TY - JOUR AU - McCabe, Catherine AU - Connolly, Leona AU - Quintana, Yuri AU - Weir, Arielle AU - Moen, Anne AU - Ingvar, Martin AU - McCann, Margaret AU - Doyle, Carmel AU - Hughes, Mary AU - Brenner, Maria PY - 2025/4/16 TI - How to Refine and Prioritize Key Performance Indicators for Digital Health Interventions: Tutorial on Using Consensus Methodology to Enable Meaningful Evaluation of Novel Digital Health Interventions JO - J Med Internet Res SP - e68757 VL - 27 KW - digital health interventions KW - key performance indicators KW - Delphi technique KW - consensus methodology KW - drug-related side effects and adverse reactions KW - referral KW - consultation UR - https://www.jmir.org/2025/1/e68757 UR - http://dx.doi.org/10.2196/68757 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68757 ER - TY - JOUR AU - Yang, Hao AU - Li, Jiaxi AU - Zhang, Chi AU - Sierra, Pazos Alejandro AU - Shen, Bairong PY - 2025/3/27 TI - Large Language Model?Driven Knowledge Graph Construction in Sepsis Care Using Multicenter Clinical Databases: Development and Usability Study JO - J Med Internet Res SP - e65537 VL - 27 KW - sepsis KW - knowledge graph KW - large language models KW - prompt engineering KW - real-world KW - GPT-4.0 N2 - Background: Sepsis is a complex, life-threatening condition characterized by significant heterogeneity and vast amounts of unstructured data, posing substantial challenges for traditional knowledge graph construction methods. The integration of large language models (LLMs) with real-world data offers a promising avenue to address these challenges and enhance the understanding and management of sepsis. Objective: This study aims to develop a comprehensive sepsis knowledge graph by leveraging the capabilities of LLMs, specifically GPT-4.0, in conjunction with multicenter clinical databases. The goal is to improve the understanding of sepsis and provide actionable insights for clinical decision-making. We also established a multicenter sepsis database (MSD) to support this effort. Methods: We collected clinical guidelines, public databases, and real-world data from 3 major hospitals in Western China, encompassing 10,544 patients diagnosed with sepsis. Using GPT-4.0, we used advanced prompt engineering techniques for entity recognition and relationship extraction, which facilitated the construction of a nuanced sepsis knowledge graph. Results: We established a sepsis database with 10,544 patient records, including 8497 from West China Hospital, 690 from Shangjin Hospital, and 357 from Tianfu Hospital. The sepsis knowledge graph comprises of 1894 nodes and 2021 distinct relationships, encompassing nine entity concepts (diseases, symptoms, biomarkers, imaging examinations, etc) and 8 semantic relationships (complications, recommended medications, laboratory tests, etc). GPT-4.0 demonstrated superior performance in entity recognition and relationship extraction, achieving an F1-score of 76.76 on a sepsis-specific dataset, outperforming other models such as Qwen2 (43.77) and Llama3 (48.39). On the CMeEE dataset, GPT-4.0 achieved an F1-score of 65.42 using few-shot learning, surpassing traditional models such as BERT-CRF (62.11) and Med-BERT (60.66). Building upon this, we compiled a comprehensive sepsis knowledge graph, comprising of 1894 nodes and 2021 distinct relationships. Conclusions: This study represents a pioneering effort in using LLMs, particularly GPT-4.0, to construct a comprehensive sepsis knowledge graph. The innovative application of prompt engineering, combined with the integration of multicenter real-world data, has significantly enhanced the efficiency and accuracy of knowledge graph construction. The resulting knowledge graph provides a robust framework for understanding sepsis, supporting clinical decision-making, and facilitating further research. The success of this approach underscores the potential of LLMs in medical research and sets a new benchmark for future studies in sepsis and other complex medical conditions. UR - https://www.jmir.org/2025/1/e65537 UR - http://dx.doi.org/10.2196/65537 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65537 ER - TY - JOUR AU - Brotto, A. Lori AU - Stephenson, R. Kyle AU - Marshall, Nisha AU - Balvan, Mariia AU - Okara, Yaroslava AU - Mahar, A. Elizabeth PY - 2025/3/25 TI - Evaluating a Digital Health Tool Designed to Improve Low Sexual Desire in Women: Mixed-Methods Implementation Science Study JO - J Med Internet Res SP - e69828 VL - 27 KW - implementation science KW - sexual interest/arousal disorder (SIAD) KW - sexuality KW - internet interventions KW - online therapy KW - telehealth KW - online interventions KW - web-based therapeutic programs/interventions KW - online CBT/MBT treatment KW - female sexual dysfunction KW - eHealth N2 - Background: Sexual health difficulties affect up to 30% of women, with desire and arousal problems being the most prevalent. While cognitive behavioral therapy and mindfulness-based therapy are effective treatments, access is limited by barriers such as specialist shortages, cost, and embarrassment. Web-based interventions offer a potential solution by providing self-paced, cost-effective treatments. eSense, a digital health program, offers cognitive behavioral therapy and mindfulness-based therapy skills targeted to women with low sexual desire, and previous trials find eSense to be highly feasible and efficacious. Objective: The goal of the present implementation science study was to use the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance of Implementation) framework to assess the integration of eSense into several sexual health clinics. We chose the RE-AIM framework because it addresses both dissemination (eg, reach) and implementation of an intervention. Methods: A total of 14 specialty clinics participated, and we report on the reported experiences of those clinics in implementing eSense. We also examined responses from 12 women on waitlists to receive sex therapy or sexual medicine care. Results: Per clinic outcomes, all aspects of implementation (reach, effectiveness, adoption, implementation, and maintenance) were in the moderate to high range for clinics, reporting that offering eSense helped them overcome negative feelings associated with their long clinic waitlists. The majority expressed a need for eSense and could see how it overcame the limitations of traditional therapy. Nearly all expressed a wish to continue offering eSense to patients after the implementation study was complete. One caveat was that half of the clinics noted cost as a key issue for future implementation, and one-third noted that the administrative burden of implementing eSense as a standard of care may be challenging. For individual users, the majority expressed an interest in knowing more about eSense and a desire to use eSense, though most of these did not complete the program in its entirety. Users experienced a significant improvement in sex-related distress with no clinically meaningful change in other outcomes and a high level of satisfaction with eSense. Most also reported doing things differently in their sexual lives after participating in eSense. Conclusions: We found that eSense demonstrates potential as a digital intervention for sexual difficulties for women, particularly concerning its moderate implementation outcomes and also because of its ability to reduce sexual distress. Future studies should address the barriers identified for broader adoption of eSense in clinical settings. Trial Registration: ClinicalTrials.gov NCT05168371; https://clinicaltrials.gov/study/NCT05168371 UR - https://www.jmir.org/2025/1/e69828 UR - http://dx.doi.org/10.2196/69828 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69828 ER - TY - JOUR AU - John, N. Jennifer AU - Gorman, Sara AU - Scales, David PY - 2025/3/24 TI - Understanding Interventions to Address Infodemics Through Epidemiological, Socioecological, and Environmental Health Models: Framework Analysis JO - JMIR Infodemiology SP - e67119 VL - 5 KW - infodemics KW - misinformation KW - disinformation KW - Covid-19 KW - infodemic management KW - health communication KW - pandemic preparedness N2 - Background: The COVID-19 pandemic was accompanied by a barrage of false, misleading, and manipulated information that inhibited effective pandemic response and led to thousands of preventable deaths. Recognition of the urgent public health threat posed by this infodemic led to the development of numerous infodemic management interventions by a wide range of actors. The need to respond rapidly and with limited information sometimes came at the expense of strategy and conceptual rigor. Given limited funding for public health communication and growing politicization of countermisinformation efforts, responses to future infodemics should be informed by a systematic and conceptually grounded evaluation of the successes and shortcomings of existing interventions to ensure credibility of the field and evidence-based action. Objectives: This study sought to identify gaps and opportunities in existing infodemic management interventions and to assess the use of public health frameworks to structure responses to infodemics. Methods: We expanded a previously developed dataset of infodemic management interventions, spanning guidelines, policies, and tools from governments, academic institutions, nonprofits, media companies, and other organizations, with 379 interventions included in total. We applied framework analysis to describe and interpret patterns within these interventions through their alignment with codes derived from 3 frameworks selected for their prominence in public health and infodemic-related scholarly discourse: the epidemiological model, the socioecological model, and the environmental health framework. Results: The epidemiological model revealed the need for rigorous, transparent risk assessments to triage misinformation. The socioecological model demonstrated an opportunity for greater coordination across levels of influence, with only 11% of interventions receiving multiple socioecological codes, and more robust partnerships with existing organizations. The environmental health framework showed that sustained approaches that comprehensively address all influences on the information environment are needed, representing only 19% of the dataset. Conclusions: Responses to future infodemics would benefit from cross-sector coordination, adoption of measurable and meaningful goals, and alignment with public health frameworks, which provide critical conceptual grounding for infodemic response approaches and ensure comprehensiveness of approach. Beyond individual interventions, a funded coordination mechanism can provide overarching strategic direction and promote collaboration. UR - https://infodemiology.jmir.org/2025/1/e67119 UR - http://dx.doi.org/10.2196/67119 ID - info:doi/10.2196/67119 ER - TY - JOUR AU - Maru, Shoko AU - Kuwatsuru, Ryohei AU - Matthias, D. Michael AU - Simpson Jr, J. Ross PY - 2025/3/21 TI - Public Disclosure of Results From Artificial Intelligence/Machine Learning Research in Health Care: Comprehensive Analysis of ClinicalTrials.gov, PubMed, and Scopus Data (2010-2023) JO - J Med Internet Res SP - e60148 VL - 27 KW - machine learning KW - ML KW - artificial intelligence KW - AI KW - algorithm KW - model KW - analytics KW - deep learning KW - health care KW - health disparities KW - disparity KW - social disparity KW - social inequality KW - social inequity KW - data-source disparities KW - ClinicalTrials.gov KW - clinical trial KW - database KW - PubMed KW - Scopus KW - public disclosure of results KW - public disclosure KW - dissemination N2 - Background: Despite the rapid growth of research in artificial intelligence/machine learning (AI/ML), little is known about how often study results are disclosed years after study completion. Objective: We aimed to estimate the proportion of AI/ML research that reported results through ClinicalTrials.gov or peer-reviewed publications indexed in PubMed or Scopus. Methods: Using data from the Clinical Trials Transformation Initiative Aggregate Analysis of ClinicalTrials.gov, we identified studies initiated and completed between January 2010 and December 2023 that contained AI/ML-specific terms in the official title, brief summary, interventions, conditions, detailed descriptions, primary outcomes, or keywords. For 842 completed studies, we searched PubMed and Scopus for publications containing study identifiers and AI/ML-specific terms in relevant fields, such as the title, abstract, and keywords. We calculated disclosure rates within 3 years of study completion and median times to disclosure?from the ?primary completion date? to the ?results first posted date? on ClinicalTrials.gov or the earliest date of journal publication. Results: Of 842 completed studies (n=357 interventional; n=485 observational), 5.5% (46/842) disclosed results on ClinicalTrials.gov, 13.9% (117/842) in journal publications, and 17.7% (149/842) through either route within 3 years of completion. Higher disclosure rates were observed for trials: 10.4% (37/357) on ClinicalTrials.gov, 19.3% (69/357) in journal publications, and 26.1% (93/357) through either route. Randomized controlled trials had even higher disclosure rates: 11.3% (23/203) on ClinicalTrials.gov, 24.6% (50/203) in journal publications, and 32% (65/203) through either route. Nevertheless, most study findings (82.3%; 693/842) remained undisclosed 3 years after study completion. Trials using randomization (vs nonrandomized) or masking (vs open label) had higher disclosure rates and shorter times to disclosure. Most trials (85%; 305/357) had sample sizes of ?1000, yet larger trials (n>1000) had higher publication rates (30.8%; 16/52) than smaller trials (n?1000) (17.4%; 53/305). Hospitals (12.4%; 42/340), academia (15.1%; 39/259), and industry (13.7%; 20/146) published the most. High-income countries accounted for 82.4% (89/108) of all published studies. Of studies with disclosed results, the median times to report through ClinicalTrials.gov and in journal publications were 505 days (IQR 399-676) and 407 days (IQR 257-674), respectively. Open-label trials were common (60%; 214/357). Single-center designs were prevalent in both trials (83.3%; 290/348) and observational studies (82.3%; 377/458). Conclusions: For over 80% of AI/ML studies completed during 2010-2023, study findings remained undisclosed even 3 years after study completion, raising questions about the representativeness of publicly available evidence. While methodological rigor was generally associated with higher publication rates, the predominance of single-center designs and high-income countries may limit the generalizability of the results currently accessible. UR - https://www.jmir.org/2025/1/e60148 UR - http://dx.doi.org/10.2196/60148 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60148 ER - TY - JOUR AU - Sood, Avi Varinn AU - Rishel Brakey, Heidi AU - Myers, Orrin AU - Shore, Xin AU - Sood, Akshay PY - 2025/3/13 TI - Interprofessional Discussion for Knowledge Transfer in a Digital ?Community of Practice? for Managing Pneumoconiosis: Mixed Methods Study JO - JMIR Form Res SP - e67999 VL - 9 KW - digital community of practice KW - knowledge transfer KW - pneumoconiosis KW - telementoring KW - rural health care KW - rural professionals KW - multidisciplinary management KW - interprofessional discussion KW - miner health KW - health equity KW - mixed methods KW - digital health KW - public health KW - digital community KW - self-efficacy KW - quantitative analyses KW - quantitative KW - technology KW - multidisciplinary care KW - patient outcome N2 - Background: Pneumoconiosis prevalence is increasing in the United States, especially among coal miners. Contemporaneously with an increased need for specialized multidisciplinary care for miners, there is a shortage of experts to fulfill this need. Miners? Wellness ECHO (Extension for Community Health Outcomes) is a digital community of practice based on interprofessional discussion for knowledge transfer. The program has been demonstrated to increase participants? self-efficacy for clinical, medicolegal, and ?soft? skills related to miners? health. Objective: We aimed to examine characteristics associated with interprofessional discussions and suggest ways to strengthen knowledge transfer. Methods: This mixed methods study used an exploratory sequential design. We video-recorded and transcribed ECHO sessions over 14 months from July 2018 to September 2019 and analyzed content to examine participant discussions. We focused on participants? statements of expertise followed by other participants? acceptance or eschewal of these statements (utterances). We conducted quantitative analyses to examine the associations of active participation in discussion (primary outcome variable, defined as any utterance). We analyzed the association of the outcome on the following predictors: (1) participant group status, (2) study time frame, (3) participant ECHO experience status, (4) concordance of participant group identity between presenter and participant, (5) video usage, and (6) attendance frequency. We used the generalized estimating equations approach for longitudinal data, logit link function for binary outcomes, and LSMEANS to examine least squares means of fixed effects. Results: We studied 23 sessions with 158 unique participants and 539 total participants, averaging 23.4 (SD 5.6) participants per session. Clinical providers, the largest participant group, constituting 36.7% (n=58) of unique participants, were the most vocal group (mean 21.74, SD 2.11 average utterances per person-session). Benefits counselors were the least vocal group, with an average utterance rate of 0.57 (SD 0.29) per person-session and constituting 8.2% (n=13) of unique participants. Thus, various participant groups exhibited different utterance rates across sessions (P=.003). Experienced participants may have dominated active participation in discussion compared to those with less or intermediate experience, but this difference was not statistically significant (P=.11). When the didactic presenter and participant were from the same participant group, active participation by the silent group participants was greater than when both were from different groups. This association was not seen in vocal group participants (interaction P=.003). Compared to those participating by audio, those participating on video tended to have higher rates of active participation, but this difference was not statistically significant (P=.11). Conclusions: Our findings provide insight into the mechanics of interprofessional discussion in a digital community of practice managing pneumoconiosis. Our results underscore the capacity of the novel ECHO model to leverage technology and workforce diversity to facilitate interprofessional discussions on the multidisciplinary care of miners. Future research will evaluate whether this translates into improved patient outcomes. UR - https://formative.jmir.org/2025/1/e67999 UR - http://dx.doi.org/10.2196/67999 ID - info:doi/10.2196/67999 ER - TY - JOUR AU - Langley, E. Jodi AU - Sibley, Daniel AU - Chiekwe, Joy AU - Keats, R. Melanie AU - Snow, Stephanie AU - Purcell, Judith AU - Sollows, Stephen AU - Hill, Leslie AU - Watton, David AU - Gaudry, E. Abbigael AU - Hashish, Ibrahim AU - Wallace, Alison PY - 2025/3/10 TI - Prehabilitation Program for Lung and Esophageal Cancers (Boosting Recovery and Activity Through Early Wellness): Protocol for a Nonrandomized Trial JO - JMIR Res Protoc SP - e60791 VL - 14 KW - cancer KW - prehabilitation KW - physical activity KW - lung KW - esophageal KW - wellness KW - surgical KW - candidacy KW - feasibility KW - implementation KW - community-based KW - coaching program KW - Canada KW - lung cancer KW - esophageal cancer KW - surgery KW - nonrandomized trial KW - mixed method N2 - Background: Cancer is the leading cause of death in Canada, responsible for 28.2% of all deaths. Based on surgical candidacy and disease status, both lung and esophageal cancer are treated through surgical resection by a thoracic surgeon. Although surgery contributes to improved outcomes, the 30-day postoperative mortality risks are as high as 10% and 2.8%, respectively. Evidence has shown that prehabilitation is a way in which patients can have improved postoperative outcomes. Prehabilitation is multimodal, often including some form of movement, nutrition, stress management, and smoking cessation. Given the complexity of the health care system, pragmatic trials are important methodological tools to assess internal validity and improve current practice under real-world conditions. Concurrently, using community resources is imperative to keep people active in their community and create sustainable programming. Objective: The Boosting Recovery and Activity Through Early Wellness (BREATHE WELL) study aims to explore the feasibility, implementation, and preliminary effectiveness of a clinically integrated, community-based, prehabilitation health coaching program. This includes nutrition, smoking cessation, sleep hygiene, and movement for individuals scheduled to undergo surgery for lung or esophageal cancer. Methods: This is a pilot, nonrandomized, pragmatic, repeated measures, mixed methods trial. We will recruit 32 participants diagnosed with lung or esophageal cancer and are scheduled to undergo surgical resection into the prehabilitation program, with 32 additional participants who decline participation to act as a control group. Participants who agree will then go through an 8-week tailored prehabilitation program (in person or virtual), covering movement, nutrition, stress management, nutrition, goal setting, and smoking cessation. They will complete 6 sessions prior to surgery and then have 4 sessions, 1×/week following surgery. Following the completion of the program, they will have 3 booster sessions via phone or Zoom (Zoom Video Communications). The primary outcome is feasibility: (1) recruitment feasibility?recruitment rate (the number of participants referred per month), enrollment rate (the number of enrolled participants divided by the number of referred participants), reasons for declining, and prehabilitation window (time between consent and surgery); and (2) intervention feasibility?adherence to the movement intervention, attrition, safety, study completion rate, and adverse events. Secondary outcomes include measures of preliminary effectiveness including patient-reported outcomes, such as well-being, fatigue, and functional measures. All measures will be assessed before, during, and after the prehabilitation program. Results: Enrollment has begun in January 2025, with 2 participants enrolled in the health coaching program. The full study is expected to be completed in approximately 3 years and be published in winter 2027. Conclusions: This study will inform the feasibility, implementation, and preliminary effectiveness of a clinically integrated, community-based, prehabilitation program in Nova Scotia, Canada, for people scheduled to undergo curative intent surgery for lung and esophageal cancer. Trial Registration: ClinicalTrials.gov NCT06354959; https://clinicaltrials.gov/study/NCT06354959 International Registered Report Identifier (IRRID): PRR1-10.2196/60791 UR - https://www.researchprotocols.org/2025/1/e60791 UR - http://dx.doi.org/10.2196/60791 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60791 ER - TY - JOUR AU - Rojas-Cárdenas, Andrés AU - Cleaver, Shaun AU - Sarmiento, Ivan AU - Rock, Julie AU - Grenier, Yan AU - Charrier, Francis AU - Gosselin, Rose-Anne AU - Cockcroft, Anne AU - Andersson, Neil PY - 2025/3/10 TI - Indigenous Community Views of Disability in Canada: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e57590 VL - 14 KW - Indigenous health KW - intercultural dialog KW - cultural safety KW - traditional medicine KW - disability N2 - Background: Indigenous people do not necessarily view disability in the same way as do other groups. Indigenous concepts of disability are connected to their ancestral history, cultural customs, and environmental context. Some Indigenous languages do not contain a word equivalent to disability. Western approaches to disability seldom reflect the voices of Indigenous people. Objective: The objective of this scoping review is to collate the perspectives, concepts, and understandings of disability in Indigenous communities in Canada and to map the factors that influence social approaches to disability from an Indigenous perspective. Methods: Following the methodological framework for scoping reviews of Arksey and O?Malley, we will search electronic databases, including PubMed, Scopus, Web of Science, EBSCOhost