARS-CoV-2 %K patient data %K health care %D 2022 %7 18.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Admissions are generally classified as COVID-19 hospitalizations if the patient has a positive SARS-CoV-2 polymerase chain reaction (PCR) test. However, because 35% of SARS-CoV-2 infections are asymptomatic, patients admitted for unrelated indications with an incidentally positive test could be misclassified as a COVID-19 hospitalization. Electronic health record (EHR)–based studies have been unable to distinguish between a hospitalization specifically for COVID-19 versus an incidental SARS-CoV-2 hospitalization. Although the need to improve classification of COVID-19 versus incidental SARS-CoV-2 is well understood, the magnitude of the problems has only been characterized in small, single-center studies. Furthermore, there have been no peer-reviewed studies evaluating methods for improving classification. Objective: The aims of this study are to, first, quantify the frequency of incidental hospitalizations over the first 15 months of the pandemic in multiple hospital systems in the United States and, second, to apply electronic phenotyping techniques to automatically improve COVID-19 hospitalization classification. Methods: From a retrospective EHR-based cohort in 4 US health care systems in Massachusetts, Pennsylvania, and Illinois, a random sample of 1123 SARS-CoV-2 PCR-positive patients hospitalized from March 2020 to August 2021 was manually chart-reviewed and classified as “admitted with COVID-19” (incidental) versus specifically admitted for COVID-19 (“for COVID-19”). EHR-based phenotyping was used to find feature sets to filter out incidental admissions. Results: EHR-based phenotyped feature sets filtered out incidental admissions, which occurred in an average of 26% of hospitalizations (although this varied widely over time, from 0% to 75%). The top site-specific feature sets had 79%-99% specificity with 62%-75% sensitivity, while the best-performing across-site feature sets had 71%-94% specificity with 69%-81% sensitivity. Conclusions: A large proportion of SARS-CoV-2 PCR-positive admissions were incidental. Straightforward EHR-based phenotypes differentiated admissions, which is important to assure accurate public health reporting and research. %M 35476727 %R 10.2196/37931 %U https://www.jmir.org/2022/5/e37931 %U https://doi.org/10.2196/37931 %U http://www.ncbi.nlm.nih.gov/pubmed/35476727 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34769 %T The Effect of Dissemination Pathways on Uptake and Relative Costs for a Transdiagnostic, Self-guided Internet Intervention for Reducing Depression, Anxiety, and Suicidal Ideation: Comparative Implementation Study %A Batterham,Philip J %A Gulliver,Amelia %A Kurz,Ella %A Farrer,Louise M %A Vis,Christiaan %A Schuurmans,Josien %A Calear,Alison L %+ Centre for Mental Health Research, The Australian National University, 63 Eggleston Rd, Canberra, 2601, Australia, 61 261251031, philip.batterham@anu.edu.au %K implementation %K mental health %K adherence %K uptake %K internet %D 2022 %7 6.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-guided web-based programs are effective; however, inadequate implementation of these programs limits their potential to provide effective and low-cost treatment for common mental health problems at scale. There is a lack of research examining optimal methods for the dissemination of web-based programs in the community. Objective: This study aimed to compare the uptake, reach, relative costs, and adherence associated with 3 community-based pathways for delivering a low-intensity web-based transdiagnostic mental health program. The 3 dissemination pathways were social media advertising, advertising in general practice, and advertising in pharmacies. Methods: Participants were recruited on the web, from general practices, or from community pharmacies; completed a screener for psychological distress; and were offered the 4-week FitMindKit program—a 12-module psychotherapeutic intervention. Uptake was defined as the number of participants who enrolled in the web-based program; reach was defined as the rate of uptake per exposure; and costs were calculated based on staff time, equipment, and advertising. Adherence was assessed as the number of modules of FitMindKit completed by the participants. Results: Uptake comprised 1014 participants who were recruited through the 3 dissemination pathways: on the web (991/1014, 97.73%), in general practice (16/1014, 1.58%), and in pharmacy (7/1014, 0.69%). Reach was highest for social media: 1 in every 50 people exposed to web-based advertising took up the intervention compared with 1 in every 441 in general practitioner clinics and 1 in every 1708 in pharmacies. The dissemination cost was US $4.87 per user on social media, US $557 per user for general practitioner clinics, and US $1272 per user for pharmacy dissemination. No significant differences in adherence were observed between the conditions, whereas all pathways showed an underrepresentation of men and linguistic diversity. Conclusions: The web-based dissemination pathway was the most efficient and cost-effective for delivering a self-guided internet-based mental health program to people in the community. More research is needed to identify how best to engage men and those with culturally diverse backgrounds in web-based interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001688279; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376113 %M 35522458 %R 10.2196/34769 %U https://www.jmir.org/2022/5/e34769 %U https://doi.org/10.2196/34769 %U http://www.ncbi.nlm.nih.gov/pubmed/35522458 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e32006 %T Factors Predicting Engagement of Older Adults With a Coach-Supported eHealth Intervention Promoting Lifestyle Change and Associations Between Engagement and Changes in Cardiovascular and Dementia Risk: Secondary Analysis of an 18-Month Multinational Randomized Controlled Trial %A Coley,Nicola %A Andre,Laurine %A Hoevenaar-Blom,Marieke P %A Ngandu,Tiia %A Beishuizen,Cathrien %A Barbera,Mariagnese %A van Wanrooij,Lennard %A Kivipelto,Miia %A Soininen,Hilkka %A van Gool,Willem %A Brayne,Carol %A Moll van Charante,Eric %A Richard,Edo %A Andrieu,Sandrine %A , %A , %+ Center for Epidemiology and Research in Population health (CERPOP), University of Toulouse III Paul Sabatier (UPS), National Institute of Health and Medical Research (INSERM) mixed research unit (UMR) 1295, 37 allées Jules Guesde, Toulouse, 31000, France, 33 561145680, nicola.coley@inserm.fr %K aging %K eHealth %K disparities %K engagement %K prevention %K cardiovascular %K lifestyle %K risk factors %D 2022 %7 9.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions could help to prevent age-related diseases, but little is known about how older adults engage with such interventions, especially in the long term, or whether engagement is associated with changes in clinical, behavioral, or biological outcomes in this population. Disparities in engagement levels with digital health interventions may exist among older people and be associated with health inequalities. Objective: This study aimed to describe older adults’ engagement with an eHealth intervention, identify factors associated with engagement, and examine associations between engagement and changes in cardiovascular and dementia risk factors (blood pressure, cholesterol, BMI, physical activity, diet, and cardiovascular and dementia risk scores). Methods: This was a secondary analysis of the 18-month randomized controlled Healthy Ageing Through Internet Counselling in the Elderly trial of a tailored internet-based intervention encouraging behavior changes, with remote support from a lifestyle coach, to reduce cardiovascular and cognitive decline risk in 2724 individuals aged ≥65 years, recruited offline in the Netherlands, Finland, and France. Engagement was assessed via log-in frequency, number of lifestyle goals set, measurements entered and messages sent to coaches, and percentage of education materials read. Clinical and biological data were collected during in-person visits at baseline and 18 months. Lifestyle data were self-reported on a web-based platform. Results: Of the 1389 intervention group participants, 1194 (85.96%) sent at least one message. They logged in a median of 29 times, and set a median of 1 goal. Higher engagement was associated with significantly greater improvement in biological and behavioral risk factors, with evidence of a dose-response effect. Compared with the control group, the adjusted mean difference (95% CI) in 18-month change in the primary outcome, a composite z-score comprising blood pressure, BMI, and cholesterol, was −0.08 (−0.12 to −0.03), −0.04 (−0.08 to 0.00), and 0.00 (−0.08 to 0.08) in the high, moderate, and low engagement groups, respectively. Low engagers showed no improvement in any outcome measures compared with the control group. Participants not using a computer regularly before the study engaged much less with the intervention than those using a computer up to 7 (adjusted odds ratio 5.39, 95% CI 2.66-10.95) or ≥7 hours per week (adjusted odds ratio 6.58, 95% CI 3.21-13.49). Those already working on or with short-term plans for lifestyle improvement at baseline, and with better cognition, engaged more. Conclusions: Greater engagement with an eHealth lifestyle intervention was associated with greater improvement in risk factors in older adults. However, those with limited computer experience, who tended to have a lower level of education, or who had poorer cognition engaged less. Additional support or forms of intervention delivery for such individuals could help minimize potential health inequalities associated with the use of digital health interventions in older people. %M 35385395 %R 10.2196/32006 %U https://www.jmir.org/2022/5/e32006 %U https://doi.org/10.2196/32006 %U http://www.ncbi.nlm.nih.gov/pubmed/35385395 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e36835 %T Readability of English, German, and Russian Disease-Related Wikipedia Pages: Automated Computational Analysis %A Gordejeva,Jelizaveta %A Zowalla,Richard %A Pobiruchin,Monika %A Wiesner,Martin %+ Department of Medical Informatics, Heilbronn University, Max-Planck-Str 39, Heilbronn, 74081, Germany, 49 7131504 ext 6947, martin.wiesner@hs-heilbronn.de %K readability %K health literacy %K health education %K Wikipedia %D 2022 %7 16.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Wikipedia is a popular encyclopedia for health- and disease-related information in which patients seek advice and guidance on the web. Yet, Wikipedia articles can be unsuitable as patient education materials, as investigated in previous studies that analyzed specific diseases or medical topics with a comparatively small sample size. Currently, no data are available on the average readability levels of all disease-related Wikipedia pages for the different localizations of this particular encyclopedia. Objective: This study aimed to analyze disease-related Wikipedia pages written in English, German, and Russian using well-established readability metrics for each language. Methods: Wikipedia database snapshots and Wikidata metadata were chosen as resources for data collection. Disease-related articles were retrieved separately for English, German, and Russian starting with the main concept of Human Diseases and Disorders (German: Krankheit; Russian: Заболевания человека). In the case of existence, the corresponding International Classification of Diseases, Tenth Revision (ICD-10), codes were retrieved for each article. Next, the raw texts were extracted and readability metrics were computed. Results: The number of articles included in this study for English, German, and Russian Wikipedia was n=6127, n=6024, and n=3314, respectively. Most disease-related articles had a Flesch Reading Ease (FRE) score <50.00, signaling difficult or very difficult educational material (English: 5937/6125, 96.93%; German: 6004/6022, 99.7%; Russian: 2647/3313, 79.9%). In total, 70% (7/10) of the analyzed articles could be assigned an ICD-10 code with certainty (English: 4235/6127, 69.12%; German: 4625/6024, 76.78%; Russian: 2316/3314, 69.89%). For articles with ICD-10 codes, the mean FRE scores were 28.69 (SD 11.00), 20.33 (SD 9.98), and 38.54 (SD 13.51) for English, German, and Russian, respectively. A total of 9 English ICD-10 chapters (11 German and 10 Russian) showed significant differences: chapter F (FRE 23.88, SD 9.95; P<.001), chapter E (FRE 25.14, SD 9.88; P<.001), chapter H (FRE 30.04, SD 10.57; P=.049), chapter I (FRE 30.05, SD 9.07; P=.04), chapter M (FRE 31.17, 11.94; P<.001), chapter T (FRE 32.06, SD 10.51; P=.001), chapter A (FRE 32.63, SD 9.25; P<.001), chapter B (FRE 33.24, SD 9.07; P<.001), and chapter S (FRE 39.02, SD 8.22; P<.001). Conclusions: Disease-related English, German, and Russian Wikipedia articles cannot be recommended as patient education materials because a major fraction is difficult or very difficult to read. The authors of Wikipedia pages should carefully revise existing text materials for readers with a specific interest in a disease or its associated symptoms. Special attention should be given to articles on mental, behavioral, and neurodevelopmental disorders (ICD-10 chapter F) because these articles were most difficult to read in comparison with other ICD-10 chapters. Wikipedia readers should be supported by editors providing a short and easy-to-read summary for each article. %M 35576562 %R 10.2196/36835 %U https://www.jmir.org/2022/5/e36835 %U https://doi.org/10.2196/36835 %U http://www.ncbi.nlm.nih.gov/pubmed/35576562 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e31352 %T The Effectiveness of a Computer-Tailored Web-Based Physical Activity Intervention Using Fitbit Activity Trackers in Older Adults (Active for Life): Randomized Controlled Trial %A Alley,Stephanie J %A van Uffelen,Jannique %A Schoeppe,Stephanie %A Parkinson,Lynne %A Hunt,Susan %A Power,Deborah %A Waterman,Natasha %A Waterman,Courtney %A To,Quyen G %A Duncan,Mitch J %A Schneiders,Anthony %A Vandelanotte,Corneel %+ Physical Activity Research Group, Appleton Institute, Central Queensland University, Building 7, Bruce Hwy, Rockhampton, 4701, Australia, 61 749232263, s.alley@cqu.edu.au %K internet %K online %K activity trackers %K activity monitors %K wearables %K physical activity %K mobile phone %D 2022 %7 12.