ProQuest, Autochtonia, and APA PsycINFO. We will search gray literature through the Google search engine, conference abstracts, dissertation databases, government documents, and Indigenous organization websites. We will include quantitative, qualitative, and mixed methods studies in English and French. The included studies will describe Indigenous approaches to disability, as they are understood based on personal, cultural, and historical contexts. Two reviewers will use Covidence software (Cochrane) to remove duplicates, screen articles, record the step-by-step selection process, and extract data from the included articles. We will follow the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines. We will present the findings in tables, charts, narrative summaries, and through fuzzy cognitive mapping. We will contextualize the literature?s findings by comparing them with the stakeholders in Quebec and provide a discussion to explore potential solutions for the identified factors. Results: An initial limited search was conducted in January 2024. The study will be conducted in 2025. Publication of the results is expected in late 2025. Conclusions: We anticipate that the findings from the scoping review will be useful for professionals, researchers, policy makers, and Indigenous communities themselves interested in co-designing and implementing evidence-informed disability programs and services, which will prevent mismatches between the programs and the sociocultural context. We will disseminate the results of this review through workshops with the participating communities, direct engagement with relevant local stakeholders, and through conference presentations and publications in scientific journals. Trial Registration: OSF Registries osf.io/9rzkx; https://osf.io/9rzkx International Registered Report Identifier (IRRID): DERR1-10.2196/57590 UR - https://www.researchprotocols.org/2025/1/e57590 UR - http://dx.doi.org/10.2196/57590 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57590 ER - TY - JOUR AU - Li, Xuezhu AU - Huang, Lifeng AU - Zhang, Hui AU - Liang, Zhanming PY - 2025/3/5 TI - Enabling Telemedicine From the System-Level Perspective: Scoping Review JO - J Med Internet Res SP - e65932 VL - 27 KW - telemedicine KW - telehealth KW - digital health KW - success factors KW - challenges N2 - Background: Telemedicine is a strategy for providing health care services remotely that improves service accessibility. Telemedicine has attracted growing research interest in the past 10 years, including systematic reviews that synthesize evidence to share experiences and enhance knowledge. However, most of the published systematic reviews have focused on synthesizing evidence from studies on telemedicine at the organizational level. A collected understanding of factors on the system level that influence the successful implementation and adoption of telemedicine needs to be developed, especially in regional and rural areas. Objective: This scoping review aims to explore key success factors and challenges that influence the implementation and adoption of telemedicine at the system level, particularly in regional and rural areas. Methods: This scoping review was conducted in accordance with the framework by Arksey and O?Malley and reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A total of 5 databases (CINAHL, Cochrane, Medline, Ovid, and Scopus) were searched for research articles published in English between January 2010 and 2023, using the established inclusion criteria. Results: Of the 10,691 papers identified, 89 were included in this review, including 16 (17.98%) studies conducted in regional and rural areas and 13 (14.61%) in metropolitan areas. Another 13 (14.61%) studies were conducted in both metropolitan areas and regional and rural areas. Overall, 6 categories with more than 70 key success factors, including system-level requirements (n=13, 18.40%), economic considerations and funding (n=6, 8.70%), technological requirements (n=6, 8.70%), organizational requirements (n=19, 27.54%), understanding and supporting clinicians (n=12, 17.39%), and understanding and improving patients? perceptions (n=13, 18.84%), were identified. Additionally, 5 categories containing over 50 challenges, including those related to system levels (n=11, 23.91%), technological requirements (n=6, 13.04%), organizational requirements (n=13, 28.26%), clinicians (n=10, 21.74%), and patients (n=6, 13.04%), were identified. Among the identified factors, 11 (9.57%) were specific to regional and rural areas. Conclusions: This scoping review confirms that the successful implementation of telemedicine requires collective efforts at both the system and organizational levels, including coordination and collaboration across different regions and organizations. It underscores the importance of establishing a national network that enhances public awareness of telemedicine and clarity in payment and benefit distribution models and strengthens data security protection measures. The review also highlights the necessity of addressing infrastructural deficiencies, including internet connectivity in regional and rural areas, and suggests the implementation of targeted incentives and support measures. The required collective efforts are detailed in the proposed framework that promotes popularizing telemedicine, enhancing the overall quality and efficiency of health care services, and achieving broader health equity. UR - https://www.jmir.org/2025/1/e65932 UR - http://dx.doi.org/10.2196/65932 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053725 ID - info:doi/10.2196/65932 ER - TY - JOUR AU - Finnegan, Harriet AU - Mountford, Nicola PY - 2025/3/3 TI - 25 Years of Electronic Health Record Implementation Processes: Scoping Review JO - J Med Internet Res SP - e60077 VL - 27 KW - electronic health record system KW - EHR KW - electronic medical record KW - EMR KW - scoping review KW - process KW - implementation N2 - Background: Electronic health record (EHR) systems have undergone substantial evolution over the past 25 years, transitioning from rudimentary digital repositories to sophisticated tools that are integral to modern health care delivery. These systems have the potential to increase efficiency and improve patient care. However, for these systems to reach their potential, we need to understand how the process of EHR implementation works. Objective: This scoping review aimed to examine the implementation process of EHRs from 1999 to 2024 and to articulate process-focused recommendations for future EHR implementations that build on this history of EHR research. Methods: We conducted a scoping literature review following a systematic methodological framework. A total of 5 databases were selected from the disciplines of medicine and business: EBSCO, PubMed, Embase, IEEE Explore, and Scopus. The search included studies published from 1999 to 2024 that addressed the process of implementing an EHR. Keywords included ?EHR,? ?EHRS,? ?Electronic Health Record*,? ?EMR,? ?EMRS,? ?Electronic Medical Record*,? ?implemen*,? and ?process.? The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. The selected literature was thematically coded using NVivo qualitative analysis software, with the results reported qualitatively. Results: This review included 90 studies that described the process of EHR implementation in different settings. The studies identified key elements, such as the role of the government and vendors, the importance of communication and relationships, the provision of training and support, and the implementation approach and cost. Four process-related categories emerged from these results: compliance processes, collaboration processes, competence-development processes, and process costs. Conclusions: Although EHRs hold immense promise in improving patient care, enhancing research capabilities, and optimizing health care efficiency, there is a pressing need to examine the actual implementation process to understand how to approach implementation. Our findings offer 7 process-focused recommendations for EHR implementation formed from analysis of the selected literature. UR - https://www.jmir.org/2025/1/e60077 UR - http://dx.doi.org/10.2196/60077 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053758 ID - info:doi/10.2196/60077 ER - TY - JOUR AU - Miao, Shumei AU - Ji, Pei AU - Zhu, Yongqian AU - Meng, Haoyu AU - Jing, Mang AU - Sheng, Rongrong AU - Zhang, Xiaoliang AU - Ding, Hailong AU - Guo, Jianjun AU - Gao, Wen AU - Yang, Guanyu AU - Liu, Yun PY - 2025/3/3 TI - The Construction and Application of a Clinical Decision Support System for Cardiovascular Diseases: Multimodal Data-Driven Development and Validation Study JO - JMIR Med Inform SP - e63186 VL - 13 KW - CVD KW - CDSS KW - multimodel data KW - knowledge engine KW - development KW - cardiovascular disease KW - clinical decision support system N2 - Background: Due to the acceleration of the aging population and the prevalence of unhealthy lifestyles, the incidence of cardiovascular diseases (CVDs) in China continues to grow. However, due to the uneven distribution of medical resources across regions and significant disparities in diagnostic and treatment levels, the diagnosis and management of CVDs face considerable challenges. Objective: The purpose of this study is to build a cardiovascular diagnosis and treatment knowledge base by using new technology, form an auxiliary decision support system, and integrate it into the doctor?s workstation, to improve the assessment rate and treatment standardization rate. This study offers new ideas for the prevention and management of CVDs. Methods: This study designed a clinical decision support system (CDSS) with data, learning, knowledge, and application layers. It integrates multimodal data from hospital laboratory information systems, hospital information systems, electronic medical records, electrocardiography, nursing, and other systems to build a knowledge model. The unstructured data were segmented using natural language processing technology, and medical entity words and entity combination relationships were extracted using IDCNN (iterated dilated convolutional neural network) and TextCNN (text convolutional neural network). The CDSS refers to global CVD assessment indicators to design quality control strategies and an intelligent treatment plan recommendation engine map, establishing a big data analysis platform to achieve multidimensional, visualized data statistics for management decision support. Results: The CDSS system is embedded and interfaced with the physician workstation, triggering in real-time during the clinical diagnosis and treatment process. It establishes a 3-tier assessment control through pop-up windows and screen domination operations. Based on the intelligent diagnostic and treatment reminders of the CDSS, patients are given intervention treatments. The important risk assessment and diagnosis rate indicators significantly improved after the system came into use, and gradually increased within 2 years. The indicators of mandatory control, directly became 100% after the CDSS was online. The CDSS enhanced the standardization of clinical diagnosis and treatment. Conclusions: This study establishes a specialized knowledge base for CVDs, combined with clinical multimodal information, to intelligently assess and stratify cardiovascular patients. It automatically recommends intervention treatments based on assessments and clinical characterizations, proving to be an effective exploration of using a CDSS to build a disease-specific intelligent system. UR - https://medinform.jmir.org/2025/1/e63186 UR - http://dx.doi.org/10.2196/63186 ID - info:doi/10.2196/63186 ER - TY - JOUR AU - Mess, Veronica Elisabeth AU - Regner, Matthias AU - Balic, Sabahudin AU - Kleybolte, Lukas AU - Daufratshofer, Lisa AU - Mahler, Andreas AU - Tilmes, Sabrina AU - Werlitz, Viktor AU - Reuter, Claudia AU - Teynor, Alexandra PY - 2025/2/21 TI - Detailed Analysis and Road Map Proposal for Care Transition Records and Their Transmission Process: Mixed Methods Study JO - JMIR Nursing SP - e60810 VL - 8 KW - care transition record KW - transmission management KW - observations KW - process modeling KW - telematics infrastructure KW - TI KW - Fast Healthcare Interoperability Resources KW - FHIR KW - Health Level 7 KW - HL7 KW - medical information object KW - MIO KW - care information object care transition record KW - CIO-CTR KW - Pflegerisches Informationsobjekt-Überleitungsbogen KW - PIO-ULB KW - artificial intelligence KW - AI N2 - Background: The digitalization of health care in Germany holds great potential to improve patient care, resource management, and efficiency. However, strict data protection regulations, fragmented infrastructures, and resistance to change hinder progress. These challenges leave care institutions reliant on outdated paper-based workflows, particularly for patient data transmission, despite the pressing need for efficient tools to support health care professionals amid a nursing shortage and rising demand for care. Objective: This paper aims to analyze Germany?s care transition record (CTR) and CTR transmission process as part of transition management and suggests improvements toward a seamless digital solution. Methods: To understand the current challenges of manual CTR transfers, we used a mixed methods approach, which included a web-based questionnaire with nursing professionals, field observations, business process model and notation modeling, semantic and frequency analysis of CTR entries, and user story mapping. Results: A web-based questionnaire involving German nursing professionals (N=59) revealed considerable delays in patient care due to manual, patient-transferred CTRs. Of the 33 usable responses (n=33), 70% (n=23) of the respondents advocating for digital transmission to improve efficiency. Observations (N=11) in care facilities (n=5, 45%) and a hospital (n=6, 55%) confirmed the high administrative burden, averaging 34.67 (SD 10.78) minutes per CTR within a hospital and 44.6 (SD 20.5) minutes in care facilities. A semantic analysis of various CTRs (N=4) highlighted their differences and complexity, stressing the need for standardization. Analyzing a new CTR standard (care information object CTR) and manually mapping an existing CTR to it showed that the procedure was ambiguous, and some associations remained unclear. A frequency analysis of CTR entities revealed which were most used. In addition, discussions with care staff pointed out candidates for the most relevant entities. On the basis of the key findings, a stepwise transition approach toward a road map proposal for a standardized, secure transfer of CTRs was conceptualized. This road map in the form of a user story map, encompassing a ?CTR transformer? (mapping of traditional CTRs to a new standard) and ?care information object CTR viewer/editor? (in short, CIO-CTR viewer and editor; a new standard for viewing, editing, and exporting), shows a possibility to bridge the transition time until all institutions fully support the new standard. Conclusions: A future solution should simplify the overall CTR transmission process by minimizing manual transfers into in-house systems, standardizing the CTR, and providing a secure digital transfer. This could positively impact the overall care process and patient experience. With our solutions, we attempt to support care staff in their daily activities and processes until nationwide state regulations are implemented successfully, though the timeline for this remains uncertain. UR - https://nursing.jmir.org/2025/1/e60810 UR - http://dx.doi.org/10.2196/60810 UR - http://www.ncbi.nlm.nih.gov/pubmed/39982779 ID - info:doi/10.2196/60810 ER - TY - JOUR AU - Hopkin, Gareth AU - Coole, Holly AU - Edelmann, Francesca AU - Ayiku, Lynda AU - Branson, Richard AU - Campbell, Paul AU - Cooper, Sophie AU - Salmon, Mark PY - 2025/2/19 TI - Toward a New Conceptual Framework for Digital Mental Health Technologies: Scoping Review JO - JMIR Ment Health SP - e63484 VL - 12 KW - digital mental health KW - digital health KW - mental health KW - eHealth KW - categorization KW - conceptual KW - framework KW - regulation KW - synthesis KW - review methods KW - review methodology KW - systematic N2 - Background: Digital mental health technologies (DMHTs) are becoming more widely available and are seen as having the potential to improve the quality of mental health care. However, conversations around the potential impact of DMHTs can be impacted by a lack of focus on the types of technologies that are available. Several frameworks that could apply to DMHTs are available, but they have not been developed with comprehensive methods and have limitations. Objective: To address limitations with current frameworks, we aimed to identify existing literature on the categorization of DMHTs, to explore challenges with categorizing DMHTs for specific purposes, and to develop a new conceptual framework. Methods: We used an iterative approach to develop the framework. First, we completed a rapid review of the literature to identify studies that provided domains that could be used to categorize DMHTs. Second, findings from this review and associated issues were discussed by an expert working group, including professionals from a wide range of relevant settings. Third, we synthesized findings to develop a new conceptual framework. Results: The rapid review identified 3603 unique results, and hand searching identified another 3 potentially relevant papers. Of these, 24 papers were eligible for inclusion, which provided 10 domains to categorize DMHTs. The expert working group proposed a broad framework and based on the findings of the review and group discussions, we developed a new conceptual framework with 8 domains that represent important characteristics of DMHTs. These 8 domains are population, setting, platform or system, purpose, type of approach, human interaction, human responsiveness, and functionality. Conclusions: This conceptual framework provides a structure for various stakeholders to define the key characteristics of DMHTs. It has been developed with more comprehensive methods than previous attempts with similar aims. The framework can facilitate communication within the field and could undergo further iteration to ensure it is appropriate for specific purposes. UR - https://mental.jmir.org/2025/1/e63484 UR - http://dx.doi.org/10.2196/63484 ID - info:doi/10.2196/63484 ER - TY - JOUR AU - Snow, Martha AU - Silva-Ribeiro, Wagner AU - Baginsky, Mary AU - Di Giorgio, Sonya AU - Farrelly, Nicola AU - Larkins, Cath AU - Poole, Karen AU - Steils, Nicole AU - Westwood, Joanne AU - Malley, Juliette PY - 2025/2/14 TI - Best Practices for Implementing Electronic Care Records in Adult Social Care: Rapid Scoping Review JO - JMIR Aging SP - e60107 VL - 8 KW - digital care records KW - adult social care KW - digitization KW - domiciliary care KW - care homes KW - electronic care records KW - PRISMA N2 - Background: In the past decade, the use of digital or electronic records in social care has risen worldwide, capturing key information for service delivery. The COVID-19 pandemic accelerated digitization in health and social care. For example, the UK government created a fund specifically for adult social care provider organizations to adopt digital social care records. These developments offer valuable learning opportunities for implementing digital care records in adult social care settings. Objective: This rapid scoping review aimed to understand what is known about the implementation of digital care records in adult social care and how implementation varies across use cases, settings, and broader contexts. Methods: A scoping review methodology was used, with amendments made to enable a rapid review. Comprehensive searches based on the concepts of digital care records, social care, and interoperability were conducted across the MEDLINE, EmCare, Web of Science Core Collection, HMIC Health Management Information Consortium, Social Policy and Practice, and Social Services Abstracts databases. Studies published between 2018 and 2023 in English were included. One reviewer screened titles and abstracts, while 2 reviewers extracted data. Thematic analysis mapped findings against the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework. Results: Our search identified 2499 references. After screening titles and abstracts, 71 records were selected for full-text review, resulting in 31 references from 29 studies. Studies originated from 11 countries, including 1 multicountry study, with the United Kingdom being the most represented (10/29, 34%). Studies were most often conducted in nursing homes or facilities (7/29, 24%) with older people as the target population (6/29, 21%). Health records were the most investigated record type (12/29, 41%). We identified 45 facilitators and 102 barriers to digital care record implementation across 28 studies, spanning 6 of the 7 NASSS framework domains and aligning with 5 overarching themes that require greater active management regarding implementation. Intended or actual implementation outcomes were reported in 17 (59%) of the 29 studies. Conclusions: The findings suggest that implementation is complex due to a lack of consensus on what digital care records and expected outcomes and impacts should look like. The literature often lacks clear definitions and robust study designs. To be successful, implementation should consider complexity, while studies should use robust frameworks and mixed methods or quantitative designs where appropriate. Future research should define the target population, gather data on carer or service user experiences, and focus on digital care records specifically used in social care. UR - https://aging.jmir.org/2025/1/e60107 UR - http://dx.doi.org/10.2196/60107 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60107 ER - TY - JOUR AU - Bamgboje-Ayodele, Adeola AU - Boscolo, Adrian AU - Burger, Mitchell AU - Hutchings, Owen AU - Shaw, Miranda AU - Shaw, Tim AU - Tariq, Amina AU - Naicker, Sundresan AU - McPhail, Steven AU - Baysari, Melissa PY - 2025/2/11 TI - Health IT Implementation and the Impact of the COVID-19 Pandemic on Clinician-IT Dynamics: Qualitative Study JO - J Med Internet Res SP - e57847 VL - 27 KW - health IT KW - implementation KW - COVID-19 pandemic KW - process evaluation KW - sociotechnical factors KW - virtual hospital KW - COVID-19 N2 - Background: The COVID-19 pandemic necessitated the rapid development and implementation of health ITs to support health care delivery. Health IT implementation is difficult at the best of times, due to complex sociotechnical challenges that vary across contexts and settings; however, it is currently unclear how the pandemic impacted health IT implementation processes. The aim of this study was to explore the impact of the pandemic on health IT implementation processes, including pre- and postimplementation phases, and identify the sociotechnical factors that shaped health IT implementation during an unprecedented circumstance. Objective: This study aimed to explore the impact of the pandemic on HIT implementation processes, including pre- and postimplementation phases, and identify the socio-technical factors that shaped health IT implementation during an unprecedented circumstance. Methods: Participants were from one of two teams: (1) health care staff members (doctors, nurses, nurse unit managers, and support staff members) from a virtual hospital in Australia; and (2) IT professionals within the broader health care organization assigned to the hospital. Participants took part in an interview or focus group from July to November 2022. Participants were asked to describe the process used for rapid health IT design and implementation during the COVID-19 pandemic. Qualitative data were analyzed thematically. Results: A total of 15 participants took part in the study. Both internal and external team structures, and the communication pathways that underpinned these, were reported to influence the health IT lifecycle, which in turn impacted outcomes, particularly when perceived normal ways of working were challenged during the pandemic. Across the pre-post lifecycle, preimplementation processes were viewed to be most impacted by the COVID-19 pandemic. Participants reported that their roles and responsibilities changed during health IT implementations in the pandemic, impacting co-design processes and highlighting the need for health IT implementation processes to cater for new work and the redistribution of existing work. Conclusions: Our study uncovered the negative impact of the COVID-19 pandemic on team structures, communication pathways, and health