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical activity is an integral part of healthy aging; yet, most adults aged ≥65 years are not sufficiently active. Preliminary evidence suggests that web-based interventions with computer-tailored advice and Fitbit activity trackers may be well suited for older adults. Objective: The aim of this study was to examine the effectiveness of Active for Life, a 12-week web-based physical activity intervention with 6 web-based modules of computer-tailored advice to increase physical activity in older Australians. Methods: Participants were recruited both through the web and offline and were randomly assigned to 1 of 3 trial arms: tailoring+Fitbit, tailoring only, or a wait-list control. The computer-tailored advice was based on either participants’ Fitbit data (tailoring+Fitbit participants) or self-reported physical activity (tailoring-only participants). The main outcome was change in wrist-worn accelerometer (ActiGraph GT9X)–measured moderate to vigorous physical activity (MVPA) from baseline to after the intervention (week 12). The secondary outcomes were change in self-reported physical activity measured by means of the Active Australia Survey at the midintervention point (6 weeks), after the intervention (week 12), and at follow-up (week 24). Participants had a face-to-face meeting at baseline for a demonstration of the intervention and at baseline and week 12 to return the accelerometers. Generalized linear mixed model analyses were conducted with a γ distribution and log link to compare MVPA and self-reported physical activity changes over time within each trial arm and between each of the trial arms. Results: A total of 243 participants were randomly assigned to tailoring+Fitbit (n=78, 32.1%), tailoring only (n=96, 39.5%), and wait-list control (n=69, 28.4%). Attrition was 28.8% (70/243) at 6 weeks, 31.7% (77/243) at 12 weeks, and 35.4% (86/243) at 24 weeks. No significant overall time by group interaction was observed for MVPA (P=.05). There were no significant within-group changes for MVPA over time in the tailoring+Fitbit group (+3%, 95% CI –24% to 40%) or the tailoring-only group (–4%, 95% CI –24% to 30%); however, a significant decline was seen in the control group (–35%, 95% CI –52% to –11%). The tailoring+Fitbit group participants increased their MVPA 59% (95% CI 6%-138%) more than those in the control group. A significant time by group interaction was observed for self-reported physical activity (P=.02). All groups increased their self-reported physical activity from baseline to week 6, week 12, and week 24, and this increase was greater in the tailoring+Fitbit group than in the control group at 6 weeks (+61%, 95% CI 11%-133%). Conclusions: A computer-tailored physical activity intervention with Fitbit integration resulted in improved MVPA outcomes in comparison with a control group in older adults. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000646246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000646246 %M 35552166 %R 10.2196/31352 %U https://www.jmir.org/2022/5/e31352 %U https://doi.org/10.2196/31352 %U http://www.ncbi.nlm.nih.gov/pubmed/35552166 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e27694 %T The Accuracy of Artificial Intelligence in the Endoscopic Diagnosis of Early Gastric Cancer: Pooled Analysis Study %A Chen,Pei-Chin %A Lu,Yun-Ru %A Kang,Yi-No %A Chang,Chun-Chao %+ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, No 252, Wuxing St, Taipei, 110, Taiwan, 886 227372181, chunchao@tmu.edu.tw %K artificial intelligence %K early gastric cancer %K endoscopy %D 2022 %7 16.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) for gastric cancer diagnosis has been discussed in recent years. The role of AI in early gastric cancer is more important than in advanced gastric cancer since early gastric cancer is not easily identified in clinical practice. However, to our knowledge, past syntheses appear to have limited focus on the populations with early gastric cancer. Objective: The purpose of this study is to evaluate the diagnostic accuracy of AI in the diagnosis of early gastric cancer from endoscopic images. Methods: We conducted a systematic review from database inception to June 2020 of all studies assessing the performance of AI in the endoscopic diagnosis of early gastric cancer. Studies not concerning early gastric cancer were excluded. The outcome of interest was the diagnostic accuracy (comprising sensitivity, specificity, and accuracy) of AI systems. Study quality was assessed on the basis of the revised Quality Assessment of Diagnostic Accuracy Studies. Meta-analysis was primarily based on a bivariate mixed-effects model. A summary receiver operating curve and a hierarchical summary receiver operating curve were constructed, and the area under the curve was computed. Results: We analyzed 12 retrospective case control studies (n=11,685) in which AI identified early gastric cancer from endoscopic images. The pooled sensitivity and specificity of AI for early gastric cancer diagnosis were 0.86 (95% CI 0.75-0.92) and 0.90 (95% CI 0.84-0.93), respectively. The area under the curve was 0.94. Sensitivity analysis of studies using support vector machines and narrow-band imaging demonstrated more consistent results. Conclusions: For early gastric cancer, to our knowledge, this was the first synthesis study on the use of endoscopic images in AI in diagnosis. AI may support the diagnosis of early gastric cancer. However, the collocation of imaging techniques and optimal algorithms remain unclear. Competing models of AI for the diagnosis of early gastric cancer are worthy of future investigation. Trial Registration: PROSPERO CRD42020193223; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=193223 %M 35576561 %R 10.2196/27694 %U https://www.jmir.org/2022/5/e27694 %U https://doi.org/10.2196/27694 %U http://www.ncbi.nlm.nih.gov/pubmed/35576561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e33742 %T Impact of Hospital Characteristics and Governance Structure on the Adoption of Tracking Technologies for Clinical and Supply Chain Use: Longitudinal Study of US Hospitals %A Zhu,Xiao %A Tao,Youyou %A Zhu,Ruilin %A Wu,Dezhi %A Ming,Wai-kit %+ Management Science Department, Lancaster University Management School, Lancaster University, Bailrigg, Lancaster, LA1 4YX, United Kingdom, 44 1524592938, ruilin.zhu@lancaster.ac.uk %K radio frequency identification %K bar coding %K tracking technology adoption %K smart hospital %K hospital affiliation %K governance structure %K location %K clinical use %K supply chain use %D 2022 %7 26.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the increasing adoption rate of tracking technologies in hospitals in the United States, few empirical studies have examined the factors involved in such adoption within different use contexts (eg, clinical and supply chain use contexts). To date, no study has systematically examined how governance structures impact technology adoption in different use contexts in hospitals. Given that the hospital governance structure fundamentally governs health care workflows and operations, understanding its critical role provides a solid foundation from which to explore factors involved in the adoption of tracking technologies in hospitals. Objective: This study aims to compare critical factors associated with the adoption of tracking technologies for clinical and supply chain uses and examine how governance structure types affect the adoption of tracking technologies in hospitals. Methods: This study was conducted based on a comprehensive and longitudinal national census data set comprising 3623 unique hospitals across 50 states in the United States from 2012 to 2015. Using mixed effects population logistic regression models to account for the effects within and between hospitals, we captured and examined the effects of hospital characteristics, locations, and governance structure on adjustments to the innate development of tracking technology over time. Results: From 2012 to 2015, we discovered that the proportion of hospitals in which tracking technologies were fully implemented for clinical use increased from 36.34% (782/2152) to 54.63% (1316/2409), and that for supply chain use increased from 28.58% (615/2152) to 41.3% (995/2409). We also discovered that adoption factors impact the clinical and supply chain use contexts differently. In the clinical use context, compared with hospitals located in urban areas, hospitals in rural areas (odds ratio [OR] 0.68, 95% CI 0.56-0.80) are less likely to fully adopt tracking technologies. In the context of supply chain use, the type of governance structure influences tracking technology adoption. Compared with hospitals not affiliated with a health system, implementation rates increased as hospitals affiliated with a more centralized health system—1.9-fold increase (OR 1.87, 95% CI 1.60-2.13) for decentralized or independent hospitals, 2.4-fold increase (OR 2.40, 95% CI 2.07-2.80) for moderately centralized health systems, and 3.1-fold increase for centralized health systems (OR 3.07, 95% CI 2.67-3.53). Conclusions: As the first of such type of studies, we provided a longitudinal overview of how hospital characteristics and governance structure jointly affect adoption rates of tracking technology in both clinical and supply chain use contexts, which is essential for developing intelligent infrastructure for smart hospital systems. This study informs researchers, health care providers, and policy makers that hospital characteristics, locations, and governance structures have different impacts on the adoption of tracking technologies for clinical and supply chain use and on health resource disparities among hospitals of different sizes, locations, and governance structures. %M 35617002 %R 10.2196/33742 %U https://www.jmir.org/2022/5/e33742 %U https://doi.org/10.2196/33742 %U http://www.ncbi.nlm.nih.gov/pubmed/35617002 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34302 %T A Virtual Community of Practice to Support Physician Uptake of a Novel Abortion Practice: Mixed Methods Case Study %A Dunn,Sheila %A Munro,Sarah %A Devane,Courtney %A Guilbert,Edith %A Jeong,Dahn %A Stroulia,Eleni %A Soon,Judith A %A Norman,Wendy V %+ Department of Family and Community Medicine, University of Toronto, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400 ext 4977, sheila.dunn@wchospital.ca %K mifepristone %K abortion %K community of practice %K virtual community of practice %K diffusion of innovation %K learning community %D 2022 %7 5.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual communities of practice (VCoPs) have been used to support innovation and quality in clinical care. The drug mifepristone was introduced in Canada in 2017 for medical abortion. We created a VCoP to support implementation of mifepristone abortion practice across Canada. Objective: The aim of this study was to describe the development and use of the Canadian Abortion Providers Support-Communauté de pratique canadienne sur l’avortement (CAPS-CPCA) VCoP and explore physicians’ experience with CAPS-CPCA and their views on its value in supporting implementation. Methods: This was a mixed methods intrinsic case study of Canadian health care providers’ use and physicians’ perceptions of the CAPS-CPCA VCoP during the first 2 years of a novel practice. We sampled both physicians who joined the CAPS-CPCA VCoP and those who were interested in providing the novel practice but did not join the VCoP. We designed the VCoP features to address known and discovered barriers to implementation of medication abortion in primary care. Our secure web-based platform allowed asynchronous access to information, practice resources, clinical support, discussion forums, and email notices. We collected data from the platform and through surveys of physician members as well as interviews with physician members and nonmembers. We analyzed descriptive statistics for website metrics, physicians’ characteristics and practices, and their use of the VCoP. We used qualitative methods to explore the physicians’ experiences and perceptions of the VCoP. Results: From January 1, 2017, to June 30, 2019, a total of 430 physicians representing all provinces and territories in Canada joined the VCoP and 222 (51.6%) completed a baseline survey. Of these 222 respondents, 156 (70.3%) were family physicians, 170 (80.2%) were women, and 78 (35.1%) had no prior abortion experience. In a survey conducted 12 months after baseline, 77.9% (120/154) of the respondents stated that they had provided mifepristone abortion and 33.9% (43/127) said the VCoP had been important or very important. Logging in to the site was burdensome for some, but members valued downloadable resources such as patient information sheets, consent forms, and clinical checklists. They found email announcements helpful for keeping up to date with changing regulations. Few asked clinical questions to the VCoP experts, but physicians felt that this feature was important for isolated or rural providers. Information collected through member polls about health system barriers to implementation was used in the project’s knowledge translation activities with policy makers to mitigate these barriers. Conclusions: A VCoP developed to address known and discovered barriers to uptake of a novel medication abortion method engaged physicians from across Canada and supported some, including those with no prior abortion experience, to implement this practice. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028443 %M 35511226 %R 10.2196/34302 %U https://www.jmir.org/2022/5/e34302 %U https://doi.org/10.2196/34302 %U http://www.ncbi.nlm.nih.gov/pubmed/35511226 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e36086 %T Research on Digital Technology Use in Cardiology: Bibliometric Analysis %A Yeung,Andy Wai Kan %A Kulnik,Stefan Tino %A Parvanov,Emil D %A Fassl,Anna %A Eibensteiner,Fabian %A Völkl-Kernstock,Sabine %A Kletecka-Pulker,Maria %A Crutzen,Rik %A Gutenberg,Johanna %A Höppchen,Isabel %A Niebauer,Josef %A Smeddinck,Jan David %A Willschke,Harald %A Atanasov,Atanas G %+ Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23, Bauteil 86, 2 Stock, Vienna, 1090, Austria, 43 664 1929 85, atanas.atanasov@univie.ac.at %K cardiovascular %K heart %K hypertension %K atrial fibrillation %K cardiopulmonary resuscitation %K electrocardiography %K photoplethysmography %K wearable device, digital health, mHealth %K cardiology %K cardiac %K health application %D 2022 %7 11.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technology uses in cardiology have become a popular research focus in recent years. However, there has been no published bibliometric report that analyzed the corresponding academic literature in order to derive key publishing trends and characteristics of this scientific area. Objective: We used a bibliometric approach to identify and analyze the academic literature on digital technology uses in cardiology, and to unveil popular research topics, key authors, institutions, countries, and journals. We further captured the cardiovascular conditions and diagnostic tools most commonly investigated within this field. Methods: The Web of Science electronic database was queried to identify relevant papers on digital technology uses in cardiology. Publication and citation data were acquired directly from the database. Complete bibliographic data were exported to VOSviewer, a dedicated bibliometric software package, and related to the semantic content of titles, abstracts, and keywords. A term map was constructed for findings visualization. Results: The analysis was based on data from 12,529 papers. Of the top 5 most productive institutions, 4 were based in the United States. The United States was the most productive country (4224/12,529, 33.7%), followed by United Kingdom (1136/12,529, 9.1%), Germany (1067/12,529, 8.5%), China (682/12,529, 5.4%), and Italy (622/12,529, 5.0%). Cardiovascular diseases that had been frequently investigated included hypertension (152/12,529, 1.2%), atrial fibrillation (122/12,529, 1.0%), atherosclerosis (116/12,529, 0.9%), heart failure (106/12,529, 0.8%), and arterial stiffness (80/12,529, 0.6%). Recurring modalities were electrocardiography (170/12,529, 1.4%), angiography (127/12,529, 1.0%), echocardiography (127/12,529, 1.0%), digital subtraction angiography (111/12,529, 0.9%), and photoplethysmography (80/12,529, 0.6%). For a literature subset on smartphone apps and wearable devices, the Journal of Medical Internet Research (20/632, 3.2%) and other JMIR portfolio journals (51/632, 8.0%) were the major publishing venues. Conclusions: Digital technology uses in cardiology target physicians, patients, and the general public. Their functions range from assisting diagnosis, recording cardiovascular parameters, and patient education, to teaching laypersons about cardiopulmonary resuscitation. This field already has had a great impact in health care, and we anticipate continued growth. %M 35544307 %R 10.2196/36086 %U https://www.jmir.org/2022/5/e36086 %U https://doi.org/10.2196/36086 %U http://www.ncbi.nlm.nih.gov/pubmed/35544307 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e31401 %T Effect of a Popular Web Drama Video Series on HIV and Other Sexually Transmitted Infection Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men in Singapore: Community-Based, Pragmatic, Randomized Controlled Trial %A Tan,Rayner Kay Jin %A Koh,Wee Ling %A Le,Daniel %A Banerjee,Sumita %A Chio,Martin Tze-Wei %A Chan,Roy Kum Wah %A Wong,Christina Misa %A Tai,Bee Choo %A Wong,Mee Lian %A Cook,Alex R %A Chen,Mark I-Cheng %A Wong,Chen Seong %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, 117549, Singapore, 65 91878576, rayner.tan@u.nus.edu %K HIV %K STI %K testing %K health promotion %K eHealth %K mHealth %D 2022 %7 6.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Gay, bisexual, and other men who have sex with men (GBMSM) are at disproportionately higher risk of acquiring HIV and other sexually transmitted infections (STI). While HIV/STI testing rates among GBMSM are increasing worldwide, they remain suboptimal in a variety of settings. While many studies have attempted to evaluate the efficacy of a variety of community-based campaigns, including peer and reminder-based interventions on HIV/STI testing, however few have attempted to do so for a web drama series. Objective: This study evaluates the effectiveness of a popular web drama video series developed by a community-based organization in Singapore for GBMSM on HIV and other STI testing behaviors. Methods: The study is a pragmatic, randomized controlled trial to evaluate a popular web drama video series developed by a community-based organization in Singapore for GBMSM. A total of 300 HIV-negative, GBMSM men in Singapore aged 18 to 29 years old were recruited and block-randomized into the intervention (n=150) and control arms (n=150). Primary outcomes included changes in self-reported intention to test for, actual testing for, and regularity of testing for HIV, syphilis, chlamydia or gonorrhea, while secondary outcomes include changes in a variety of other knowledge-based and psychosocial measures at the end of the study period. Results: Overall, 83.3% (125/150) of participants in the intervention arm completed the proof of completion survey, compared to 88.7% (133/150) in the control arm. We