IT preimplementation processes (project management and co-design). While health care organizations are keen to transition beyond the ways of working during the pandemic, it is imperative to learn from the health IT implementation successes and failures that occurred in the pandemic via process evaluations. Our evaluation offers learnings for research (an adapted interdisciplinary team communication framework), practice (the need for health care organizations to review their communication structures, IT staff skills, and proposed processes), and education (the need for better education and training of IT professionals working in clinical settings on health concepts) on health IT implementations as the world transitions to the ?new norm.? UR - https://www.jmir.org/2025/1/e57847 UR - http://dx.doi.org/10.2196/57847 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57847 ER - TY - JOUR AU - Simón-López, Carmen Leticia AU - Ortuńo-Soriano, Ismael AU - Luengo-González, Raquel AU - Posada-Moreno, Paloma AU - Zaragoza-García, Ignacio AU - Sánchez-Gómez, Rubén PY - 2025/2/10 TI - Proposal and Strategy for Nursing-Led Research: Protocol for an Unfunded Clinical Trial JO - JMIR Res Protoc SP - e56062 VL - 14 KW - clinical trial KW - academic trial KW - nonfunded KW - commercial KW - nurse-led KW - low intervention KW - health product KW - peripheral venous cannulation KW - PVC KW - protocol KW - randomized controlled trial KW - RCT KW - adults KW - healthy adults KW - funding KW - academic sponsors KW - cause-effect results KW - insurance N2 - Background: Clinical trials are known to provide cause-and-effect results and data with low levels of bias. However, a lack of funding for clinical trials, which are considered expensive, means that academic sponsors are rarely able to conduct them. Academic trials are considered highly relevant for the valuable results they provide for clinical questions. This is why initiatives to conduct unfunded clinical trials have been identified as an important issue to pay attention to in future studies. Therefore, we present our initiative through Rogers? theory, which is highlighted in the literature for diffusing innovative change across organizations. Objective: The purpose of this paper was to describe our case regarding management for conducting a nonfunded nurse-led clinical trial based on our previous low-interventional clinical trial across a specific health organization and with nurses. Methods: We conducted a low-intervention, nonexternally funded clinical trial using the human and material resources available on site. We managed our trial in a clinical trial unit where there were staff, sources, and ongoing commercial clinical trials. We conducted our trial based on an ongoing commercial trial, and, to do so, we needed behavioral changes. We relied on Rogers? theory, and we identified strengths and barriers to change by analyzing actors' characteristics, perceptions of the situation, motivation, and information. Afterward, we divided the staff according to their characteristics related to innovation and change into permanent staff (research staff with a culture of change) and nonpermanent staff (nursing staff with occasional attendance and resistance to change). First, we preselected only those nurses who were more aware of change (innovators and pioneers) to participate in our trial to avoid a massive rejection, and later, we asked others to join (late adopters). We followed Rogers? phases. For research staff who were aware of the funding, we focused on the ?persuasion phase,? while for nursing staff, we mixed the ?knowledge and persuasion phases? and used pioneers and early adopters as a positive example for other nurses as well as nonfinancial incentives (persuasion). Our trial consisted of different methods of vein cannulation, which was performed in the ongoing commercial trial. Thus, the entire development of our low-interventional clinical trial was conducted without interfering at any point with the parallel commercial clinical trial. Results: Our management allowed effective conduct of our study, and we met our aims without external funding and without ethical impact during the commercial clinical trial. Costs remained low, primarily because the major expenses were covered by the commercial clinical trial as an inherent part of its design. Conclusions: Our initiative to conduct a low-intervention clinical trial with no or limited funding was cost-effective. This initiative can be used by researchers with valuable academic research questions who do not have the external funding to conduct studies. Trial Registration: ClinicalTrials.gov NCT04027218; https://clinicaltrials.gov/study/NCT04027218 International Registered Report Identifier (IRRID): RR1-10.2196/56062 UR - https://www.researchprotocols.org/2025/1/e56062 UR - http://dx.doi.org/10.2196/56062 UR - http://www.ncbi.nlm.nih.gov/pubmed/39927682 ID - info:doi/10.2196/56062 ER - TY - JOUR AU - Kraft, A. Stephanie AU - Chopra, Shaan AU - Duran, C. Miriana AU - Rojina, A. Janet AU - Beretta, Abril AU - López, I. Katherine AU - Javan, Russell AU - Wilfond, S. Benjamin AU - Rosenfeld, Margaret AU - Fogarty, James AU - Ko, K. Linda PY - 2025/2/6 TI - Perspectives of Hispanic and Latinx Community Members on AI-Enabled mHealth Tools: Qualitative Focus Group Study JO - J Med Internet Res SP - e59817 VL - 27 KW - wearable electronic devices KW - qualitative research KW - mobile health KW - mHealth KW - digital health KW - privacy KW - data sharing KW - artificial intelligence KW - AI KW - community KW - chronic conditions KW - chronic disease N2 - Background: Mobile health (mHealth) tools have the potential to reduce the burden of chronic conditions that disproportionately affect Hispanic and Latinx communities; however, digital divides in the access to and use of health technology suggest that mHealth has the potential to exacerbate, rather than reduce, these disparities. Objective: A key step toward developing health technology that is accessible and usable is to understand community member perspectives and needs so that technology is culturally relevant and appropriately contextualized. In this study, we aimed to examine the perspectives of Hispanic and Latinx community members in Washington State about mHealth. Methods: We recruited English- and Spanish-speaking Hispanic or Latinx adults to participate in web-based focus groups through existing community-based networks across rural and urban regions of Washington State. Focus groups included a presentation of narrative slideshow materials developed by the research team depicting mHealth use case examples of asthma in children and fall risk in older adults. Focus group questions asked participants to respond to the case examples and to further explore mHealth use preferences, benefits, barriers, and concerns. Focus group recordings were professionally transcribed, and Spanish transcripts were translated into English. We developed a qualitative codebook using deductive and inductive methods and then coded deidentified transcripts using the constant comparison method. The analysis team proposed themes based on review of coded data, which were validated through member checking with a community advisory board serving Latino individuals in the region and finalized through discussion with the entire research team. Results: Between May and September 2023, we conducted 8 focus groups in English or Spanish with 48 participants. Focus groups were stratified by language and region and included the following: 3 (n=18, 38% participants) Spanish urban groups, 2 (n=14, 29% participants) Spanish rural groups, 1 (n=6, 13% participants) English urban group, and 2 (n=10, 21% participants) English rural groups. We identified the following seven themes: (1) mHealth is seen as beneficial for promoting health and peace of mind; (2) some are unaware of, unfamiliar with, or uncomfortable with technology and may benefit from individualized support; (3) financial barriers limit access to mHealth; (4) practical considerations create barriers to using mHealth in daily life; (5) mHealth raises concern for overreliance on technology; (6) automated mHealth features are perceived as valuable but fallible, requiring human input to ensure accuracy; and (7) data sharing is seen as valuable for limited uses but raises privacy concerns. These themes illustrate key barriers to the benefits of mHealth that communities may face, provide insights into the role of mHealth within families, and examine the appropriate balance of data sharing and privacy protections. Conclusions: These findings offer important insights that can help advance the development of mHealth that responds to community values and priorities. UR - https://www.jmir.org/2025/1/e59817 UR - http://dx.doi.org/10.2196/59817 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59817 ER - TY - JOUR AU - Lyon, R. Aaron AU - Munson, A. Sean AU - Pullmann, D. Michael AU - Mosser, Brittany AU - Aung, Tricia AU - Fortney, John AU - Dopp, Alex AU - Osterhage, P. Katie AU - Haile, G. Helen AU - Bruzios, E. Kathryn AU - Blanchard, E. Brittany AU - Allred, Ryan AU - Fuller, R. Macey AU - Raue, J. Patrick AU - Bennett, Ian AU - Locke, Jill AU - Bearss, Karen AU - Walker, Denise AU - Connors, Elizabeth AU - Bruns, Eric AU - Van Draanen, Jenna AU - Darnell, Doyanne AU - Areán, A. Patricia PY - 2025/1/29 TI - Harnessing Human-Centered Design for Evidence-Based Psychosocial Interventions and Implementation Strategies in Community Settings: Protocol for Redesign to Improve Usability, Engagement, and Appropriateness JO - JMIR Res Protoc SP - e65446 VL - 14 KW - implementation science KW - human-centered design KW - evidence-based psychosocial interventions KW - mental health N2 - Background: Although substantial progress has been made in establishing evidence-based psychosocial clinical interventions and implementation strategies for mental health, translating research into practice?particularly in more accessible, community settings?has been slow. Objective: This protocol outlines the renewal of the National Institute of Mental Health?funded University of Washington Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness Center, which draws from human-centered design (HCD) and implementation science to improve clinical interventions and implementation strategies. The Center?s second round of funding (2023-2028) focuses on using the Discover, Design and Build, and Test (DDBT) framework to address 3 priority clinical intervention and implementation strategy mechanisms (ie, usability, engagement, and appropriateness), which we identified as challenges to implementation and scalability during the first iteration of the center. Local redesign teams work collaboratively and share decision-making to carry out DDBT. Methods: All 4 core studies received institutional review board approval by June 2024, and each pilot project will pursue institutional review board approval when awarded. We will provide research infrastructure to 1 large effectiveness study and 3 exploratory pilot studies as part of the center grant. At least 4 additional small pilot studies will be solicited and funded by the center. All studies will explore the use of DDBT for clinical interventions and implementation strategies to identify modification targets to improve usability, engagement, and appropriateness in accessible nonspecialty settings (Discover phase); develop redesign solutions with local teams to address modification targets (Design and Build phase); and determine if redesign improves usability, engagement, and appropriateness (Test phase), as well as implementation outcomes. Center staff will collaborate with local redesign teams to develop and test clinical interventions and implementation strategies for community settings. We will collaborate with teams to use methods and centerwide measures that facilitate cross-project analysis of the effects of DDBT-driven redesign on outcomes of interest. Results: As of January 2025, three of the 4 core studies are underway. We will generate additional evidence on the robustness of DDBT and whether combining HCD and implementation science is an asset for improving clinical interventions and implementation strategies. Conclusions: During the first round of the center, we established that DDBT is a useful approach to systematically identify and address chronic challenges of implementing clinical interventions and implementation strategies. In this subsequent grant, we expect to increase evidence of DDBT?s impact on clinical interventions and implementation strategies by expanding a list of common challenges that could benefit from modification, a list of exemplary solutions to address these challenges, and guidance on using the DDBT framework. These resources will contribute to broader discourse on how to enhance implementation of clinical interventions and implementation strategies that integrate HCD and implementation science. International Registered Report Identifier (IRRID): PRR1-10.2196/65446 UR - https://www.researchprotocols.org/2025/1/e65446 UR - http://dx.doi.org/10.2196/65446 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65446 ER - TY - JOUR AU - Muhammad, Shah AU - Soomro, Asif AU - Ahmed Khan, Samia AU - Najmi, Hina AU - Memon, Zahid AU - Ariff, Shabina AU - Soofi, Sajid AU - Bhutta, Ahmed Zufiqar PY - 2025/1/29 TI - Scaling Up Kangaroo Mother Care Through a Facility Delivery Model in Rural Districts of Pakistan: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e56142 VL - 14 KW - kangaroo mother care KW - scale up intervention KW - health facility KW - community KW - preterm infants N2 - Background: The neonatal mortality rate in Pakistan is the third highest in Asia, with 8.6 million preterm babies. These newborns require warmth, nutrition, and infection protection, typically provided by incubators. However, the high maintenance and repair costs of incubators pose a barrier to accessibility for many premature and low birth weight neonates in low- and middle-income countries. This study aims to implement a context-specific kangaroo mother care (KMC) model in Sanghar within secondary health care facilities and catchment communities. Objective: This study aims to achieve at least 80% KMC coverage for premature and low birth weight neonates. Methods: This research uses a mixed methods design grounded in implementation science principles, with the goal of developing adaptive strategies tailored to district and facility managers, as well as health care workers, leveraging previous evidence on the benefits of KMC. The research is conducted in the district of Sanghar, Sindh with an emphasis on promoting KMC for infants weighing between 1200 and 2500 g in three facilities. It includes preimplementation data collection, training of health care providers and lady health workers, and intervention involving mother-baby skin-to-skin contact, breastfeeding initiation, and postdischarge follow-ups. Ethical considerations and data management are prioritized, to improve KMC coverage and neonatal health outcomes. Results: This research will be implemented over a period of 18 months. The primary objective of this research is to achieve an 80% improvement in KMC coverage, with the secondary objective to promote optimal breastfeeding practices among postpartum mothers. Key indicators include the proportion of eligible infants enrolled in KMC, the percentage of mother-baby pairs receiving skin-to-skin care postdischarge, and the duration of KMC during the neonatal period. Additionally, the study will assess exclusive breastfeeding rates, neonatal weight gain, and neonatal deaths within the cohort. The data management team will evaluate the effectiveness of the model in achieving the targeted KMC coverage. Conclusions: The integration of KMC into the health care system will provide valuable insights for policy makers regarding effective implementation and scaling strategies. The study?s findings will highlight facilitators and barriers to KMC adoption, benefiting regions across Pakistan and globally. Additionally, these findings will offer valuable insights for the development of future newborn care programs. International Registered Report Identifier (IRRID): DERR1-10.2196/56142 UR - https://www.researchprotocols.org/2025/1/e56142 UR - http://dx.doi.org/10.2196/56142 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56142 ER - TY - JOUR AU - Soltani, Nazli AU - Dietz, Thilo AU - Ochterbeck, Doris AU - Dierkes, Jens AU - Restel, Katja AU - Christianson, Lara AU - De Santis, Karolina Karina AU - Zeeb, Hajo PY - 2025/1/28 TI - Digital Information Exchange Between the Public and Researchers in Health Studies: Scoping Review JO - J Med Internet Res SP - e63373 VL - 27 KW - health information KW - information exchange KW - communication KW - knowledge translation KW - dissemination KW - digital technology KW - research participant KW - scoping review N2 - Background: Information exchange regarding the scope and content of health studies is becoming increasingly important. Digital methods, including study websites, can facilitate such an exchange. Objective: This scoping review aimed to describe how digital information exchange occurs between the public and researchers in health studies. Methods: This scoping review was prospectively registered and adheres to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Eligibility was defined using the population (public and researchers), concept (digital information exchange), and context (health studies) framework. Bibliographic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science), bibliographies of the included studies, and Google Scholar were searched up to February 2024. Studies published in peer-reviewed journals were screened for inclusion based on the title, abstract, and full text. Data items charted from studies included bibliographic and PCC (Population, Concept, and Context) characteristics. Data were processed into categories that inductively emerged from the data and were synthesized into main themes using descriptive statistics. Results: Overall, 4072 records were screened, and 18 studies published between 2010 and 2021 were included. All studies evaluated or assessed the preferences for digital information exchange. The target populations included the public (mainly adults with any or specific diseases), researchers, or both. The digital information exchange methods included websites, emails, forums, platforms, social media, and portals. Interactivity (ie, if digital information exchange is or should be active or passive) was addressed in half of the studies. Exchange content included health information or data with the aim to inform, recruit, link, or gather innovative research ideas from participants in health studies. We identified 7 facilitators and 9 barriers to digital information exchange. The main facilitators were the consideration of any stakeholder perspectives and needs to clarify expectations and responsibilities, the use of modern or low-cost communication technologies and public-oriented language, and continuous communication of the health study process. The main barriers were that information exchange was not planned or not feasible due to inadequate resources, highly complex technical language was used, and ethical concerns (eg, breach of anonymity if study participants are brought together) were raised. Evidence gaps indicate that new studies should assess the methods and the receiver (ie, public) preferences and needs that are required to deliver and facilitate interactive digital information exchange. Conclusions: Few studies addressing digital information exchange in health studies could be identified in this review. There was little focus on interactivity in such an exchange. Digital information exchange was associated with more barriers than facilitators, suggesting that more effort is required to improve such an exchange between the public and researchers. Future studies should investigate interactive digital methods and the receiver preferences and needs required for such an exchange. UR - https://www.jmir.org/2025/1/e63373 UR - http://dx.doi.org/10.2196/63373 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63373 ER - TY - JOUR AU - Duffy, Daniel AU - Richards, Derek AU - Hisler, Garrett AU - Timulak, Ladislav PY - 2025/1/28 TI - Implementing Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety in Adults: Systematic Review JO - J Med Internet Res SP - e47927 VL - 27 KW - mixed methods systematic review KW - internet-delivered cognitive behavioral therapy KW - iCBT KW - implementation science KW - implementation research KW - depression KW - anxiety N2 - Background: Scientific implementation findings relevant to the implementation of internet-delivered cognitive behavioral therapy (iCBT) for depression and anxiety in adults remain sparse and scattered across different sources of published information. Identifying evidence-based factors that influence the implementation of iCBT is key to successfully using iCBT in real-world clinical settings. Objective: This systematic review evaluated the following: (1) aspects that research articles postulate as important for the implementation of iCBT and (2) aspects relevant to the day-to-day running of iCBT services. A mixed methods systematic review using a convergent synthesis design was conducted to bring together evidence across this sparse literature consisting of divergent scientific article types to investigate the implementation of iCBT for depression and anxiety in adults. Methods: We searched the PsycINFO, PsycArticles, MEDLINE, CINAHL Complete, and Embase databases for any published peer-reviewed scientific articles that report on the implementation of iCBT for depression or anxiety disorders in adults. A total of 40 articles spanning the case study, commentary, meta-analysis, mixed methods study, pilot randomized controlled trial, randomized controlled trial, qualitative study, quantitative study, review, and systematic review article types were identified as eligible for this mixed methods review. Data were analyzed qualitatively using the descriptive-interpretive approach. Results: The first domain highlighted the impact of therapist and patient attitudes when implementing iCBT, the superiority of guided iCBT over unguided iCBT, its noninferiority to equivalent face-to-face treatments, and its utility outside of the original target of mild-to-moderate depression and anxiety. In total, 3 subdomains were identified under the second domain: (1) the management of iCBT in the workplace, detailing the importance of managing the iCBT service, related staff, and their motivations for using it; (2) the practice of iCBT in the workplace, describing the therapeutic aspects of iCBT provision, such as the provision of support, the background of supporters, and screening procedures; and (3) contextual considerations, detailing the impact of governmental legislation on therapy conducted over the internet, the lack of an iCBT workforce as a limiting factor, and the cost estimates associated with iCBT provision. Conclusions: Broadly, the findings describe several aspects that should be taken into account when researchers or practitioners implement iCBT as part of their work. However, the findings should be interpreted with caution, as the articles reviewed spanned many article types, and few of the included studies were directly focused on evaluating the implementation of iCBT. While findings provide insight into important factors to consider during iCBT implementation, these findings and their limitations highlight the need for more implementation-specific research in this area. UR - https://www.jmir.org/2025/1/e47927 UR - http://dx.doi.org/10.2196/47927 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47927 ER - TY - JOUR AU - Sedlakova, Jana AU - Staniki?, Mina AU - Gille, Felix AU - Bernard, Jürgen AU - Horn, B. Andrea AU - Wolf, Markus AU - Haag, Christina AU - Floris, Joel AU - Morgenshtern, Gabriela AU - Schneider, Gerold AU - Zumbrunn Wojczy?ska, Aleksandra AU - Mouton Dorey, Corine AU - Ettlin, Alois Dominik AU - Gero, Daniel AU - Friemel, Thomas AU - Lu, Ziyuan AU - Papadopoulos, Kimon AU - Schläpfer, Sonja AU - Wang, Ning AU - von Wyl, Viktor PY - 2025/1/23 TI - Refining Established Practices for Research Question Definition to Foster Interdisciplinary Research Skills in a Digital Age: Consensus Study With Nominal Group Technique JO - JMIR Med Educ SP - e56369 VL - 11 KW - research question KW - digitalization KW - digital data KW - data science KW - health research KW - interdisciplinary N2 - Background: The increased use of digital data in health research demands interdisciplinary collaborations to address its methodological