found improvements in self-reporting as a regular (at least yearly) tester for HIV (15.9% difference, 95% CI, 3.2% to 28.6%; P=.02), as well as chlamydia or gonorrhea (15.5% difference, 95% CI, 4.2% to 26.9%; P=.009), indicating that the intervention had positively impacted these outcomes compared to the control condition. We also found improvements in participants’ intentions to test for HIV (16.6% difference, 95% CI, 4.3% to 28.9%; P=.009), syphilis (14.8% difference, 95% CI, 3.2% to 26.4%; P=.01), as well as chlamydia or gonorrhea (15.4% difference, 95% CI, 4.2% to 26.6%; P=.008), in the next 3 months, indicating that the intervention was effective in positively impacting intention for HIV and other STI testing among participants. Conclusions: There are clear benefits for promoting intentions to test regularly and prospectively on a broad scale through this intervention. This intervention also has potential to reach GBMSM who may not have access to conventional HIV and other STI prevention messaging, which have typically been implemented at sex-on-premises venues, bars, clubs, and in sexual health settings frequented by GBMSM. When coupled with community or population-wide structural interventions, the overall impact on testing will likely be significant. Trial Registration: ClinicalTrials.gov NCT04021953; https://clinicaltrials.gov/ct2/show/NCT04021953 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-033855 %M 35522470 %R 10.2196/31401 %U https://www.jmir.org/2022/5/e31401 %U https://doi.org/10.2196/31401 %U http://www.ncbi.nlm.nih.gov/pubmed/35522470 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37480 %T Durability of the Treatment Effects of an 8-Week Self-administered Home-Based Virtual Reality Program for Chronic Low Back Pain: 6-Month Follow-up Study of a Randomized Clinical Trial %A Garcia,Laura %A Birckhead,Brandon %A Krishnamurthy,Parthasarathy %A Mackey,Ian %A Sackman,Josh %A Salmasi,Vafi %A Louis,Robert %A Castro,Carina %A Maddox,Roselani %A Maddox,Todd %A Darnall,Beth D %+ AppliedVR, 16760 Stagg St, Suite 216, Van Nuys, CA, 91406, United States, 1 5129478494, tmaddox@appliedvr.io %K behavioral health %K chronic low back pain %K treatment %K virtual reality %D 2022 %7 25.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: We previously reported the efficacy of an 8-week home-based therapeutic immersive virtual reality (VR) program in a double-blind randomized placebo-controlled study. Community-based adults with self-reported chronic low back pain were randomized 1:1 to receive either (1) a 56-day immersive therapeutic pain relief skills VR program (EaseVRx) or (2) a 56-day sham VR program. Immediate posttreatment results revealed the superiority of therapeutic VR over sham VR for reducing pain intensity; pain-related interference with activity, mood, and stress (but not sleep); physical function; and sleep disturbance. At 3 months posttreatment, therapeutic VR maintained superiority for reducing pain intensity and pain-related interference with activity, stress, and sleep (new finding). Objective: This study assessed between-group and within-group treatment effects 6 months posttreatment to determine the extended efficacy, magnitude of efficacy, and clinical importance of home-based therapeutic VR. Methods: E-surveys were deployed at pretreatment, end-of-treatment, and posttreatment months 1, 2, 3, and 6. Self-reported data for 188 participants were analyzed in a mixed-model framework using a marginal model to allow for correlated responses across the repeated measures. Primary outcomes were pain intensity and pain-related interference with activity, mood, stress, and sleep at 6 months posttreatment. Secondary outcomes were Patient-Reported Outcome Measurement Information System (PROMIS) sleep disturbance and physical function. Results: Therapeutic VR maintained significant and clinically meaningful effects 6 months posttreatment and remained superior to sham VR for reducing pain intensity and pain-related interference with activity, stress, and sleep (ds=0.44-0.54; P<.003). Between-group comparisons for physical function and sleep disturbance showed superiority of EaseVRx over sham VR (ds=0.34; P=.02 and ds=0.46; P<.001, respectively). Participants were encouraged to contact study staff with any problems experienced during treatment; however, no participants contacted study staff to report adverse events of any type, including nausea and motion sickness. Conclusions: Our 8-week home-based VR pain management program caused important reductions in pain intensity and interference up to 6 months after treatment. Additional studies are needed in diverse samples. Trial Registration: ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177 International Registered Report Identifier (IRRID): RR2-10.2196/25291 %M 35612905 %R 10.2196/37480 %U https://www.jmir.org/2022/5/e37480 %U https://doi.org/10.2196/37480 %U http://www.ncbi.nlm.nih.gov/pubmed/35612905 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34276 %T Application of Nonfungible Tokens to Health Care. Comment on “Blockchain Technology Projects to Provide Telemedical Services: Systematic Review” %A Gambril,John %A Boyd,Carter %A Egbaria,Jamal %+ Department of Internal Medicine, Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, United States, 1 614 293 8000, alangambril@gmail.com %K telemedicine %K distributed ledger %K health information exchange %K blockchain %K cryptocurrency %K nonfungible token %K non-fungible token %K medical education %K internet %K finance %D 2022 %7 30.5.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 35635749 %R 10.2196/34276 %U https://www.jmir.org/2022/5/e34276 %U https://doi.org/10.2196/34276 %U http://www.ncbi.nlm.nih.gov/pubmed/35635749 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34437 %T Research Using Social Media to Recruit Research Participants Should Proceed With Caution. Comment on “Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial” %A Chen,Chih-Wei %A Wei,James Cheng-Chung %+ Institute of Medicine, Chung Shan Medical University, No 110, Sec 1, Jianguo N Rd, South District, Taichung, 40201, Taiwan, 886 4 24739595, jccwei@gmail.com %K telemedicine %K oxygen therapy %K noninvasive positive airway pressure %K BiPAP %K osteopathic medicine %K physical therapy %K SARS-CoV-2 %K COVID-19 %K teletherapy %K telemanagement %D 2022 %7 2.5.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 35476637 %R 10.2196/34437 %U https://www.jmir.org/2022/5/e34437 %U https://doi.org/10.2196/34437 %U http://www.ncbi.nlm.nih.gov/pubmed/35476637 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37413 %T Authors Reply to: Research Using Social Media to Recruit Research Participants Should Proceed With Caution. Comment on “Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial” %A Adly,Aya Sedky %A Adly,Mahmoud Sedky %A Adly,Afnan Sedky %+ Faculty of Engineering and Technology, Badr University in Cairo (BUC), Cairo Suez Road, Badr City, Cairo, 11511, Egypt, 20 1145559778, aya.sedky@gmail.com %K telemedicine %K oxygen therapy %K noninvasive positive airway pressure %K BiPAP %K osteopathic medicine %K physical therapy %K SARS-CoV-2 %K COVID-19 %K teletherapy %K telemanagement %D 2022 %7 2.5.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 35476751 %R 10.2196/37413 %U https://www.jmir.org/2022/5/e37413 %U https://doi.org/10.2196/37413 %U http://www.ncbi.nlm.nih.gov/pubmed/35476751 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e36396 %T Learning More About the Effects of Gamification on Physical Activity. Comment on “Evaluating the Effectiveness of Gamification on Physical Activity: Systematic Review and Meta-analysis of Randomized Controlled Trials” %A Hung,Cheng-Hsien %A Kao,Yung-Shuo %+ Department of Pharmacy, Chang Bing Show Chwan Memorial Hospital, No 6, Lugong Rd, Lukang Township, Changhua County, 50544, Taiwan, 886 4 7813888 ext 71255, chenghsien823@gmail.com %K behavior change %K eHealth %K gamification %K health behavior %K intervention %K meta-analysis %K mobile phone %K physical activity %K systematic review %K elderly %K old adults %D 2022 %7 3.5.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 35503654 %R 10.2196/36396 %U https://www.jmir.org/2022/5/e36396 %U https://doi.org/10.2196/36396 %U http://www.ncbi.nlm.nih.gov/pubmed/35503654 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e38212 %T Authors’ Reply to: Learning More About the Effects of Gamification on Physical Activity. Comment on “Evaluating the Effectiveness of Gamification on Physical Activity: Systematic Review and Meta-analysis of Randomized Controlled Trials” %A Mazeas,Alexandre %A Duclos,Martine %A Pereira,Bruno %A Chalabaev,Aïna %+ Univ Grenoble Alpes, SENS, 1741 rue de la Piscine, 38000 Grenoble, France, 33 476635081, alexandre.mazeas@univ-grenoble-alpes.fr %K behavior change %K eHealth %K gamification %K health behavior %K intervention %K meta-analysis %K mobile phone %K physical activity %K systematic review %K elderly %K old adults %D 2022 %7 3.5.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 35503414 %R 10.2196/38212 %U https://www.jmir.org/2022/5/e38212 %U https://doi.org/10.2196/38212 %U http://www.ncbi.nlm.nih.gov/pubmed/35503414 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e39712 %T Correction: Tracking Healthy People 2020 Internet, Broadband, and Mobile Device Access Goals: An Update Using Data From the Health Information National Trends Survey %A Greenberg-Worisek,Alexandra J %A Kurani,Shaheen %A Finney Rutten,Lila J %A Blake,Kelly D %A Moser,Richard P %A Hesse,Bradford W %+ Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55906, United States, 1 507 538 7388, worisek.alexandra@gmail.com %D 2022 %7 26.5.2022 %9 Corrigenda and Addenda %J J Med Internet Res %G English %X %M 35617681 %R 10.2196/39712 %U https://www.jmir.org/2022/5/e39712 %U https://doi.org/10.2196/39712 %U http://www.ncbi.nlm.nih.gov/pubmed/35617681 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e35115 %T Monitoring User Opinions and Side Effects on COVID-19 Vaccines in the Twittersphere: Infodemiology Study of Tweets %A Portelli,Beatrice %A Scaboro,Simone %A Tonino,Roberto %A Chersoni,Emmanuele %A Santus,Enrico %A Serra,Giuseppe %+ Department of Mathematics, Computer Science and Physics, University of Udine, 206 via delle Scienze, Udine, 33100, Italy, 39 0432558400, portelli.beatrice@spes.uniud.it %K adverse drug events %K COVID-19 %K digital pharmacovigilance %K opinion mining %K vaccines %K social media %K machine learning %K deep learning %K learning models %K sentiment analysis %K Twitter analysis %K Twitter %K web portal %K public health %D 2022 %7 13.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In the current phase of the COVID-19 pandemic, we are witnessing the most massive vaccine rollout in human history. Like any other drug, vaccines may cause unexpected side effects, which need to be investigated in a timely manner to minimize harm in the population. If not properly dealt with, side effects may also impact public trust in the vaccination campaigns carried out by national governments. Objective: Monitoring social media for the early identification of side effects, and understanding the public opinion on the vaccines are of paramount importance to ensure a successful and harmless rollout. The objective of this study was to create a web portal to monitor the opinion of social media users on COVID-19 vaccines, which can offer a tool for journalists, scientists, and users alike to visualize how the general public is reacting to the vaccination campaign. Methods: We developed a tool to analyze the public opinion on COVID-19 vaccines from Twitter, exploiting, among other techniques, a state-of-the-art system for the identification of adverse drug events on social media; natural language processing models for sentiment analysis; statistical tools; and open-source databases to visualize the trending hashtags, news articles, and their factuality. All modules of the system are displayed through an open web portal. Results: A set of 650,000 tweets was collected and analyzed in an ongoing process that was initiated in December 2020. The results of the analysis are made public on a web portal (updated daily), together with the processing tools and data. The data provide insights on public opinion about the vaccines and its change over time. For example, users show a high tendency to only share news from reliable sources when discussing COVID-19 vaccines (98% of the shared URLs). The general sentiment of Twitter users toward the vaccines is negative/neutral; however, the system is able to record fluctuations in the attitude toward specific vaccines in correspondence with specific events (eg, news about new outbreaks). The data also show how news coverage had a high impact on the set of discussed topics. To further investigate this point, we performed a more in-depth analysis of the data regarding the AstraZeneca vaccine. We observed how media coverage of blood clot–related side effects suddenly shifted the topic of public discussions regarding both the AstraZeneca and other vaccines. This became particularly evident when visualizing the most frequently discussed symptoms for the vaccines and comparing them month by month. Conclusions: We present a tool connected with a web portal to monitor and display some key aspects of the public’s reaction to COVID-19 vaccines. The system also provides an overview of the opinions of the Twittersphere through graphic representations, offering a tool for the extraction of suspected adverse events from tweets with a deep learning model. %M 35446781 %R 10.2196/35115 %U https://www.jmir.org/2022/5/e35115 %U https://doi.org/10.2196/35115 %U http://www.ncbi.nlm.nih.gov/pubmed/35446781 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e36114 %T Multimodal Chronic Pain Therapy for Adults via Smartphone: Randomized Controlled Clinical Trial %A Morcillo-Muñoz,Yolanda %A Sánchez-Guarnido,Antonio José %A Calzón-Fernández,Silvia %A Baena-Parejo,Isabel %+ Primary Care, Andalusian Health Service, Plaza de la Mujer s/n, District Campo de Gibraltar, Algeciras, 11207, Spain, 34 670946860, ymmcadiz1969@gmail.com %K chronic pain %K eHealth %K multimodal intervention %K catastrophizing %K self-management %K mHealth %K mobile phone %K randomized controlled trials %D 2022 %7 11.