complexities and challenges. This often entails merging the linear deductive approach of health research with the explorative iterative approach of data science. However, there is a lack of structured teaching courses and guidance on how to effectively and constructively bridge different disciplines and research approaches. Objective: This study aimed to provide a set of tools and recommendations designed to facilitate interdisciplinary education and collaboration. Target groups are lecturers who can use these tools to design interdisciplinary courses, supervisors who guide PhD and master?s students in their interdisciplinary projects, and principal investigators who design and organize workshops to initiate and guide interdisciplinary projects. Methods: Our study was conducted in 3 steps: (1) developing a common terminology, (2) identifying established workflows for research question formulation, and (3) examining adaptations of existing study workflows combining methods from health research and data science. We also formulated recommendations for a pragmatic implementation of our findings. We conducted a literature search and organized 3 interdisciplinary expert workshops with researchers at the University of Zurich. For the workshops and the subsequent manuscript writing process, we adopted a consensus study methodology. Results: We developed a set of tools to facilitate interdisciplinary education and collaboration. These tools focused on 2 key dimensions? content and curriculum and methods and teaching style?and can be applied in various educational and research settings. We developed a glossary to establish a shared understanding of common terminologies and concepts. We delineated the established study workflow for research question formulation, emphasizing the ?what? and the ?how,? while summarizing the necessary tools to facilitate the process. We propose 3 clusters of contextual and methodological adaptations to this workflow to better integrate data science practices: (1) acknowledging real-life constraints and limitations in research scope; (2) allowing more iterative, data-driven approaches to research question formulation; and (3) strengthening research quality through reproducibility principles and adherence to the findable, accessible, interoperable, and reusable (FAIR) data principles. Conclusions: Research question formulation remains a relevant and useful research step in projects using digital data. We recommend initiating new interdisciplinary collaborations by establishing terminologies as well as using the concepts of research tasks to foster a shared understanding. Our tools and recommendations can support academic educators in training health professionals and researchers for interdisciplinary digital health projects. UR - https://mededu.jmir.org/2025/1/e56369 UR - http://dx.doi.org/10.2196/56369 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56369 ER - TY - JOUR AU - Nykiel-Bailey, Sydney AU - Burrows, Kathryn AU - Szafarowicz, E. Bianca AU - Moquin, Rachel PY - 2025/1/21 TI - Faculty Perceptions on the Roles of Mentoring, Advising, and Coaching in an Anesthesiology Residency Program: Mixed Methods Study JO - JMIR Med Educ SP - e60255 VL - 11 KW - coaching KW - faculty perceptions KW - mentoring KW - perception KW - medical education KW - anesthesia KW - modality KW - support KW - Washington University KW - university KW - coaching skills KW - training KW - culture change KW - culture KW - flexibility KW - systematic framework N2 - Background: Mentoring, advising, and coaching are essential components of resident education and professional development. Despite their importance, there is limited literature exploring how anesthesiology faculty perceive these practices and their role in supporting residents. Objective: This study aims to investigate anesthesiology faculty perspectives on the significance, implantation strategies, and challenges associated with mentorship, advising, and coaching in resident education. Methods: A comprehensive survey was administrated to 93 anesthesiology faculty members at Washington University School of Medicine. The survey incorporated quantitative Likert-scale questions and qualitative short-answer responses to assess faculty perceptions of the value, preferred formats, essential skills, and capacity for fulfilling multiple roles in these support practices. Additional areas of focus included the impact of staffing shortages, training requirements, and the potential of these practices to enhance faculty recruitment and retention. Results: The response rate was 44% (n=41). Mentoring was identified as the most important aspect, with 88% (n=36) of faculty respondents indicating its significance, followed by coaching, which was highlighted by 78% (n=32) of respondents. The majority felt 1 faculty member can effectively hold multiple roles for a given trainee. The respondents desired additional training for roles and found roles to be rewarding. All roles were seen as facilitating recruitment and retention. Barriers included faculty burnout; confusion between roles; time constraints; and desire for specialized training, especially in coaching skills. Conclusions: Implementing structured mentoring, advising, and coaching can profoundly impact resident education but requires role clarity, protected time, culture change, leadership buy-in, and faculty development. Targeted training and operational investments could enable programs to actualize immense benefits from high-quality resident support modalities. Respondents emphasized that resident needs evolve over time, necessitating flexibility in appropriate faculty guidance. While coaching demands unique skills, advising hinges on expertise and mentoring depends on relationship-building. Systematic frameworks of coaching, mentoring, and advising programs could unlock immense potential. However, realizing this vision demands surmounting barriers such as burnout, productivity pressures, confusion about logistics, and culture change. Ultimately, prioritizing resident support through high-quality personalized guidance can recenter graduate medical education. UR - https://mededu.jmir.org/2025/1/e60255 UR - http://dx.doi.org/10.2196/60255 ID - info:doi/10.2196/60255 ER - TY - JOUR AU - Walzer, Stefan AU - Barthel, Carolin AU - Pazouki, Ronja AU - Marx, Helga AU - Ziegler, Sven AU - Koenig, Peter AU - Kugler, Christiane AU - Jobst, Stefan PY - 2025/1/15 TI - Teaching in the Digital Age?Developing a Support Program for Nursing Education Providers: Design-Based Research JO - JMIR Form Res SP - e66109 VL - 9 KW - digital competencies KW - nursing education KW - support program KW - needs assessment KW - design-based research KW - feasibility study KW - nursing education provider KW - qualitative research KW - nurse KW - health care KW - focus group KW - digital age KW - expert consultation KW - thematic content analysis KW - feasibility test KW - satisfaction KW - competency-based approach KW - workplace barrier KW - health care digitalization KW - digital technology N2 - Background: Health care systems and the nursing profession worldwide are being transformed by technology and digitalization. Nurses acquire digital competence through their own experience in daily practice, but also from education and training; nursing education providers thus play an important role. While nursing education providers have some level of digital competence, there is a need for ongoing training and support for them to develop more advanced skills and effectively integrate technology into their teaching. Objective: This study aims to develop a needs-based support program for nursing education providers to foster digital competencies and to test this intervention. Methods: We used a design-based research approach, incorporating iterative development with expert consultation to create and evaluate a support program for nursing education providers. Focus groups were conducted online to assess needs, and thematic content analysis was used to derive key insights. The support program was then refined through expert feedback and subjected to a feasibility and satisfaction test, with participant evaluations analyzed descriptively. Results: Six main categories emerged from the focus groups, highlighting key areas, including the use of digital technology, ongoing support needs, and the current state of digitalization in nursing education. The support program was developed based on these findings, with expert validation leading to adjustments in timing, content prioritization, and platform integration. Preliminary testing showed good overall satisfaction with the support program, although participants suggested improvements in content relevance and digital platform usability. Conclusions: Although the feasibility test showed high satisfaction with the support program, low participation rates and limited perceived knowledge gain were major concerns. The results suggest that while the program was well received, further refinements, including a focus on competency-based approaches and addressing workplace barriers, are needed to increase participation and effectiveness of such interventions. The findings of this research can be used as a basis for the development of similar programs in other educational and health care contexts. UR - https://formative.jmir.org/2025/1/e66109 UR - http://dx.doi.org/10.2196/66109 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66109 ER - TY - JOUR AU - Jiang, Yuyan AU - Liu, Xue-li AU - Wang, Liyun PY - 2025/1/15 TI - Evaluation and Comparison of the Academic Quality of Open-Access Mega Journals and Authoritative Journals: Disruptive Innovation Evaluation JO - J Med Internet Res SP - e59598 VL - 27 KW - innovative evaluation KW - disruption index KW - open-access mega journals KW - paper evaluation KW - open citation data N2 - Background: Some scholars who are skeptical about open-access mega journals (OAMJs) have argued that low-quality papers are often difficult to publish in more prestigious and authoritative journals, and OAMJs may be their main destination. Objective: This study aims to evaluate the academic quality of OAMJs and highlight their important role in clinical medicine. To achieve this aim, authoritative journals and representative OAMJs in this field were selected as research objects. The differences between the two were compared and analyzed in terms of their level of disruptive innovation. Additionally, this paper explored the countries and research directions for which OAMJs serve as publication channels for disruptive innovations. Methods: In this study, the journal information, literature data, and open citation relationship data were sourced from Journal Citation Reports (JCR), Web of Science (WoS), InCites, and the OpenCitations Index of PubMed Open PMID-to-PMID citations (POCI). Then, we calculated the disruptive innovation level of the focus paper based on the local POCI database. Results: The mean Journal Disruption Index (JDI) values for the selected authoritative journals and OAMJs were 0.5866 (SD 0.26933) and 0.0255 (SD 0.01689), respectively, showing a significant difference. Only 1.48% (861/58,181) of the OAMJ papers reached the median level of disruptive innovation of authoritative journal papers (MDAJ). However, the absolute number was roughly equal to that of authoritative journals. OAMJs surpassed authoritative journals in publishing innovative papers in 24 research directions (eg, Allergy), accounting for 40.68% of all research directions in clinical medicine. Among research topics with at least 10 authoritative papers, OAMJs matched or exceeded MDAJ in 35.71% of cases. The number of papers published in authoritative journals and the average level of disruptive innovation in each country showed a linear relationship after logarithmic treatment, with a correlation coefficient of ?0.891 (P<.001). However, the number of papers published in OAMJs in each country and the average level of disruptive innovation did not show a linear relationship after logarithmic treatment. Conclusions: While the average disruptive innovation level of papers published by OAMJs is significantly lower than that of authoritative journals, OAMJs have become an important publication channel for innovative research in various research directions. They also provide fairer opportunities for the publication of innovative results from limited-income countries. Therefore, the academic community should recognize the contribution and value of OAMJs to advancing scientific research. UR - https://www.jmir.org/2025/1/e59598 UR - http://dx.doi.org/10.2196/59598 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59598 ER - TY - JOUR AU - Kip, Hanneke AU - Beerlage-de Jong, Nienke AU - van Gemert-Pijnen, C. Lisette J. E. W. AU - Kelders, M. Saskia PY - 2025/1/13 TI - The CeHRes Roadmap 2.0: Update of a Holistic Framework for Development, Implementation, and Evaluation of eHealth Technologies JO - J Med Internet Res SP - e59601 VL - 27 KW - eHealth development KW - eHealth implementation KW - CeHRes Roadmap KW - participatory development KW - human-centered design KW - persuasive design KW - eHealth framework UR - https://www.jmir.org/2025/1/e59601 UR - http://dx.doi.org/10.2196/59601 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59601 ER - TY - JOUR AU - Powell, Daniel AU - Asad, Laiba AU - Zavaglia, Elissa AU - Ferrari, Manuela PY - 2025/1/3 TI - Promoting Digital Health Data Literacy: The Datum Project JO - JMIR Form Res SP - e60832 VL - 9 KW - health data KW - digital data KW - medical records KW - legislation KW - ethics KW - knowledge dissemination KW - learning health system KW - data bank UR - https://formative.jmir.org/2025/1/e60832 UR - http://dx.doi.org/10.2196/60832 ID - info:doi/10.2196/60832 ER - TY - JOUR AU - de Groot, Rowdy AU - van der Graaff, Frank AU - van der Doelen, Daniël AU - Luijten, Michiel AU - De Meyer, Ronald AU - Alrouh, Hekmat AU - van Oers, Hedy AU - Tieskens, Jacintha AU - Zijlmans, Josjan AU - Bartels, Meike AU - Popma, Arne AU - de Keizer, Nicolette AU - Cornet, Ronald AU - Polderman, C. Tinca J. PY - 2024/12/19 TI - Implementing Findable, Accessible, Interoperable, Reusable (FAIR) Principles in Child and Adolescent Mental Health Research: Mixed Methods Approach JO - JMIR Ment Health SP - e59113 VL - 11 KW - FAIR data KW - research data management KW - data interoperability KW - data standardization KW - OMOP CDM KW - implementation KW - health data KW - data quality KW - FAIR principles N2 - Background: The FAIR (Findable, Accessible, Interoperable, Reusable) data principles are a guideline to improve the reusability of data. However, properly implementing these principles is challenging due to a wide range of barriers. Objectives: To further the field of FAIR data, this study aimed to systematically identify barriers regarding implementing the FAIR principles in the area of child and adolescent mental health research, define the most challenging barriers, and provide recommendations for these barriers. Methods: Three sources were used as input to identify barriers: (1) evaluation of the implementation process of the Observational Medical Outcomes Partnership Common Data Model by 3 data managers; (2) interviews with experts on mental health research, reusable health data, and data quality; and (3) a rapid literature review. All barriers were categorized according to type as described previously, the affected FAIR principle, a category to add detail about the origin of the barrier, and whether a barrier was mental health specific. The barriers were assessed and ranked on impact with the data managers using the Delphi method. Results: Thirteen barriers were identified by the data managers, 7 were identified by the experts, and 30 barriers were extracted from the literature. This resulted in 45 unique barriers. The characteristics that were most assigned to the barriers were, respectively, external type (n=32/45; eg, organizational policy preventing the use of required software), tooling category (n=19/45; ie, software and databases), all FAIR principles (n=15/45), and not mental health specific (n=43/45). Consensus on ranking the scores of the barriers was reached after 2 rounds of the Delphi method. The most important recommendations to overcome the barriers are adding a FAIR data steward to the research team, accessible step-by-step guides, and ensuring sustainable funding for the implementation and long-term use of FAIR data. Conclusions: By systematically listing these barriers and providing recommendations, we intend to enhance the awareness of researchers and grant providers that making data FAIR demands specific expertise, available tooling, and proper investments. UR - https://mental.jmir.org/2024/1/e59113 UR - http://dx.doi.org/10.2196/59113 ID - info:doi/10.2196/59113 ER - TY - JOUR AU - Han, Qing PY - 2024/12/11 TI - Topics and Trends of Health Informatics Education Research: Scientometric Analysis JO - JMIR Med Educ SP - e58165 VL - 10 KW - health informatics education KW - scientometric analysis KW - structural topic model KW - health informatics KW - medical informatics KW - medical education N2 - Background: Academic and educational institutions are making significant contributions toward training health informatics professionals. As research in health informatics education (HIE) continues to grow, it is useful to have a clearer understanding of this research field. Objective: This study aims to comprehensively explore the research topics and trends of HIE from 2014 to 2023. Specifically, it aims to explore (1) the trends of annual articles, (2) the prolific countries/regions, institutions, and publication sources, (3) the scientific collaborations of countries/regions and institutions, and (4) the major research themes and their developmental tendencies. Methods: Using publications in Web of Science Core Collection, a scientometric analysis of 575 articles related to the field of HIE was conducted. The structural topic model was used to identify topics discussed in the literature and to reveal the topic structure and evolutionary trends of HIE research. Results: Research interest in HIE has clearly increased from 2014 to 2023, and is continually expanding. The United States was found to be the most prolific country in this field. Harvard University was found to be the leading institution with the highest publication productivity. Journal of Medical Internet Research, Journal of The American Medical Informatics Association, and Applied Clinical Informatics were the top 3 journals with the highest articles in this field. Countries/regions and institutions having higher levels of international collaboration were more impactful. Research on HIE could be modeled into 7 topics related to the following areas: clinical (130/575, 22.6%), mobile application (123/575, 21.4%), consumer (99/575, 17.2%), teaching (61/575, 10.6%), public health (56/575, 9.7%), discipline (55/575, 9.6%), and nursing (51/575, 8.9%). The results clearly indicate the unique foci for each year, depicting the process of development for health informatics research. Conclusions: This is believed to be the first scientometric analysis exploring the research topics and trends in HIE. This study provides useful insights and implications, and the findings could be used as a guide for HIE contributors. UR - https://mededu.jmir.org/2024/1/e58165 UR - http://dx.doi.org/10.2196/58165 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58165 ER - TY - JOUR AU - Tonkikh, Orly AU - Young, M. Heather AU - Bell, F. Janice AU - Famula, Jessica AU - Whitney, Robin AU - Mongoven, Jennifer AU - Kelly, Kathleen PY - 2024/12/10 TI - The Implementation Outcomes and Population Impact of a Statewide IT Deployment for Family Caregivers: Mixed Methods Study JO - JMIR Aging SP - e63355 VL - 7 KW - web-based assessment KW - caregiver KW - technology implementation KW - Consolidated Framework for Implementation Research KW - CFIR KW - information technology KW - IT KW - family caregivers KW - eHealth N2 - Background: In 2022, the US Department of Health and Human Services released the first National Strategy to Support Family Caregivers, identifying actions for both government and the private sector. One of the major goals is to expand data, research, and evidence-based practices to support family caregivers. While IT tools are widely deployed in health care settings, they are rarely available at scale in community agencies. In 2019, the state of California recognized the importance of a statewide database and a platform to serve caregivers remotely by enhancing existing service supports and investing in a web-based platform, CareNav. Implementation commenced in early 2020 across all 11 California Caregiver Resource Centers. Objective: This paper describes the implementation strategies and outcomes of the statewide implementation of CareNav, a web-based platform to support family caregivers. Methods: The Consolidated Framework for Implementation Research (CFIR), including a recent addendum, guided this mixed methods evaluation. Two major approaches were used to evaluate the implementation process: in-depth qualitative interviews with key informants (n=82) and surveys of staff members (n=112) and caregivers (n=2229). We analyzed the interview transcripts using qualitative descriptive methods; subsequently, we identified subthemes and relationships among the ideas, mapping the findings to the CFIR addendum. For the surveys, we used descriptive statistics. Results: We present our findings about implementation strategies, implementation outcomes (ie, adoption, fidelity, and sustainment), and the impact on population health (organizational effectiveness and equity, as well as caregiver satisfaction, health, and well-being). The platform was fully adopted within 18 months, and the system is advancing toward sustainment through statewide collaboration. The deployment has augmented organizational effectiveness and quality, enhanced equity, and improved caregiver health and well-being. Conclusions: This study provides a use case for technological implementation across a multisite system with diverse community-based agencies. Future research can expand the understanding of the barriers and facilitators to achieving relevant outcomes and population impact. UR - https://aging.jmir.org/2024/1/e63355 UR - http://dx.doi.org/10.2196/63355 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63355 ER - TY - JOUR AU - Atigossou, Gbčtoho Orthelo Léonel AU - Capo-chichi, Martial Sčgbédji Joseph AU - Mitcha?, Mahutchegnon Penielle AU - Honado, S. Aristide PY - 2024/12/9 TI - Evaluating the Impact of Assistive Technologies on Individuals With Disabilities in Benin: Protocol for a Cross-Sectional Study JO - JMIR Res Protoc SP - e60869 VL - 13 KW - assistive technologies KW - assistive technology assessment KW - individuals with disabilities KW - disabilities KW - cross-sectional study KW - well-being KW - quality of life KW - effects KW - Benin N2 - Background: A significant proportion of individuals with disabilities in resource-limited countries require at least 1 assistive technology (AT) device to enhance their functioning and autonomy. However, there is limited evidence regarding the actual needs of AT users in these regions concerning the adequacy of ATs. Objective: This research aims to assess the effects of ATs on AT users in a resource-limited country. Methods: A cross-sectional study will be conducted in Benin, a sub-Saharan African country, using a nonprobability sample of AT users. Participants will undergo evaluation using standardized tools to assess their psycho-affective status, satisfaction with ATs, perception of the functional effects of ATs, well-being, and quality of life. Additionally, a survey based on the World Health Organization's rATA (rapid assistive technology assessment) tool will be conducted to gather sociodemographic and other data concerning the use of ATs. The findings will be organized and discussed using the Consortium on Assistive Technology Outcomes Research taxonomy, focusing on aspects related to the effectiveness and social significance of ATs, as well as the subjective well-being of AT users. Results: The process of identifying potential participants began in August 2024, and data collection is scheduled to start in January 2025 and continue for 12 months. Conclusions: This research will provide an overview of the effects induced by the use of ATs, as well as describe the profile of AT users in Benin. To our knowledge, this will be the first study to examine the impact of ATs in Benin. It will therefore make a significant contribution to the existing data on the use of ATs in sub-Saharan Africa. International Registered