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Combination therapies delivered remotely via the internet or mobile devices are increasingly being used to improve and promote the self-management of chronic conditions. However, little is known regarding the long-term effects of these interventions. Objective: The aim of this study is to evaluate the effectiveness of a multimodal intervention program that measures associated variables such as catastrophizing, pain acceptance, and quality of life using a mobile device in people with chronic pain in an outpatient setting. Methods: A randomized controlled clinical trial was performed using parallel treatment groups. A total of 209 patients with chronic musculoskeletal pain were randomly assigned to one of the two study arms. The intervention group received a standard web-based psychosocial therapy-type program of activities through a smartphone for 6 weeks. The control group only had access to the Find out more section of the app, which contained audiovisual material for pain management based on a self-help approach. The primary outcome was catastrophizing measured using the Pain Catastrophizing Scale (PCS). Secondary outcomes were pain acceptance measured using the Chronic Pain Acceptance Questionnaire and health-related quality of life measured using the EuroQol Visual Analogue Scale. Assessments were conducted at baseline (T1), after treatment (T2), and at the 3-month follow-up (T3). The variations between the different phases were assessed using the percentage change rescaled with log base 2. The Cohen d was calculated based on the results of the linear mixed model. The investigators of the study who evaluated the results were not involved in patient recruitment and were blinded to the group assignment. Results: Positive effects were found in the intervention group (T2–T1) in catastrophizing between the baseline and posttreatment phases (P<.001) and in helplessness (−0.72 vs 0.1; P=.002), rumination (−1.59 vs −0.53; P<.001), acceptance (0.38 vs 0.05; P=.001), and quality of life (0.43 vs −0.01; P=.002), although no significant changes were found for magnification (0.2 vs 0.77; P=.14) and satisfaction with health (0.25 vs −0.27; P=.13). Three months after treatment, significant differences were observed in the intervention group for the outcome variable of catastrophizing (PCS; −0.59 vs 0.2; P=.006) and the PCS subscales of helplessness (−0.65 vs 0.01; P=.07), rumination (1.23 vs −0.59; P=.04), and magnification (0.1 vs 0.86; P=.02). Conclusions: The results of our study suggest that app-based mobile multidimensional treatments for adults with chronic pain improve catastrophizing, quality of life, and psychological flexibility immediately after treatment and that the effects are maintained for the primary outcome of catastrophizing for at least 3 months following treatment. Moreover, they promote self-management and can be used to complement face-to-face pain treatments. Trial Registration: ClinicalTrials.gov NCT04509154; https://clinicaltrials.gov/ct2/show/NCT04509154 %M 35373 %R 10.2196/36114 %U https://www.jmir.org/2022/5/e36114 %U https://doi.org/10.2196/36114 %U http://www.ncbi.nlm.nih.gov/pubmed/35373 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e31810 %T Triage Accuracy of Symptom Checker Apps: 5-Year Follow-up Evaluation %A Schmieding,Malte L %A Kopka,Marvin %A Schmidt,Konrad %A Schulz-Niethammer,Sven %A Balzer,Felix %A Feufel,Markus A %+ Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30450 570425, malte.schmieding@charite.de %K digital health %K triage %K symptom checker %K patient-centered care %K eHealth apps %K mobile phone %D 2022 %7 10.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Symptom checkers are digital tools assisting laypersons in self-assessing the urgency and potential causes of their medical complaints. They are widely used but face concerns from both patients and health care professionals, especially regarding their accuracy. A 2015 landmark study substantiated these concerns using case vignettes to demonstrate that symptom checkers commonly err in their triage assessment. Objective: This study aims to revisit the landmark index study to investigate whether and how symptom checkers’ capabilities have evolved since 2015 and how they currently compare with laypersons’ stand-alone triage appraisal. Methods: In early 2020, we searched for smartphone and web-based applications providing triage advice. We evaluated these apps on the same 45 case vignettes as the index study. Using descriptive statistics, we compared our findings with those of the index study and with publicly available data on laypersons’ triage capability. Results: We retrieved 22 symptom checkers providing triage advice. The median triage accuracy in 2020 (55.8%, IQR 15.1%) was close to that in 2015 (59.1%, IQR 15.5%). The apps in 2020 were less risk averse (odds 1.11:1, the ratio of overtriage errors to undertriage errors) than those in 2015 (odds 2.82:1), missing >40% of emergencies. Few apps outperformed laypersons in either deciding whether emergency care was required or whether self-care was sufficient. No apps outperformed the laypersons on both decisions. Conclusions: Triage performance of symptom checkers has, on average, not improved over the course of 5 years. It decreased in 2 use cases (advice on when emergency care is required and when no health care is needed for the moment). However, triage capability varies widely within the sample of symptom checkers. Whether it is beneficial to seek advice from symptom checkers depends on the app chosen and on the specific question to be answered. Future research should develop resources (eg, case vignette repositories) to audit the capabilities of symptom checkers continuously and independently and provide guidance on when and to whom they should be recommended. %M 35536633 %R 10.2196/31810 %U https://www.jmir.org/2022/5/e31810 %U https://doi.org/10.2196/31810 %U http://www.ncbi.nlm.nih.gov/pubmed/35536633