Report Identifier (IRRID): PRR1-10.2196/60869 UR - https://www.researchprotocols.org/2024/1/e60869 UR - http://dx.doi.org/10.2196/60869 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60869 ER - TY - JOUR AU - Vanderhout, Shelley AU - Bird, Marissa AU - Giannarakos, Antonia AU - Panesar, Balpreet AU - Whitmore, Carly PY - 2024/12/6 TI - Evaluation Methods, Indicators, and Outcomes in Learning Health Systems: Protocol for a Jurisdictional Scan JO - JMIR Res Protoc SP - e57929 VL - 13 KW - learning health systems KW - evaluation KW - jurisdictional scan KW - counterfactuals KW - LHS KW - health system KW - real-time evidence KW - informatics KW - organizational culture KW - learning cycles KW - benchmark KW - patient care KW - gaps KW - health care KW - inequities KW - development KW - implementation KW - intervention KW - new approach N2 - Background: In learning health systems (LHSs), real-time evidence, informatics, patient-provider partnerships and experiences, and organizational culture are combined to conduct ?learning cycles? that support improvements in care. Although the concept of LHSs is fairly well established in the literature, evaluation methods, mechanisms, and indicators are less consistently described. Furthermore, LHSs often use ?usual care? or ?status quo? as a benchmark for comparing new approaches to care, but disentangling usual care from multifarious care modalities found across settings is challenging. There is a need to identify which evaluation methods are used within LHSs, describe how LHS growth and maturity are conceptualized, and determine what tools and measures are being used to evaluate LHSs at the system level. Objective: This study aimed to (1) identify international examples of LHSs and describe their evaluation approaches, frameworks, indicators, and outcomes; and (2) describe common characteristics, emphases, assumptions, or challenges in establishing counterfactuals in LHSs. Methods: A jurisdictional scan, which is a method used to explore, understand, and assess how problems have been framed by others in a given field, will be conducted according to modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. LHSs will be identified through a search of peer-reviewed and gray literature using Ovid MEDLINE, EBSCO CINAHL, Ovid Embase, Clarivate Web of Science, PubMed non-MEDLINE databases, and the web. We will describe evaluation approaches used both at the LHS learning cycle and system levels. To gain a comprehensive understanding of each LHS, including details specific to evaluation, self-identified LHSs will be included if they are described according to at least 4 of 11 prespecified criteria (core functionalities, analytics, use of evidence, co-design or implementation, evaluation, change management or governance structures, data sharing, knowledge sharing, training or capacity building, equity, and sustainability). Search results will be screened, extracted, and analyzed to inform a descriptive review pertaining to our main objectives. Evaluation methods and approaches, both within learning cycles and at the system level, as well as frameworks, indicators, and target outcomes, will be identified and summarized descriptively. Across evaluations, common challenges, assumptions, contextual factors, and mechanisms will be described. Results: As of October 2024, the database searches described above yielded 3503 citations after duplicate removal. Full-text screening of 117 articles is complete, and 49 articles are under analysis. Results are expected in early 2025. Conclusions: This research will characterize the current landscape of LHS evaluation approaches and provide a foundation for developing consistent and scalable metrics of LHS growth, maturity, and success. This work will also serve to identify opportunities for improving the alignment of current evaluation approaches and metrics with population health needs, community priorities, equity, and health system strategic aims. Trial Registration: Open Science Framework b5u7e; https://osf.io/b5u7e International Registered Report Identifier (IRRID): DERR1-10.2196/57929 UR - https://www.researchprotocols.org/2024/1/e57929 UR - http://dx.doi.org/10.2196/57929 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57929 ER - TY - JOUR AU - Sussex, Jon AU - Atherton, Helen AU - Abel, Gary AU - Clark, Christopher AU - Cockcroft, Emma AU - Leach, Brandi AU - Marriott, Christine AU - Newbould, Jennifer AU - Pitchforth, Emma AU - Winder, Rachel AU - Campbell, John PY - 2024/12/4 TI - Supporting Patients? Use of Digital Services in Primary Health Care in England: Synthesis of Evidence From a Mixed Methods Study of ?Digital Facilitation? JO - JMIR Hum Factors SP - e52516 VL - 11 KW - web-based health services KW - primary care KW - digital facilitation KW - evidence synthesis KW - medical practitioners KW - digital services KW - digital intervention KW - mixed methods study KW - scoping review KW - ethnography N2 - Background: General medical practitioners and other staff at primary care medical practices have an important role in facilitating patient access to online services in the National Health Service in England. These services range from online ordering of repeat prescriptions to conducting online consultations with health care professionals. We have defined ?digital facilitation? as that range of processes, procedures, and personnel that seeks to support patients in their uptake and use of online services. Objective: We report how we have synthesized the evidence from a mixed methods study of digital facilitation in primary care in England. The study?s objectives were to identify, characterize, and explore the benefits and challenges of different models of digital facilitation in general medical practices in England and to design a framework for evaluation of the effectiveness and costs of digital facilitation interventions. Methods: Our study comprised scoping review of literature, survey of staff in general practices, survey of patients, and ethnography at case study practices plus stakeholder interviews. We compiled a triangulation matrix of the findings from individual work packages through an iterative process whereby each work package?s results were first analyzed separately and were then cumulatively combined across work packages in 3 successive workshops. From the resulting matrix, we developed a program theory and an implementation theory and constructed a framework for evaluations of digital facilitation in primary care. The final step of the synthesis process was to discuss the results with national and regional National Health Service stakeholders. Results: Triangulation yielded a combined set of findings summarized within 11 thematic groupings: 3 setting the scene within which digital facilitation takes place, and 8 related to different types of digital facilitation, their implementation, and effectiveness. Some thematic groupings were evident in the findings of all 4 of the research work packages; others were not addressed in all the work packages but were evident from those where they were addressed. Throughout the synthesis, there were no instances where findings from one work package contradicted the findings of another. Findings either reinforced each other or offered complementary or additional insights. The discussion at the stakeholder meeting held at the end of the study resulted in the research team clarifying some findings but not changing any of them. Conclusions: Digital facilitation can take many forms, though much of what is currently done in primary care practices in England is reactive and passive. Clear lines of responsibility, digital tools and platforms that work well for patients and practice staff, and investment in staff time and training are all needed if digital facilitation is to deliver on its promise. We propose a framework for future evaluations of the effectiveness and costs of digital facilitation interventions. UR - https://humanfactors.jmir.org/2024/1/e52516 UR - http://dx.doi.org/10.2196/52516 ID - info:doi/10.2196/52516 ER - TY - JOUR AU - Benjamin, Jennifer AU - Pillow, Tyson AU - MacNeill, Heather AU - Masters, Ken AU - Agrawal, Anoop AU - Mehta, Neil PY - 2024/12/3 TI - Reflections From the Pandemic: Is Connectivism the Panacea for Clinicians? JO - J Med Internet Res SP - e53344 VL - 26 KW - learning theory KW - learning framework KW - connectivism KW - panacea KW - COVID-19 KW - generative artificial intelligence KW - GAI KW - health care community KW - clinician KW - health care KW - airborne disease KW - learning KW - information KW - misinformation KW - autonomy KW - diversity UR - https://www.jmir.org/2024/1/e53344 UR - http://dx.doi.org/10.2196/53344 UR - http://www.ncbi.nlm.nih.gov/pubmed/39625749 ID - info:doi/10.2196/53344 ER - TY - JOUR AU - Preti, M. Luigi AU - Ardito, Vittoria AU - Compagni, Amelia AU - Petracca, Francesco AU - Cappellaro, Giulia PY - 2024/11/25 TI - Implementation of Machine Learning Applications in Health Care Organizations: Systematic Review of Empirical Studies JO - J Med Internet Res SP - e55897 VL - 26 KW - artificial intelligence KW - machine learning KW - implementation KW - health care organization KW - barriers KW - facilitators N2 - Background: There is a growing enthusiasm for machine learning (ML) among academics and health care practitioners. Despite the transformative potential of ML-based applications for patient care, their uptake and implementation in health care organizations are sporadic. Numerous challenges currently impede or delay the widespread implementation of ML in clinical practice, and limited knowledge is available regarding how these challenges have been addressed. Objective: This work aimed to (1) examine the characteristics of ML-based applications and the implementation process in clinical practice, using the Consolidated Framework for Implementation Research (CFIR) for theoretical guidance and (2) synthesize the strategies adopted by health care organizations to foster successful implementation of ML. Methods: A systematic literature review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was conducted in PubMed, Scopus, and Web of Science over a 10-year period (2013-2023). The search strategy was built around 4 blocks of keywords (artificial intelligence, implementation, health care, and study type). Only empirical studies documenting the implementation of ML applications in clinical settings were considered. The implementation process was investigated using a thematic analysis and coding procedure. Results: Thirty-four studies were selected for data synthesis. Selected papers were relatively recent, with only 9% (3/34) of records published before 2019. ML-based applications were implemented mostly within hospitals (29/34, 85%). In terms of clinical workflow, ML-based applications supported mostly prognosis (20/34, 59%) and diagnosis (10/34, 29%). The implementation efforts were analyzed using CFIR domains. As for the inner setting domain, access to knowledge and information (12/34, 35%), information technology infrastructure (11/34, 32%), and organizational culture (9/34, 26%) were among the most observed dimensions influencing the success of implementation. As for the ML innovation itself, factors deemed relevant were its design (15/34, 44%), the relative advantage with respect to existing clinical practice (14/34, 41%), and perceived complexity (14/34, 41%). As for the other domains (ie, processes, roles, and outer setting), stakeholder engagement (12/34, 35%), reflecting and evaluating practices (11/34, 32%), and the presence of implementation leaders (9/34, 26%) were the main factors identified as important. Conclusions: This review sheds some light on the factors that are relevant and that should be accounted for in the implementation process of ML-based applications in health care. While the relevance of ML-specific dimensions, like trust, emerges clearly across several implementation domains, the evidence from this review highlighted that relevant implementation factors are not necessarily specific for ML but rather transversal for digital health technologies. More research is needed to further clarify the factors that are relevant to implementing ML-based applications at the organizational level and to support their uptake within health care organizations. Trial Registration: PROSPERO 403873; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=403873 International Registered Report Identifier (IRRID): RR2-10.2196/47971 UR - https://www.jmir.org/2024/1/e55897 UR - http://dx.doi.org/10.2196/55897 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55897 ER - TY - JOUR AU - Blank, Ann Carol AU - Biedka, Sarah AU - Montalmant, Abigail AU - Saft, Katelyn AU - Lape, Miranda AU - Mao, Kate AU - Bradt, Joke AU - Liou, T. Kevin PY - 2024/11/22 TI - Scope, Findability, and Quality of Information About Music-Based Interventions in Oncology: Quantitative Content Analysis of Public-Facing Websites at National Cancer Institute?Designated Cancer Centers JO - JMIR Cancer SP - e53440 VL - 10 KW - music-based interventions KW - cancer KW - oncology KW - symptom management KW - music therapy KW - music services KW - National Cancer Institute N2 - Background: Music-based interventions (MBIs) are evidence-based, nonpharmacological treatments that include music therapy (MT) delivered by board-certified music therapists, as well as music services (MS) delivered by other health professionals and volunteers. Despite MBI?s growing evidence base in cancer symptom management, it remains unclear how MBI-related information is presented to the public. Over 80% of people with cancer use the internet to find health-related information. In the United States, the National Cancer Institute (NCI) identifies certain Cancer Centers (CCs) as NCI-designated CCs or Comprehensive Cancer Centers (CCCs) based on their excellence in research. As NCI-designated CCs and CCCs are considered the gold standard in cancer care, their websites are viewed by the public as important sources of information. Objective: We aimed to determine scope, findability, and quality of MBI-related information on public-facing websites of NCI-designated CCs/CCCs. Methods: We reviewed 64 NCI-designated CC/CCC websites (excluding basic laboratories) between November 2022 and January 2023. We extracted data on the scope of information: (1) type of MBI offered (MT or MS), (2) format (individual, group), (3) method of delivery (in person or remotely delivered), (4) setting (inpatient or outpatient), (5) target population (pediatric or adult), (6) MBI practitioner qualifications, (7) clinical indications or benefits, (8) presence of testimonials, (9) cost, and (10) scheduling or referral information. We also extracted data on findability (ie, presence of direct link or drop-down menu and the number of clicks to locate MBI-related information). Based on the scope and findability data, we rated the information quality as high, moderate, or low using an adapted scale informed by prior research. Results: Thirty-one (48%) of the 64 CC/CCCs described MBIs on their websites. Of these, 6 (19%) mentioned both MT and MS, 16 (52%) mentioned MT only, and 9 (29%) mentioned MS only. The most common format was hybrid, involving individuals and groups (n=20, 65%). The most common delivery method was in person (n=16, 52%). The most common target population was adults (n=12, 39%). The most common MBI practitioners were board-certified music therapists (n=21, 68%). The most described indications or benefits were psychological. Twenty-eight (90%) websites lacked testimonials, and 26 (84%) lacked cost information. Twenty-six (84%) websites provided scheduling or referral information. MBI-related information was found with an average of 4 (SD 1) clicks. Nine (29%) websites were of high quality, 18 (58%) were moderate, and 4 (13%) were low. Conclusions: Based on public websites, MBIs were most commonly delivered in person by board-certified music therapists to outpatient and inpatient adults, using individual and group formats to provide psychological benefits. The findability and quality of this information should be improved to promote the dissemination of MBIs for cancer symptom management. UR - https://cancer.jmir.org/2024/1/e53440 UR - http://dx.doi.org/10.2196/53440 ID - info:doi/10.2196/53440 ER - TY - JOUR AU - Bermejo-Martínez, Gemma AU - Julián, Antonio José AU - Villanueva-Blasco, José Víctor AU - Aibar, Alberto AU - Corral-Abós, Ana AU - Abarca-Sos, Alberto AU - Generelo, Eduardo AU - Mur, Melania AU - Bueno, Manuel AU - Ferrer, Elisa AU - Artero, Isabel AU - García-González, Luis AU - Murillo-Pardo, Berta AU - Ferriz, Roberto AU - Menal-Puey, Susana AU - Marques-Lopes, Iva AU - Fajó-Pascual, Marta AU - Ibor-Bernalte, Eduardo AU - Zaragoza Casterad, Javier PY - 2024/11/20 TI - Development of a Web Platform to Facilitate the Implementation and Evaluation of Health Promoting Schools: Protocol for a Double Diamond Design Approach JO - JMIR Res Protoc SP - e52110 VL - 13 KW - web platform KW - health promoting schools KW - co-design process KW - Double Diamond Design Model KW - implementation processes. N2 - Background: Health Promoting Schools (HPS) have emerged as a powerful framework to promote healthy behaviors in many countries. However, HPS still present several challenges, highlighting the excessive workload involved in the accreditation, design, implementation, and evaluation processes. In this sense, a resource to facilitate the implementation processes may have a positive impact on the support of HPS. Objective: The aim of this study was to describe the co-design processes undertaken and resulting learnings to develop the Red Escuelas Promotoras de Salud (network of health promoting schools; REDEPS)-Gestion platform to facilitate the accreditation, design, implementation procedures, and evaluation processes of the Aragon's Health-Promoting School Network. Methods: The Double Diamond Design Approach was used to co-design this web-platform. The different stakeholders that participated in this co-design, progressed through a 4-stage reflective phase, to discover, define, develop, and deliver the REDEPS-Gestion platform. Results: Participants agreed that the functions of the REDEPS-Gestion platform should permit the management of both the educational centers and the administration such as accreditation processes, definition and review intervention projects, and preparation and review of the different progress reports to evaluate the HPS. Despite co-design being a well-established approach to creative practice, especially within the public sector, some challenges emerged during the co-design process, such as engaging and facilitating stakeholders? participation or the complexity of combining the interests of all stakeholders. This approach allowed us to identify the main barriers for future users and implement platform improvements. Conclusions: We hope that the REDEPS-Gestion platform will therefore be able to contribute to facilitating the implementation of HPS. The Double Diamond Design Approach used to co-design this web platform was an efficient and feasible methodological design approach. The REDEPS-Gestion platform will facilitate HPS implementation in Aragon as well as all the processes involving HPS. Future work will determine its effectiveness in improving HPS implementation. International Registered Report Identifier (IRRID): DERR1-10.2196/52110 UR - https://www.researchprotocols.org/2024/1/e52110 UR - http://dx.doi.org/10.2196/52110 UR - http://www.ncbi.nlm.nih.gov/pubmed/39566054 ID - info:doi/10.2196/52110 ER - TY - JOUR AU - Abbasgholizadeh Rahimi, Samira AU - Shrivastava, Richa AU - Brown-Johnson, Anita AU - Caidor, Pascale AU - Davies, Claire AU - Idrissi Janati, Amal AU - Kengne Talla, Pascaline AU - Madathil, Sreenath AU - Willie, M. Bettina AU - Emami, Elham PY - 2024/11/15 TI - EDAI Framework for Integrating Equity, Diversity, and Inclusion Throughout the Lifecycle of AI to Improve Health and Oral Health Care: Qualitative Study JO - J Med Internet Res SP - e63356 VL - 26 KW - equity, diversity, and inclusion KW - EDI KW - health care KW - oral health care KW - machine learning KW - artificial intelligence KW - AI N2 - Background: Recent studies have identified significant gaps in equity, diversity, and inclusion (EDI) considerations within the lifecycle of artificial intelligence (AI), spanning from data collection and problem definition to implementation stages. Despite the recognized need for integrating EDI principles, there is currently no existing guideline or framework to support this integration in the AI lifecycle. Objective: This study aimed to address this gap by identifying EDI principles and indicators to be integrated into the AI lifecycle. The goal was to develop a comprehensive guiding framework to guide the development and implementation of future AI systems. Methods: This study was conducted in 3 phases. In phase 1, a comprehensive systematic scoping review explored how EDI principles have been integrated into AI in health and oral health care settings. In phase 2, a multidisciplinary team was established, and two 2-day, in-person international workshops with over 60 representatives from diverse backgrounds, expertise, and communities were conducted. The workshops included plenary presentations, round table discussions, and focused group discussions. In phase 3, based on the workshops? insights, the EDAI framework was developed and refined through iterative feedback from participants. The results of the initial systematic scoping review have been published separately, and this paper focuses on subsequent phases of the project, which is related to framework development. Results: In this study, we developed the EDAI framework, a comprehensive guideline that integrates EDI principles and indicators throughout the entire AI lifecycle. This framework addresses existing gaps at various stages, from data collection to implementation, and focuses on individual, organizational, and systemic levels. Additionally, we identified both the facilitators and barriers to integrating EDI within the AI lifecycle in health and oral health care. Conclusions: The developed EDAI framework provides a comprehensive, actionable guideline for integrating EDI principles into AI development and deployment. By facilitating the systematic incorporation of these principles, the framework supports the creation and implementation of AI systems that are not only technologically advanced but also sensitive to EDI principles. UR - https://www.jmir.org/2024/1/e63356 UR - http://dx.doi.org/10.2196/63356 UR - http://www.ncbi.nlm.nih.gov/pubmed/39546793 ID - info:doi/10.2196/63356 ER - TY - JOUR AU - Shojaei, Fereshtehossadat AU - Shojaei, Fatemehalsadat AU - Desai, P. Archita AU - Long, Emily AU - Mehta, Jade AU - Fowler, R. Nicole AU - Holden, J. Richard AU - Orman, S. Eric AU - Boustani, Malaz PY - 2024/11/13 TI - The Feasibility of AgileNudge+ Software to Facilitate Positive Behavioral Change: Mixed Methods Design JO - JMIR Form Res SP - e57390 VL - 8 KW - AgileNudge+ KW - agile KW - nudge strategy KW - nudging interventions KW - agile implementation KW - human behavior KW - software design KW - human-computer interaction KW - user experience design KW - usability testing N2 - Background: In today?s digital age, web-based apps have become integral to daily life, driving transformative shifts in human behavior. ?AgileNudge+? (Indiana University Center for Health Innovation and Implementation Science) is a web-based solution to simplify the process of positive behavior change using nudging as an intervention. By integrating knowledge from behavioral economics with technology, AgileNudge+ organizes multiple steps, simplifies complex tasks, minimizes errors by enhancing user engagement, and provides resources for creating and testing nudge interventions. Objective: This paper aimed to outline the design process, methodologies, and usefulness of ?AgileNudge+? for the development of evidence-based nudges. It used a mixed methods approach to evaluate the software?s interface usability and usefulness for creating and testing nudge interventions. Methods: AgileNudge+ was developed through iterative processes integrating principles from behavioral economics and user-centered design. The content of AgileNudge+ operationalizes an Agile science?based process to efficiently design, embed, and disseminate evidence-based nudges that encourage positive behavior change without limiting choice. Using a mixed methods approach, we tested AgileNudge+ software?s ability to organize and simplify the nudge intervention process, allowing a diverse range of scholars with limited knowledge of Agile science to use nudges. Usability testing assessed the tool?s usefulness and interface with a sample of 18 health care professionals, each asked to interact with the software and create a nudge intervention to solve a problem within their professional project?s sphere. Results: The study was funded in August 2022, with data collection occurring from June 2023 to July 2024. As of July 2024, we have enrolled 18 participants. Quantitative results found a mean usefulness rating of AgileNudge+ of 3.83 (95% CI 3.00-4.66). Qualitative results highlighted ways to modify the language used in AgileNudge+ to be more comprehensible to a diverse user base and promoted modifications to the software that facilitate real-time assistance and prioritize time efficiency in user interactions. Feedback further supported the positive impact of gamification on participant motivation when using the software. Conclusions: AgileNudge+ is an effective assistive tool for simplifying the positive behavior change process using nudge interventions, with tailored content and interactions to meet users? needs and demands. Building onto the current design, future iterations of AgileNudge+ will use artificial intelligence to process large volumes of data while reducing the time and mental energy required to scan for existing cognitive biases and nudge prototypes. The software is also being upgraded to build on current gamification efforts, encouraging more sustained motivation by increasing the temporal resolution of the digital interface. These modifications stay true to the agility and user-centered aspects of AgileNudge+, emphasizing the novelty of the constantly evolving software design process. UR - https://formative.jmir.org/2024/1/e57390 UR - http://dx.doi.org/10.2196/57390 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57390 ER - TY - JOUR AU - Oudshoorn, Cathelijn AU - Frielink, Noud AU - Riper, Heleen AU - Embregts, Petri PY - 2024/11/12 TI - Acceptance and Use of eHealth in Support and Psychological Therapy for People With Intellectual Disabilities: Two Cross-Sectional Studies of Health Care Professionals JO - JMIR Form Res SP - e52788 VL - 8 KW - acceptance KW - health care professionals KW - intellectual disabilities KW - eHealth KW - disability KW - psychological therapy KW - support KW - cross-sectional survey N2 - Background: Acceptance of health care professionals is of paramount importance for the uptake and implementation of eHealth. The Unified Theory of Acceptance and Use of Technology (UTAUT) model is a widely used framework for studying health care professionals? acceptance and actual use of eHealth among general client populations. However, there is limited understanding of the eHealth acceptance of health care professionals working with people with intellectual disabilities (ID). Objective: This study aimed to explore the applicability of the UTAUT model toward understanding the acceptance, intention to use, and actual use of eHealth among support staff and therapists working with people with ID. Methods: A total of 2 cross-sectional survey studies were conducted among health care professionals from 5 health care organizations for people with ID in the Netherlands in 2018 (n=311) and in 2021 during the COVID-19 pandemic (n=326). In addition to confirmatory and exploratory factor analyses to evaluate both the original UTAUT model and an extended version, descriptive analysis was used to explore participants? characteristics, acceptance levels, and eHealth usage. Moderator analysis and multiple regression analysis were also used. Results: A confirmatory factor analysis indicated a poor fit for both the original 4-factor UTAUT model and the extended version. An exploratory factor analysis was then conducted, resulting in a more satisfactory 5-factor model after removing 1 item with a factor loading <.40. Internal consistency of the 5 factors ranged from acceptable to good (Cronbach ?=.76-.85). Collectively, all factors predicted the intention to use eHealth in 2018 (R2=0.47; F5,305=54.885; P<.001) and in 2021 (R2=0.43; F5,320=49.32; P<.001). Participants scored moderately on all 5 acceptance factors in both 2018 and 2021. Moderator analysis indicated that age and voluntariness influence the relationship between factors that determined acceptance and intention to use eHealth. Conclusions: The findings from 2 cross-sectional studies conducted in 2018 and 2021, using an extended UTAUT model, gave a deeper understanding of eHealth acceptance among health care professionals who work with people with ID. UR - https://formative.jmir.org/2024/1/e52788 UR - http://dx.doi.org/10.2196/52788 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52788 ER - TY - JOUR AU - Deinboll, Anne AU - Moe, Fredriksen Cathrine AU - Ludvigsen, Spliid Mette PY - 2024/11/11 TI - Participation in eHealth Communication Interventions Among Patients Undergoing Hemodialysis: Scoping Review JO - J Med Internet Res SP - e51900 VL - 26 KW - eHealth KW - electronic health records KW - hemodialysis KW - patient participation KW - renal dialysis KW - renal insufficiency KW - chronic KW - mobile phone N2 - Background: eHealth communication interventions have been shown to offer individuals with chronic kidney disease the opportunity to embrace dialysis therapies with greater confidence, the potential to obtain better clinical outcomes, and an increased quality of life. eHealth is an emerging field that offers diverse, flexible designs and delivery options. However, existing evidence on eHealth communication among patients undergoing hemodialysis is sparse and scattered and lacks systematization. Objective: This scoping review aims to identify and map the current evidence on patient participation in eHealth communication interventions. We aimed to map the associations between interventions and electronic health records, the participative role of individuals living with chronic kidney disease and undergoing hemodialysis, and the barriers to and facilitators of patient involvement in eHealth communication with health care professionals. Methods: This study used the Joanna Briggs Institute methodology for conducting a scoping review. Studies eligible for inclusion were those that included adult patients (aged >18 y) undergoing all types of hemodialysis, including prescheduled in-center hemodialysis and conventional home-based hemodialysis. Systematic searches were completed in Ovid MEDLINE, Ovid Embase, EBSCOhost CINAHL with Full Text, Scopus, and ProQuest Dissertations and Theses. Extracted data from the included studies were presented in figures and tables along with descriptions that responded to the research questions. This review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: In total, 9 peer-reviewed studies were included. The main result was a low participative patient role and a vaguely described link to electronic health records. The key participative facilitators were availability of and access to the intervention; security, trust, and confidence; patient knowledge of their health situation and use of self-care; and patient preparedness for an uncertain future health situation and the ability to relate to family and friends about it. The key participative barriers were lack of availability of and access to information, mistrust and lack of safety, lack of knowledge of health situation and self-care, and relational issues. All barriers and facilitators were related to health literacy. Conclusions: This scoping review summarizes 4 specific and 3 nonspecific eHealth communication interventions developed and evaluated in various studies involving patients receiving hemodialysis. A knowledge gap exists between low levels of patient participation in eHealth communication and patients? limited access to electronic health records. eHealth communication interventions should implement patient participation and focus on the fact that different modalities of eHealth communication can complement face-to-face communication. International Registered Report Identifier (IRRID): RR2-10.2196/38615 UR - https://www.jmir.org/2024/1/e51900 UR - http://dx.doi.org/10.2196/51900 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51900 ER - TY - JOUR AU - Pimenta, Cristina M. AU - Torres, Silva Thiago AU - Hoagland, Brenda AU - Cohen, Mirian AU - Mann, Gruber Claudio AU - Jalil, M. Cristina AU - Carvalheira, Eduardo AU - Freitas, Lucilene AU - Fernandes, Nilo AU - Castanheira, Debora AU - Benedetti, Marcos AU - Moreira, Julio AU - Simpson, Keila AU - Trefiglio, Roberta AU - O?Malley, Gabrielle AU - Veloso, G. Valdilea AU - Grinsztejn, Beatriz PY - 2024/10/24 TI - Preparing for the Implementation of Long-Acting Injectable Cabotegravir for HIV Pre-Exposure Prophylaxis Within the Brazilian Public Health System (ImPrEP CAB Brasil): Qualitative Study JO - JMIR Public Health Surveill SP - e60961 VL - 10 KW - pre-exposure prophylaxis KW - PrEP KW - implementation KW - public health system KW - cabotegravir KW - HIV prevention KW - Latin America KW - long-acting PrEP N2 - Background: Although long-acting, injectable cabotegravir (CAB-LA) pre-exposure prophylaxis (PrEP) has proven efficacious for HIV prevention in clinical trials, research is needed to guide effective implementation in real-world settings. Formative work with community members and health care providers (HCPs) is important to provide insight into the needs and contexts of specific populations and reveal potential barriers and facilitators for implementation projects. Objective: We aimed to describe the results from formative work to develop an implementation package for CAB-LA PrEP within the ImPrEP CAB Brasil study. Methods: ImPrEP CAB Brasil is an implementation study of same-day delivery of CAB-LA PrEP for young sexual and gender minority (SGM) groups (aged 18-30 years) in 6 existing oral PrEP public health clinics. We conducted formative research to prepare for the implementation of ImPrEP CAB Brasil through community mobilization, process mapping with HCPs with experience in CAB-LA, and focus group discussions (FGDs) with young SGM groups (n=92) and HCPs (n=20) to identify initial perceptions of facilitators and barriers for CAB-LA PrEP implementation, refine the mobile health (mHealth) educational tool, and evaluate the acceptability of using a text message appointment reminder intervention through WhatsApp. FGDs were recorded, transcribed, systematically coded, and analyzed with thematic categorization by trained researchers using a qualitative data analysis program ATLAS.ti (version 7). Results: A community mobilization team comprising 34 SGM community leaders collaborated in creating a prototype for an mHealth educational tool and contributed to the planning of peer education activities. We created 3 process maps for each site to describe the initial visit, follow-up visits, and laboratory flow. The main challenge identified for same-day CAB-LA PrEP delivery was the extended duration of clinic visits due to the numerous laboratory tests and HIV counseling steps required. Proposed solutions included having point-of-care HIV rapid tests instead of laboratory tests and additional counseling staff. Barriers for CAB-LA PrEP implementation identified through FGDs were the training of HCPs, support for adherence to injection appointments, and stigma or discrimination against SGM groups and persons using PrEP. The mHealth educational tool and WhatsApp reminders were highly acceptable by SGM groups and HCPs, indicating their potential to support PrEP choice and adherence. Content analysis on the cultural appropriateness of the language and overall clarity of the material contributed to the refinement of the mHealth tool. Conclusions: Structured formative work with SGM persons and HCPs generated important refinements to context-specific materials and plans to launch ImPrEP CAB Brasil in public health clinics. Ongoing implementation monitoring will use the process maps to identify additional barriers and potential solutions to same-day delivery of CAB-LA PrEP. Summative evaluations are needed to measure the effectiveness of the mHealth educational tool to support PrEP choice and the use of WhatsApp appointment reminders. UR - https://publichealth.jmir.org/2024/1/e60961 UR - http://dx.doi.org/10.2196/60961 UR - http://www.ncbi.nlm.nih.gov/pubmed/39446416 ID - info:doi/10.2196/60961 ER - TY - JOUR AU - Fernando, Manasha AU - Abell, Bridget AU - McPhail, M. Steven AU - Tyack, Zephanie AU - Tariq, Amina AU - Naicker, Sundresan PY - 2024/10/17 TI - Applying the Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability Framework Across Implementation Stages to Identify Key Strategies to Facilitate Clinical Decision Support System Integration Within a Large Metropolitan Health Service: Interview and Focus Group Study JO - JMIR Med Inform SP - e60402 VL - 12 KW - medical informatics KW - adoption and implementation KW - behavior KW - health systems N2 - Background: Computerized clinical decision support systems (CDSSs) enhance patient care through real-time, evidence-based guidance for health care professionals. Despite this, the effective implementation of these systems for health services presents multifaceted challenges, leading to inappropriate use and abandonment over the course of time. Using the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework, this qualitative study examined CDSS adoption in a metropolitan health service, identifying determinants across implementation stages to optimize CDSS integration into health care practice. Objective: This study aims to identify the theory-informed (NASSS) determinants, which included multiple CDSS interventions across a 2-year period, both at the health-service level and at the individual hospital setting, that either facilitate or hinder the application of CDSSs within a metropolitan health service. In addition, this study aimed to map these determinants onto specific stages of the implementation process, thereby developing a system-level understanding of CDSS application across implementation stages. Methods: Participants involved in various stages of the implementation process were recruited (N=30). Participants took part in interviews and focus groups. We used a hybrid inductive-deductive qualitative content analysis and a framework mapping approach to categorize findings into barriers, enablers, or neutral determinants aligned to NASSS framework domains. These determinants were also mapped to implementation stages using the Active Implementation Framework stages approach. Results: Participants comprised clinical adopters (14/30, 47%), organizational champions (5/30, 16%), and those with roles in organizational clinical informatics (5/30, 16%). Most determinants were mapped to the organization level, technology, and adopter subdomains. However, the study findings also demonstrated a relative lack of long-term implementation planning. Consequently, determinants were not uniformly distributed across the stages of implementation, with 61.1% (77/126) identified in the exploration stage, 30.9% (39/126) in the full implementation stage, and 4.7% (6/126) in the installation stages. Stakeholders engaged in more preimplementation and full-scale implementation activities, with fewer cycles of monitoring and iteration activities identified. Conclusions: These findings addressed a substantial knowledge gap in the literature using systems thinking principles to identify the interdependent dynamics of CDSS implementation. A lack of sustained implementation strategies (ie, training and longer-term, adopter-level championing) weakened the sociotechnical network between developers and adopters, leading to communication barriers. More rigorous implementation planning, encompassing all 4 implementation stages, may, in a way, help in addressing the barriers identified and enhancing enablers. UR - https://medinform.jmir.org/2024/1/e60402 UR - http://dx.doi.org/10.2196/60402 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60402 ER - TY - JOUR AU - Meskó, Bertalan AU - Kristóf, Tamás AU - Dhunnoo, Pranavsingh AU - Árvai, Nóra AU - Katonai, Gellért PY - 2024/10/9 TI - Exploring the Need for Medical Futures Studies: Insights From a Scoping Review of Health Care Foresight JO - J Med Internet Res SP - e57148 VL - 26 KW - foresight KW - futures studies KW - health care future KW - medical futures KW - technology foresight N2 - Background: The historical development and contemporary instances of futures studies, an interdisciplinary field that focuses on exploring and formulating alternative futures, exemplify the increasing significance of using futures methods in shaping the health care domain. Despite the wide array of these methodologies, there have been limited endeavors to employ them within the medical community thus far. Objective: We undertook the first scoping review to date about the application of futures methodologies and published foresight projects in health care. Methods: Through the use of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) method, we identified 59 studies that were subsequently categorized into the following 5 distinct themes: national strategies (n=19), strategic health care foresight (n=15), health care policy and workforce dynamics (n=6), pandemic preparedness and response (n=7), and specialized medical domains (n=12). Results: Our scoping review revealed that the application of futures methods and foresight has been successfully demonstrated in a wide range of fields, including national strategies, policy formulation, global threat preparedness, and technological advancements. The results of our review indicate that a total of 8 futures methods have already been used in medicine and health care, while there are more than 50 futures methods available. It may underscore the notion that the field is unexploited. Furthermore, the absence of structured methodologies and principles for employing foresight and futures techniques in the health care domain warrants the creation of medical futures studies as a separate scientific subfield within the broad domains of health care, medicine, and life sciences. This subfield would focus on the analysis of emerging technological trends, the evaluation of policy implications, and the proactive anticipation and mitigation of potential challenges. Conclusions: Futures studies can significantly enhance medical science by addressing a crucial deficiency in the promotion of democratic participation, facilitating interdisciplinary dialogue, and shaping alternative futures. To further contribute to the development of a new research community in medical futures studies, it is recommended to establish a specialized scientific journal. Additionally, appointing dedicated futurists in decision-making and national strategy, and incorporating futures methods into the medical curriculum could be beneficial. UR - https://www.jmir.org/2024/1/e57148 UR - http://dx.doi.org/10.2196/57148 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57148 ER - TY - JOUR AU - Juhl, Haase Marie AU - Soerensen, Lykkegaard Ann AU - Vardinghus-Nielsen, Henrik AU - Mortensen, Sinding Lea AU - Kolding Kristensen, Jette AU - Olesen, Estrup Anne PY - 2024/10/9 TI - Designing an Intervention to Improve Medication Safety for Nursing Home Residents Based on Experiential Knowledge Related to Patient Safety Culture at the Nursing Home Front Line: Cocreative Process Study JO - JMIR Form Res SP - e54977 VL - 8 KW - intervention development KW - nursing home KW - frontline professionals KW - medication safety KW - quality improvement KW - patient safety culture KW - experiential knowledge KW - cocreation KW - resilient health care systems KW - safety II perspective KW - human resources KW - integrated knowledge translation N2 - Background: Despite years of attention, avoiding medication-related harm remains a global challenge. Nursing homes provide essential health care for frail older individuals, who often experience multiple chronic diseases and polypharmacy, increasing their risk of medication errors. Evidence of effective interventions to improve medication safety in these settings is inconclusive. Focusing on patient safety culture is a potential key to intervention development as it forms the foundation for overall patient safety and is associated with medication errors. Objective: This study aims to develop an intervention to improve medication safety for nursing home residents through a cocreative process guided by integrated knowledge translation and experience-based codesign. Methods: This study used a cocreative process guided by integrated knowledge translation and experience-based co-design principles. Evidence on patient safety culture was used as an inspirational source for exploration of medication safety. Data collection involved semistructured focus groups to generate experiential knowledge (stage 1) to inform intervention design in a multidisciplinary workshop (stage 2). Research validation engaging different types of research expertise and municipal managerial representatives in finalizing the intervention design was essential. Acceptance of the final intervention for evaluation was aimed for through contextualization focused on partnership with a municipal advisory board. An abductive, rapid qualitative analytical approach to data analysis was chosen using elements from analyzing in the present, addressing the time-dependent, context-bound aspects of the cocreative process. Results: Experiential knowledge was represented by three main themes: (1) closed systems and gaps between functions, (2) resource interpretation and untapped potential, and (3) community of medication safety and surveillance. The main themes informed the design of preliminary intervention components in a multidisciplinary workshop. An intervention design process focused on research validation in addition to contextualization resulted in the Safe Medication in Nursing Home Residents (SAME) intervention covering (1) campaign material visualizing key roles and responsibilities regarding medication for nursing home residents and (2) ?Medication safety reflexive spaces? focused on social and health care assistants. Conclusions: The cocreative process successfully resulted in the multifaceted SAME intervention, grounded in lived experiences shared by some of the most important (but often underrepresented in research) stakeholders: frontline health care professionals and representatives of nursing home residents. This study brought attention toward closed systems related to functions in medication management and surveillance, not only informing the SAME intervention design but as opportunities for further exploration in future research. Evaluation of the intervention is an important next step. Overall, this study represents an important contribution to the complex field of medication safety. International Registered Report Identifier (IRRID): RR2-10.2196/43538 UR - https://formative.jmir.org/2024/1/e54977 UR - http://dx.doi.org/10.2196/54977 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54977 ER - TY - JOUR AU - Knox, Liam AU - Coates, Elizabeth AU - Griffiths, Alys AU - Ali, Yasmin AU - Hobson, Esther AU - McDermott, Christopher PY - 2024/10/8 TI - Development and Evaluation of the Telehealth in Motor Neuron Disease System: The TIME Study Protocol JO - JMIR Res Protoc SP - e57685 VL - 13 KW - motor neuron disease KW - amyotrophic lateral sclerosis KW - telehealth KW - digital health KW - process evaluation KW - implementation KW - co-production KW - digital technology KW - mhealth KW - eHealth KW - virtual medicine N2 - Background: For more responsive care provision for motor neuron disease and caregivers, a digital system called Telehealth in MND-Care (TiM-C) was created. TiM-C sends regular symptom questionnaires to users; their responses are sent to health care professionals (HCPs). To enable people with motor neuron disease to participate in research studies more easily, a parallel platform was developed from TiM-C, called Telehealth in MND-Research (TiM-R). TiM-R can advertise studies, collect data, and make them available to MND researchers. Objective: This study has 4 work packages (WPs) to facilitate service approval, codevelop the TiM systems, and evaluate the service. Each WP aims to understand (1) what helps and hinders the approval of the TiM-C system as a National Health Service; (2) what aspects of MND care and research are currently unmet and can be addressed through the TiM-C and TiM-R systems; (3) how TiM-C influences MND care, from the perspective of people with motor neuron disease, their caregivers, and HCPs; and (4) the costs and benefits associated with TiM-C. Methods: WP1 will use semistructured interviews with 10-15 people involved in the approval of TiM-C to understand the barriers and facilitators to governance processes. WP2 will use individual and group interviews with 25-35 users (people with motor neuron disease, caregivers, HCPs, MND researchers, and industry) of TiM-C and TiM-R to understand the current unmet needs of these user groups and how TiM services can be developed to meet these needs. WP3 will use a process evaluation involving 5 elements; local context, engagement, user experiences, service impact, and mechanisms of action. A range of methods, including audits, analysis of routine data, questionnaires, interviews, and observations will be used with people with motor neuron disease, caregivers, and HCPs, both those using the system and those who declined the service when invited. WP4 will use data collected through the process evaluation and known costs to conduct a cost-consequence and budget impact analysis to explore the cost-benefit of the TiM-C service. Most data collected will be qualitative, with thematic and framework analysis used to develop themes from transcripts and observations. Descriptive statistics or t tests and chi-square tests will be used to describe and analyze quantitative data. Results: This study has received ethical approval and has begun recruitment in 1 site. Further, 13 specialist MND centers will adopt TiM-C and the TIME study, beginning in July 2024. The study will conclude in November 2026 and a final report will be produced 3 months after the completion date. Conclusions: This study will facilitate the implementation and development of TiM-C and TiM-R and fully evaluate the TiM-C service, enabling informed decision-making among health care providers regarding continued involvement and contribute to the wider literature relating to how technology-enabled care services can affect clinical care. International Registered Report Identifier (IRRID): DERR1-10.2196/57685 UR - https://www.researchprotocols.org/2024/1/e57685 UR - http://dx.doi.org/10.2196/57685 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57685 ER - TY - JOUR AU - Trinkley, E. Katy AU - Maw, M. Anna AU - Torres, Huebner Cristina AU - Huebschmann, G. Amy AU - Glasgow, E. Russell PY - 2024/10/7 TI - Applying Implementation Science to Advance Electronic Health Record?Driven Learning Health Systems: Case Studies, Challenges, and Recommendations JO - J Med Internet Res SP - e55472 VL - 26 KW - learning health systems KW - implementation science KW - chronic care KW - electronic health record KW - evidence-based medicine KW - information technology KW - research and technology UR - https://www.jmir.org/2024/1/e55472 UR - http://dx.doi.org/10.2196/55472 UR - http://www.ncbi.nlm.nih.gov/pubmed/39374069 ID - info:doi/10.2196/55472 ER - TY - JOUR AU - Chang, Eunsuk AU - Sung, Sumi PY - 2024/10/7 TI - Use of SNOMED CT in Large Language Models: Scoping Review JO - JMIR Med Inform SP - e62924 VL - 12 KW - SNOMED CT KW - ontology KW - knowledge graph KW - large language models KW - natural language processing KW - language models N2 - Background: Large language models (LLMs) have substantially advanced natural language processing (NLP) capabilities but often struggle with knowledge-driven tasks in specialized domains such as biomedicine. Integrating biomedical knowledge sources such as SNOMED CT into LLMs may enhance their performance on biomedical tasks. However, the methodologies and effectiveness of incorporating SNOMED CT into LLMs have not been systematically reviewed. Objective: This scoping review aims to examine how SNOMED CT is integrated into LLMs, focusing on (1) the types and components of LLMs being integrated with SNOMED CT, (2) which contents of SNOMED CT are being integrated, and (3) whether this integration improves LLM performance on NLP tasks. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we searched ACM Digital Library, ACL Anthology, IEEE Xplore, PubMed, and Embase for relevant studies published from 2018 to 2023. Studies were included if they incorporated SNOMED CT into LLM pipelines for natural language understanding or generation tasks. Data on LLM types, SNOMED CT integration methods, end tasks, and performance metrics were extracted and synthesized. Results: The review included 37 studies. Bidirectional Encoder Representations from Transformers and its biomedical variants were the most commonly used LLMs. Three main approaches for integrating SNOMED CT were identified: (1) incorporating SNOMED CT into LLM inputs (28/37, 76%), primarily using concept descriptions to expand training corpora; (2) integrating SNOMED CT into additional fusion modules (5/37, 14%); and (3) using SNOMED CT as an external knowledge retriever during inference (5/37, 14%). The most frequent end task was medical concept normalization (15/37, 41%), followed by entity extraction or typing and classification. While most studies (17/19, 89%) reported performance improvements after SNOMED CT integration, only a small fraction (19/37, 51%) provided direct comparisons. The reported gains varied widely across different metrics and tasks, ranging from 0.87% to 131.66%. However, some studies showed either no improvement or a decline in certain performance metrics. Conclusions: This review demonstrates diverse approaches for integrating SNOMED CT into LLMs, with a focus on using concept descriptions to enhance biomedical language understanding and generation. While the results suggest potential benefits of SNOMED CT integration, the lack of standardized evaluation methods and comprehensive performance reporting hinders definitive conclusions about its effectiveness. Future research should prioritize consistent reporting of performance comparisons and explore more sophisticated methods for incorporating SNOMED CT?s relational structure into LLMs. In addition, the biomedical NLP community should develop standardized evaluation frameworks to better assess the impact of ontology integration on LLM performance. UR - https://medinform.jmir.org/2024/1/e62924 UR - http://dx.doi.org/10.2196/62924 UR - http://www.ncbi.nlm.nih.gov/pubmed/39374057 ID - info:doi/10.2196/62924 ER - TY - JOUR AU - Elser, Alexander AU - Kopkow, Christian AU - Schäfer, Georg Axel PY - 2024/9/23 TI - Implementation of a Virtual Reality Intervention in Outpatient Physiotherapy for Chronic Pain: Protocol for a Pilot Implementation Study JO - JMIR Res Protoc SP - e58089 VL - 13 KW - chronic pain KW - implementation KW - virtual reality KW - VR KW - physiotherapy KW - virtual reality intervention KW - pain KW - outpatient KW - chronic pain conditions KW - evidence-based N2 - Background: Chronic pain is a global health issue that causes physical, psychological, and social disabilities for patients, as well as high costs for societies. Virtual reality (VR) is a new treatment that provides an opportunity to narrow the gap between clinical practice and recommended care in the use of patient education and behavioral interventions in the outpatient physiotherapy setting. However, there is currently no implementation strategy to integrate VR treatments into this setting. Objective: This protocol outlines a pilot implementation study that aims to (1) identify barriers and facilitators for implementing a VR intervention in outpatient physiotherapy care for people with chronic pain and (2) develop and pilot test an implementation strategy in 5 practices in Germany. Methods: The study consists of 4 phases. The first phase involves adapting the treatment protocol of the VR intervention to the local context of outpatient physiotherapy practices in Germany. The second phase includes the collection of barriers and facilitators through semistructured interviews from physiotherapists and the development of a theory-driven implementation strategy based on the Theoretical Domains framework and the Behavior Change Wheel. This strategy will be applied in the third phase, which will also include a 6-month span of using VR interventions in practices, along with a process evaluation. The fourth phase consists of semistructured interviews to evaluate the developed implementation strategy. Results: The recruitment process and phase 1, including the adaptation of the treatment protocol, have already been completed. We recruited 5 physiotherapy practices in Lower Saxony, Germany, where the VR intervention will be implemented. The collection of barriers and facilitators through semistructured interviews is scheduled to begin in February 2024. Conclusions: This pilot implementation study aims to develop a theory-driven implementation strategy for integrating a VR intervention into outpatient physiotherapy care for people with chronic pain. The identified barriers and facilitators, along with the implementation strategy, will serve as a starting point for future randomized controlled implementation studies in different settings to refine the implementation process and integrate VR interventions into the outpatient care of people with chronic pain. Trial Registration: German Clinical Trials Register DRKS00030862; https://tinyurl.com/3zf7uujx International Registered Report Identifier (IRRID): DERR1-10.2196/58089 UR - https://www.researchprotocols.org/2024/1/e58089 UR - http://dx.doi.org/10.2196/58089 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58089 ER - TY - JOUR AU - Pugh, Jo Mary AU - Haun, N. Jolie AU - White, Jon P. AU - Cochran, Gerald AU - Mohanty, F. April AU - McAndrew, M. Lisa AU - Gordon, J. Adam AU - Nelson, E. Richard AU - Vanneman, E. Megan AU - Naranjo, E. Diana AU - Benzinger, C. Rachel AU - Jones, L. Audrey AU - Kean, Jacob AU - Zickmund, L. Susan AU - Fagerlin, Angela PY - 2024/9/19 TI - Developing Evidence to Support Policy: Protocol for the StrAtegic PoLicy EvIdence-Based Evaluation CeNTer (SALIENT) JO - JMIR Res Protoc SP - e59830 VL - 13 KW - evidence-based policy-making KW - policy evaluation KW - knowledge translation KW - veterans KW - implementation science N2 - Background: All federal agencies are required to support appropriation requests with evidence and evaluation (US Public Law 115-435; the Evidence Act). The StrAtegic PoLicy EvIdence-Based Evaluation CeNTer (SALIENT) is 1 of 6 centers that help the Department of Veterans Affairs (VA) meet this requirement. Objective: Working with the existing VA evaluation structure, SALIENT evaluations will contribute to (1) optimize policies and programs for veteran populations; (2) improve outcomes regarding health, equity, cost, and provider well-being; (3) advance the science of dissemination and knowledge translation; and (4) expand the implementation and dissemination science workforce. Methods: We leverage the Lean Sprint methodology (iterative, incremental, rule-governed approach to clearly defined, and time-boxed work) and 3 cores to develop our evaluation plans collaboratively with operational partners and key stakeholders including veterans, policy experts, and clinicians. The Operations Core will work with evaluation teams to develop timelines, facilitate work, monitor progress, and guide quality improvement within SALIENT. The Methods Core will work with evaluation teams to identify the most appropriate qualitative, quantitative, and mixed methods approaches to address each evaluation, ensure that the analyses are conducted appropriately, and troubleshoot when problems with data acquisition and analysis arise. The Knowledge Translation (KT) Core will target key partners and decision makers using a needs-based market segmentation approach to ensure that needs are incorporated in the dissemination of knowledge. The KT Core will create communications briefs, playbooks, and other materials targeted at these market segments to facilitate implementation of evidence-based practices and maximize the impact of evaluation results. Results: The SALIENT team has developed a center infrastructure to support high-priority evaluations, often to be responsive to shifting operational needs and priorities. Our team has engaged in our core missions and operations to rapidly evaluate a high-priority areas, develop a comprehensive Lean Sprint systems redesign approach to training, and accelerate rapid knowledge translation. Conclusions: With an array of interdisciplinary expertise, operational partnerships, and integrated resources, SALIENT has an established and evolving infrastructure to rapidly develop and implement high-impact evaluations. Projects are developed with sustained efficiency approaches that can pivot to new priorities as needed and effectively translate knowledge for key stakeholders and policy makers, while creating a learning health system infrastructure to foster the next generation of evaluation and implementation scientists. International Registered Report Identifier (IRRID): PRR1-10.2196/59830 UR - https://www.researchprotocols.org/2024/1/e59830 UR - http://dx.doi.org/10.2196/59830 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59830 ER - TY - JOUR AU - Van der Roest, Geralde Henriëtte AU - Christie, Liane Hannah AU - Franco-Martin, Angel Manuel AU - Dröes, Rose-Marie AU - de Vugt, Elizabeth Marjolein AU - Meiland, Franka PY - 2024/9/13 TI - Determinants of Successful Implementation of Assistive Technologies for Dementia: Exploratory Survey JO - JMIR Aging SP - e53640 VL - 7 KW - assistive technology KW - dementia KW - implementation KW - caregiving KW - psychosocial research N2 - Background: Despite positive results for the use of assistive technologies (ATs) in dementia, the uptake of ATs lags behind. It is considered important to assess determinants of successful or unsuccessful implementation of ATs. Objective: We explored factors that influence the implementation of ATs for community-dwelling people with dementia, with the aim to better understand potentially effective implementation strategies. Methods: A cross-sectional survey for researchers was developed and disseminated, exploring factors that influence either successful or unsuccessful implementation of ATs for dementia. The survey consisted of closed and open questions. Results: The response rate was 10% (21/206); the 21 respondents who completed the survey were from 8 countries. Determinants of implementation were described for 21 ATs, of which 12 were successfully and 9 were unsuccessfully implemented. Various types of ATs were included, such as online platforms, sensors, or physical aids. The main determinants of implementation success were related to the AT itself, contextual factors, research activities, and implementation strategies. There was a lack of research data on some ethical issues and cost-effectiveness. Conclusions: This study provided insight into some main barriers to and facilitators of implementation of ATs in dementia related to the AT itself, context, research-related activities, and applied implementation strategies. Lessons were formulated for various stakeholders to improve the implementation effectiveness of ATs in dementia. UR - https://aging.jmir.org/2024/1/e53640 UR - http://dx.doi.org/10.2196/53640 ID - info:doi/10.2196/53640 ER - TY - JOUR AU - Al-Adili, Lina AU - Malmqvist, Moa AU - Reinius, Maria AU - Helispää Rodriguez, Inka AU - Stenfors, Terese AU - Brommels, Mats PY - 2024/9/12 TI - Implementation of a Recovery College Embedded in a Swedish Psychiatry Organization: Qualitative Case Study JO - J Particip Med SP - e55882 VL - 16 KW - mental health KW - educational intervention KW - recovery college KW - implementation research approach KW - qualitative research KW - coproduction N2 - Background: Recovery colleges are service user?led educational interventions aiming at empowering people with mental health issues and promoting recovery through peer learning. Despite the increasing interest in recovery colleges in recent years and the demonstrated beneficial effects for users, there is limited research addressing aspects that influence their implementation. This knowledge is necessary for the successful integration of such interventions in various contexts. Objective: This study aims to explore factors that influence the implementation of a recovery college embedded within a Swedish psychiatry organization. Methods: A qualitative case study of a recovery college based on semistructured interviews with 8 course participants, 4 course leaders, and 4 clinical staff was conducted. The transcripts were scrutinized with conventional content analysis, and the interpretation of results was guided by the Consolidated Framework for Implementation Research. Results: The findings highlight key areas that either hinder or promote the successful implementation of the recovery college. These areas included recruitment, resources, staff attitudes, and ways of organizing courses. Each area has elements that appear both as facilitators and barriers, demonstrating the duality of conditions. Conclusions: Allocating dedicated resources, engaging individuals with service user experience as organizers who are willing to share their personal experience, having an open-door policy, creating an open space for participants to share their experiences, and offering practical advice and written material are useful to create favorable conditions for a recovery college to reach its goals of empowering psychiatry service users. UR - https://jopm.jmir.org/2024/1/e55882 UR - http://dx.doi.org/10.2196/55882 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55882 ER - TY - JOUR AU - Toulany, Alene AU - Khodyakov, Dmitry AU - Mooney, Sarah AU - Stromquist, Lisa AU - Bailey, Katherine AU - Barber, EH Claire AU - Batthish, Michelle AU - Cleverley, Kristin AU - Dimitropoulos, Gina AU - Gorter, Willem Jan AU - Grahovac, Danijela AU - Grimes, Ruth AU - Guttman, Beverly AU - Hébert, L. Michčle AU - John, Tomisin AU - Lo, Lisha AU - Luong, Dorothy AU - MacGregor, Laura AU - Mukerji, Geetha AU - Pidduck, Jacklynn AU - Senthilnathan, Vjura AU - Shulman, Rayzel AU - Trbovich, Patricia AU - Munce, EP Sarah PY - 2024/9/10 TI - Quality Indicators for Transition from Pediatric to Adult Care for Youth With Chronic Conditions: Proposal for an Online Modified Delphi Study JO - JMIR Res Protoc SP - e60860 VL - 13 KW - transition to adult care KW - adolescent health KW - chronic conditions KW - quality indicators KW - consensus KW - caregivers KW - adolescent KW - stakeholder engagement KW - patient engagement KW - Delphi N2 - Background: The transition from pediatric to adult care poses a significant health system?level challenge impeding the delivery of quality health services for youth with chronic health conditions. In Canada and globally, the transition to adult care is regarded as a top priority in adolescent health in need of readily applicable, adaptable, and relevant national metrics to evaluate and benchmark transition success across disease populations and clinical care settings. Unfortunately, existing literature fails to account for the lack of engagement from youth and caregivers in developing indicators, and its applicability across chronic conditions, primary care involvement, and health equity considerations. Objective: Our proposed study aims to establish a consensus-driven set of quality indicators for the transition to adult care that are universally applicable across physical, developmental, and mental health conditions, clinical care settings, and health jurisdictions. Methods: Using an integrated knowledge translation (iKT) approach, a panel comprising youth, caregivers, interdisciplinary health care providers, and health system leaders will be established to collaborate with our research team to ensure that the study methodology, materials, and knowledge dissemination are suitable and reflect the perspectives of youth and their families. We will then conduct an iterative 3-round Online Modified Delphi (OMD) study (n=160) to (1) compare and contrast the perspectives of youth, caregivers, health care providers, and health system leaders on quality indicators for transition; and (2) prioritize a key set of quality indicators for transition applicable across disease populations that are the most important, useful, and feasible in the Canadian context. Using the RAND/UCLA Appropriateness Method (RAM) multistage analytic approach, data from each panel and stakeholder group will be examined separately and compared to establish a key set of indicators endorsed by both panels. Results: The study is funded by the Canadian Institutes of Health Research and Physicians Services Incorporated. Conclusions: This study will produce quality indicators to evaluate and inform action equitably to improve transition from pediatric to adult care for youth and their families in Canada. International Registered Report Identifier (IRRID): PRR1-10.2196/60860 UR - https://www.researchprotocols.org/2024/1/e60860 UR - http://dx.doi.org/10.2196/60860 UR - http://www.ncbi.nlm.nih.gov/pubmed/38889353 ID - info:doi/10.2196/60860 ER - TY - JOUR AU - Abascal Miguel, Lucía AU - Forster, Maeve AU - Gallalee, Sarah AU - Carson, Mariam AU - Fieldhouse, K. Jane AU - Keir, Alexandra AU - Maya, Sigal AU - Rahman, Sabahat AU - Reid, A. Michael J. AU - Vasilopoulos, Hariclea AU - Lima Sanchez, Nimbe Dania PY - 2024/9/9 TI - Bridging Language Barriers in COVID-19 Research: Descriptive Study of AccesoCovid.com?s Reach and User Engagement JO - JMIR Form Res SP - e53978 VL - 8 KW - COVID-19 research dissemination KW - multilingual scientific platform KW - language barriers in science KW - Spanish scientific communication KW - equitable access to research KW - global health equity N2 - Background: The COVID-19 pandemic underscored the challenge of swiftly disseminating research findings to a global audience. Language barriers further exacerbated disparities in access to timely scientific information, particularly for non-English speaking communities. The majority of COVID-19 research was published in English, limiting accessibility for Spanish-speaking populations. Objective: This paper aims to assess the reach and effectiveness of AccesoCovid.com, a platform designed to disseminate up-to-date COVID-19 research in both English and Spanish, addressing the language gap in scientific communication. Methods: AccesoCovid.com was developed through a partnership between the University of California, San Francisco (UCSF) and Universidad Nacional Autónoma de México (UNAM). The website?s performance and user engagement were evaluated using Google Analytics over a span of 2 years. Key metrics included user language preference, geographical distribution, and site traffic. The website summarized and translated 1032 articles on various COVID-19 topics, such as ?Pharmaceutical Interventions and Vaccines.? Results: From February 2021 to February 2023, the platform attracted 57,000 users. Of the 43,000 unique new visitors, 84.2% (n=36,219) hailed from Spanish-speaking regions. The majority accessed the site organically through search engines, with 88.4% (n=38,000) of users arriving this way, while 5000 (11.6%) users accessed the site directly. Most users (n=30,894, 72.1%) preferred the Spanish version of the site. The website?s most accessed category was ?Pharmaceutical Interventions and Vaccines,? followed by ?Clinical Presentation and Management? and ?Mental Health.? Regarding language distribution, 72.1% (n=30,894) of users primarily used Spanish; 21.4% (n=9215) used English; and 6.7% (n=2891) spoke other languages, including Portuguese, Chinese, and German. Geographically, the website attracted visitors from 179 countries, with the highest visitor counts from Mexico (n=12,342, 28.7%), Spain (n=6405, 14.9%), the United States (n=4416, 10.3%), and Peru (n=3821, 8.9%). Conclusions: AccesoCovid.com successfully bridged a critical language gap in the dissemination of COVID-19 research. Its success underscores the pressing need for multilingual scientific resources. The platform demonstrated significant user engagement and reach, particularly in Spanish-speaking countries. This highlights the potential for similar platforms to ensure equitable access to scientific knowledge across diverse linguistic communities. Future efforts should focus on expanding to other languages and conducting formal evaluations to enhance user satisfaction and impact. UR - https://formative.jmir.org/2024/1/e53978 UR - http://dx.doi.org/10.2196/53978 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250219 ID - info:doi/10.2196/53978 ER - TY - JOUR AU - Roberts, Anne Natasha AU - Pelecanos, Anita AU - Alexander, Kimberly AU - Wyld, David AU - Janda, Monika PY - 2024/8/27 TI - Implementation of Patient-Reported Outcomes in a Medical Oncology Setting (the iPROMOS Study): Type II Hybrid Implementation Study JO - J Med Internet Res SP - e55841 VL - 26 KW - implementation science KW - iPARIHS KW - clinical practice KW - intervention KW - implementation KW - facilitator KW - facilitation KW - patient-reported outcomes, patient-reported outcome measures KW - oncology KW - symptom KW - symptoms KW - detection KW - investigate KW - service KW - services KW - clinic KW - clinics KW - Australia KW - binary logistic models KW - regression model KW - regression models KW - patient KW - patients KW - supportive care N2 - Background: Clinical trials have demonstrated that patient-reported outcome measures (PROMs) can improve mortality and morbidity outcomes when used in clinical practice. Objective: This study aimed to prospectively investigate the implementation of PROMs in routine oncology. Outcomes measured included improved symptom detection, clinical response to symptom information, and health service outcomes. Methods: Two of 12 eligible clinics were randomized to implement symptom PROMs in a medical oncology outpatient department in Australia. Randomization was carried out at the clinic level. Patients in control clinics continued with usual care; those in intervention clinics completed a symptom PROM at presentation. This was a pilot study investigating symptom detection, using binary logistic models, and clinical response to PROMs investigated using multiple regression models. Results: A total of 461 patient encounters were included, consisting of 242 encounters in the control and 222 in the intervention condition. Patients in these clinics most commonly had head and neck, lung, prostate, breast, or colorectal cancer and were seen in the clinic for surveillance and oral or systemic treatments for curative, metastatic, or palliative cancer care pathways. Compared with control encounters, the proportion of symptoms detected increased in intervention encounters (odds ratio 1.05, 95% CI 0.99-1.11; P=.08). The odds of receiving supportive care, demonstrated by nonroutine allied health review, increased in the intervention compared with control encounters (odds ratio 3.54, 95% CI 1.26-9.90; P=.02). Conclusions: Implementation of PROMs in routine care did not significantly improve symptom detection but increased the likelihood of nonroutine allied health reviews for supportive care. Larger studies are needed to investigate health service outcomes. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000398202; https://tinyurl.com/3cxbemy4 UR - https://www.jmir.org/2024/1/e55841 UR - http://dx.doi.org/10.2196/55841 UR - http://www.ncbi.nlm.nih.gov/pubmed/39190468 ID - info:doi/10.2196/55841 ER - TY - JOUR AU - Cresswell, Kathrin AU - de Keizer, Nicolette AU - Magrabi, Farah AU - Williams, Robin AU - Rigby, Michael AU - Prgomet, Mirela AU - Kukhareva, Polina AU - Wong, Shui-Yee Zoie AU - Scott, Philip AU - Craven, K. Catherine AU - Georgiou, Andrew AU - Medlock, Stephanie AU - Brender McNair, Jytte AU - Ammenwerth, Elske PY - 2024/8/7 TI - Evaluating Artificial Intelligence in Clinical Settings?Let Us Not Reinvent the Wheel JO - J Med Internet Res SP - e46407 VL - 26 KW - artificial intelligence KW - evaluation KW - theory KW - patient safety KW - optimisation KW - health care KW - optimization UR - https://www.jmir.org/2024/1/e46407 UR - http://dx.doi.org/10.2196/46407 UR - http://www.ncbi.nlm.nih.gov/pubmed/39110494 ID - info:doi/10.2196/46407 ER - TY - JOUR AU - Weile, Synne Kathrine AU - Mathiasen, René AU - Winther, Falck Jeanette AU - Hasle, Henrik AU - Henriksen, Tram Louise PY - 2024/7/25 TI - Hjernetegn.dk?The Danish Central Nervous System Tumor Awareness Initiative Digital Decision Support Tool: Design and Implementation Report JO - JMIR Med Inform SP - e58886 VL - 12 KW - digital health initiative KW - digital health initiatives KW - clinical decision support KW - decision support KW - decision support system KW - decision support systems KW - decision support tool KW - decision support tools KW - diagnostic delay KW - awareness initiative KW - pediatric neurology KW - pediatric CNS tumors KW - CNS tumor KW - CNS tumour KW - CNS tumours KW - co-creation KW - health systems and services KW - communication KW - central nervous system N2 - Background: Childhood tumors in the central nervous system (CNS) have longer diagnostic delays than other pediatric tumors. Vague presenting symptoms pose a challenge in the diagnostic process; it has been indicated that patients and parents may be hesitant to seek help, and health care professionals (HCPs) may lack awareness and knowledge about clinical presentation. To raise awareness among HCPs, the Danish CNS tumor awareness initiative hjernetegn.dk was launched. Objective: This study aims to present the learnings from designing and implementing a decision support tool for HCPs to reduce diagnostic delay in childhood CNS tumors. The aims also include decisions regarding strategies for dissemination and use of social media, and an evaluation of the digital impact 6 months after launch. Methods: The phases of developing and implementing the tool include participatory co-creation workshops, designing the website and digital platforms, and implementing a press and media strategy. The digital impact of hjernetegn.dk was evaluated through website analytics and social media engagement. Implementation (Results): hjernetegn.dk was launched in August 2023. The results after 6 months exceeded key performance indicators. The analysis showed a high number of website visitors and engagement, with a plateau reached 3 months after the initial launch. The LinkedIn campaign and Google Search strategy also generated a high number of impressions and clicks. Conclusions: The findings suggest that the initiative has been successfully integrated, raising awareness and providing a valuable tool for HCPs in diagnosing childhood CNS tumors. The study highlights the importance of interdisciplinary collaboration, co-creation, and ongoing community management, as well as broad dissemination strategies when introducing a digital support tool. UR - https://medinform.jmir.org/2024/1/e58886 UR - http://dx.doi.org/10.2196/58886 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58886 ER - TY - JOUR AU - Rabbani, Fauziah AU - Nafis, Javeria AU - Akhtar, Samina AU - Khan, Shahid Muhammad AU - Sayani, Saleem AU - Siddiqui, Amna AU - Siddiqi, Sameen AU - Merali, Zul PY - 2024/7/23 TI - Technology-Assisted Mental Health Intervention Delivered by Frontline Workers at Community Doorsteps for Reducing Anxiety and Depression in Rural Pakistan: Protocol for the mPareshan Mixed Methods Implementation Trial JO - JMIR Res Protoc SP - e54272 VL - 13 KW - anxiety KW - depression KW - feasibility KW - mental health KW - health workers KW - mPareshan app KW - implementation research N2 - Background: There is a dearth of specialized mental health workforce in low- and middle-income countries. Use of mobile technology by frontline community health workers (CHWs) is gaining momentum in Pakistan and needs to be explored as an alternate strategy to improve mental well-being. Objective: The aim of this study is to assess the feasibility, acceptability, and usefulness of an app-based counseling intervention delivered by government lady health workers (LHWs) to reduce anxiety and depression in rural Pakistan. Methods: Project mPareshan is a single-arm, pre- and posttest implementation research trial in Badin District, Sindh, using mixed methods of data collection executed in 3 phases (preintervention, intervention, and postintervention). In the preintervention phase, formative qualitative assessments through focus group discussions and in-depth interviews assess the acceptability and appropriateness of intervention through perceptions of all concerned stakeholders using a specific interview guide. A REDCap (Research Electronic Data Capture)-based baseline survey using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 Scale (GAD-7) determines the point prevalence of depression and anxiety among consenting men and women older than 18 years. Individuals with mild and moderate anxiety and depression are identified as screen positives (SPs) and are eligible for mPareshan app?based intervention. Mental health literacy of health workers is improved through customized training adapting the World Health Organization?s Mental Health Gap Action Programme guide 2.0. The intervention (mPareshan app) consists of tracking, counseling, and referral segments. The tracking segment facilitates participant consent and enrollment while the referral segment is used by LHWs to transfer severe cases to the next level of specialist care. Through the counseling segment, identified SPs are engaged during LHWs? routine home visits in 6 face-to-face 20-minute counseling sessions over 6 months. Each session imparts psychoeducation through audiovisual aids, breathing exercises, and coping skills to reduce stress. Clinical and implementation outcomes include change in mean anxiety and depression scores and identification of facilitators and barriers in intervention uptake and rollout. Results: At the time of this submission (April 2024), we are analyzing the results of 366 individuals who participated in the baseline prevalence survey, the change in knowledge and skills of 72 health workers who took the mPareshan training, change in anxiety and depression scores of 98 SPs recruited for app-based counseling intervention, and perceptions of stakeholders pre- and postintervention gathered through 8 focus group discussions and 18 in-depth interviews. Conclusions: This trial will assess the feasibility of early home-based mental health screening, counseling, and prompt referrals by frontline health workers to reduce anxiety and depression in the community. The study findings will set the stage for integrating mental health into primary health care. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12622000989741; https://tinyurl.com/5n844c8z International Registered Report Identifier (IRRID): DERR1-10.2196/54272 UR - https://www.researchprotocols.org/2024/1/e54272 UR - http://dx.doi.org/10.2196/54272 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54272 ER - TY - JOUR AU - Campbell, Laura AU - Quicke, Jonathan AU - Stevenson, Kay AU - Paskins, Zoe AU - Dziedzic, Krysia AU - Swaithes, Laura PY - 2024/7/8 TI - Using Twitter (X) to Mobilize Knowledge for First Contact Physiotherapists: Qualitative Study JO - J Med Internet Res SP - e55680 VL - 26 KW - Twitter KW - X KW - social media KW - first contact physiotherapy KW - musculoskeletal KW - knowledge mobilisation KW - primary care KW - mindlines KW - qualitative KW - physiotherapy KW - implementation N2 - Background: Twitter (now X) is a digital social network commonly used by health care professionals. Little is known about whether it helps health care professionals to share, mobilize, and cocreate knowledge or reduce the time between research knowledge being created and used in clinical practice (the evidence-to-practice gap). Musculoskeletal first contact physiotherapists (FCPs) are primary care specialists who diagnose and treat people with musculoskeletal conditions without needing to see their general practitioner (family physician) first. They often work as a sole FCP in practice; hence, they are an ideal health care professional group with whom to explore knowledge mobilization using Twitter. Objective: We aimed to explore how Twitter is and can be used to mobilize knowledge, including research findings, to inform FCPs? clinical practice. Methods: Semistructured interviews of FCPs with experience of working in English primary care were conducted. FCPs were purposively sampled based on employment arrangements and Twitter use. Recruitment was accomplished via known FCP networks and Twitter, supplemented by snowball sampling. Interviews were conducted digitally and used a topic guide exploring FCP's perceptions and experiences of accessing knowledge, via Twitter, for clinical practice. Data were analyzed thematically and informed by the knowledge mobilization mindlines model. Public contributors were involved throughout. Results: In total, 19 FCPs consented to the interview (Twitter users, n=14 and female, n=9). Three themes were identified: (1) How Twitter meets the needs of FCPs, (2) Twitter and a journey of knowledge to support clinical practice, and (3) factors impeding knowledge sharing on Twitter. FCPs described needs relating to isolated working practices, time demands, and role uncertainty. Twitter provided rapid access to succinct knowledge, the opportunity to network, and peer reassurance regarding clinical cases, evidence, and policy. FCPs took a journey of knowledge exchange on Twitter, including scrolling for knowledge, filtering for credibility and adapting knowledge for in-service training and clinical practice. Participants engaged best with images and infographics. FCPs described misinformation, bias, echo chambers, unprofessionalism, hostility, privacy concerns and blurred personal boundaries as factors impeding knowledge sharing on Twitter. Consequently, many did not feel confident enough to actively participate on Twitter. Conclusions: This study explores how Twitter is and can be used to mobilize knowledge to inform FCP clinical practice. Twitter can meet the knowledge needs of FCPs through rapid access to succinct knowledge, networking opportunities, and professional reassurance. The journey of knowledge exchange from Twitter to clinical practice can be explained by considering the mindlines model, which describes how FCPs exchange knowledge in digital and offline contexts. Findings demonstrate that Twitter can be a useful adjunct to FCP practice, although several factors impede knowledge sharing on the platform. We recommend social media training and enhanced governance guidance from professional bodies to support the use of Twitter for knowledge mobilization. UR - https://www.jmir.org/2024/1/e55680 UR - http://dx.doi.org/10.2196/55680 UR - http://www.ncbi.nlm.nih.gov/pubmed/38742615 ID - info:doi/10.2196/55680 ER - TY - JOUR AU - Ahmed, Mona AU - Marín, Mayca AU - Gangas, Pilar AU - Bentlage, Ellen AU - Louro, Claudia AU - Brach, Michael PY - 2024/6/27 TI - Improving the Acceptability and Implementation of Information and Communication Technology?Based Health Care Platforms for Older People With Dementia or Parkinson Disease: Qualitative Study Results of Key Stakeholders JO - JMIR Form Res SP - e58501 VL - 8 KW - acceptability KW - implementation KW - neurodegenerative diseases KW - Parkinson disease KW - dementia KW - chronic diseases KW - health care technologies KW - older people KW - stakeholders KW - information and communication technology KW - ICT KW - user-centered design KW - co-design N2 - Background: The management of neurodegenerative diseases (NDDs) in older populations is usually demanding and involves care provision by various health care services, resulting in a greater burden on health care systems in terms of costs and resources. The convergence of various health services within integrated health care models, which are enabled and adopted jointly with information and communication technologies (ICTs), has been identified as an effective alternative health care solution. However, its widespread implementation faces formidable challenges. Both the development and implementation of integrated ICTs are linked to the collaboration and acceptance of different groups of stakeholders beyond patients and health care professionals, with reported discrepancies in the needs and preferences among these groups. Objective: Complementing a previous publication, which reported on the needs and requirements of end users in the development of the European Union?funded project PROCare4Life (Personalized Integrated Care Promoting Quality of Life for Older People), this paper aimed to report on the opinions of other key stakeholders from various fields, including academia, media, market, and decision making, for improving the acceptability and implementation of an integrated ICT-based health care platform supporting the management of NDDs. Methods: The study included 30 individual semistructured interviews that took place between June and August 2020 in 5 European countries (Germany, Italy, Portugal, Romania, and Spain). Interviews were mostly conducted online, except in cases where participants requested to be interviewed in person. In these cases, COVID-19 PROCare4Life safety procedures were applied. Results: This study identified 2 themes and 5 subthemes. User engagement, providing training and education, and the role played by the media were identified as strategic measures to ensure the acceptability of ICT-based health care platforms. Sustainable funding and cooperation with authorities were foreseen as additional points to be considered in the implementation process. Conclusions: The importance of the user-centered design approach in ensuring the involvement of users in the development of ICT-based platforms has been highlighted. The most common challenges that hinder the acceptability and implementation of ICT-based health care platforms can be addressed by creating synergies among the efforts of users, academic stakeholders, developers, policy makers, and decision makers. To support future projects in developing ICT-based health care platforms, this study outlined the following recommendations that can be integrated when conducting research on users? needs: (1) properly identify the particular challenges faced by future user groups without neglecting their social and clinical contexts; (2) iteratively assess the digital skills of future users and their acceptance of the proposed platform; (3) align the functionalities of the ICT platform with the real needs of future users; and (4) involve key stakeholders to guide the reflection on how to implement the platform in the future. International Registered Report Identifier (IRRID): RR2-10.2196/22463 UR - https://formative.jmir.org/2024/1/e58501 UR - http://dx.doi.org/10.2196/58501 UR - http://www.ncbi.nlm.nih.gov/pubmed/38935424 ID - info:doi/10.2196/58501 ER - TY - JOUR AU - Hooker, A. Stephanie AU - Crain, Lauren A. AU - Muegge, Jule AU - Rossom, C. Rebecca AU - Pronk, P. Nicolaas AU - Pasumarthi, Prasad Dhavan AU - Kunisetty, Gopikrishna AU - Masters, S. Kevin PY - 2024/6/25 TI - Applying Meaning and Self-Determination Theory to the Development of a Web-Based mHealth Physical Activity Intervention: Proof-of-Concept Pilot Study JO - JMIR Form Res SP - e55722 VL - 8 KW - physical activity KW - midlife KW - digital health KW - SMS text messaging KW - theory-based KW - meaning in life KW - mobile phone N2 - Background: Meaning in life is positively associated with health, well-being, and longevity, which may be partially explained by engagement in healthier behaviors, including physical activity (PA). However, promoting awareness of meaning is a behavior change strategy that has not been tested in previous PA interventions. Objective: This study aims to develop, refine, and pilot-test the Meaningful Activity Program (MAP; MAP to Health), a web-based mobile health PA intervention, theoretically grounded in meaning and self-determination theory, for insufficiently active middle-aged adults. Methods: Following an iterative user-testing and refinement phase, we used a single-arm double baseline proof-of-concept pilot trial design. Participants included 35 insufficiently active adults in midlife (aged 40-64 years) interested in increasing their PA. After a 4-week baseline period, participants engaged in MAP to Health for 8 weeks. MAP to Health used a web-based assessment and just-in-time SMS text messaging to individualize the intervention; promote meaning salience; support the basic psychological needs of autonomy, competence, and relatedness; and increase PA. Participants completed measures of the hypothesized mechanisms of behavior change, including meaning salience, needs satisfaction, and autonomous motivation at pretest (?4 weeks), baseline (0 weeks), midpoint (4 weeks), and posttest (8 weeks) time points, and wore accelerometers for the study duration. At the end of the intervention, participants completed a qualitative interview. Mixed models compared changes in behavioral mechanisms during the intervention to changes before the intervention. Framework matrix analyses were used to analyze qualitative data. Results: Participants were aged 50.8 (SD 8.2) years on average; predominantly female (27/35, 77%); and 20% (7/35) Asian, 9% (3/35) Black or African American, 66% (23/35) White, and 6% (2/35) other race. Most (32/35, 91%) used MAP to Health for ?5 of 8 weeks. Participants rated the intervention as easy to use (mean 4.3, SD 0.8 [out of 5.0]) and useful (mean 4.3, SD 0.6). None of the hypothesized mechanisms changed significantly during the preintervention phase (Cohen d values <0.15). However, autonomy (P<.001; Cohen d=0.76), competence (P<.001; Cohen d=0.65), relatedness (P=.004; Cohen d=0.46), autonomous motivation (P<.001; Cohen d=0.37), and meaning salience (P<.001; Cohen d=0.40) increased significantly during the intervention. Comparison of slopes before the intervention versus during the intervention revealed that increases during the intervention were significantly greater for autonomy (P=.002), competence (P<.001), and meaning salience (P=.001); however, slopes were not significantly different for relatedness (P=.10) and autonomous motivation (P=.17). Qualitative themes offered suggestions for improvement. Conclusions: MAP to Health was acceptable to participants, feasible to deliver, and associated with increases in the target mechanisms of behavior change. This is the first intervention to use meaning as a behavior change strategy in a PA intervention. Future research will test the efficacy of the intervention in increasing PA compared to a control condition. UR - https://formative.jmir.org/2024/1/e55722 UR - http://dx.doi.org/10.2196/55722 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55722 ER - TY - JOUR AU - Soares, Andrey AU - Schilling, M. Lisa AU - Richardson, Joshua AU - Kommadi, Bhagvan AU - Subbian, Vignesh AU - Dehnbostel, Joanne AU - Shahin, Khalid AU - Robinson, A. Karen AU - Afzal, Muhammad AU - Lehmann, P. Harold AU - Kunnamo, Ilkka AU - Alper, S. Brian PY - 2024/6/25 TI - Making Science Computable Using Evidence-Based Medicine on Fast Healthcare Interoperability Resources: Standards Development Project JO - J Med Internet Res SP - e54265 VL - 26 KW - evidence-based medicine KW - FHIR KW - Fast Healthcare Interoperability Resources KW - computable evidence KW - EBMonFHIR KW - evidence-based medicine on Fast Healthcare Interoperability Resources N2 - Background: Evidence-based medicine (EBM) has the potential to improve health outcomes, but EBM has not been widely integrated into the systems used for research or clinical decision-making. There has not been a scalable and reusable computer-readable standard for distributing research results and synthesized evidence among creators, implementers, and the ultimate users of that evidence. Evidence that is more rapidly updated, synthesized, disseminated, and implemented would improve both the delivery of EBM and evidence-based health care policy. Objective: This study aimed to introduce the EBM on Fast Healthcare Interoperability Resources (FHIR) project (EBMonFHIR), which is extending the methods and infrastructure of Health Level Seven (HL7) FHIR to provide an interoperability standard for the electronic exchange of health-related scientific knowledge. Methods: As an ongoing process, the project creates and refines FHIR resources to represent evidence from clinical studies and syntheses of those studies and develops tools to assist with the creation and visualization of FHIR resources. Results: The EBMonFHIR project created FHIR resources (ie, ArtifactAssessment, Citation, Evidence, EvidenceReport, and EvidenceVariable) for representing evidence. The COVID-19 Knowledge Accelerator (COKA) project, now Health Evidence Knowledge Accelerator (HEvKA), took this work further and created FHIR resources that express EvidenceReport, Citation, and ArtifactAssessment concepts. The group is (1) continually refining FHIR resources to support the representation of EBM; (2) developing controlled terminology related to EBM (ie, study design, statistic type, statistical model, and risk of bias); and (3) developing tools to facilitate the visualization and data entry of EBM information into FHIR resources, including human-readable interfaces and JSON viewers. Conclusions: EBMonFHIR resources in conjunction with other FHIR resources can support relaying EBM components in a manner that is interoperable and consumable by downstream tools and health information technology systems to support the users of evidence. UR - https://www.jmir.org/2024/1/e54265 UR - http://dx.doi.org/10.2196/54265 UR - http://www.ncbi.nlm.nih.gov/pubmed/38916936 ID - info:doi/10.2196/54265 ER - TY - JOUR AU - Lyzwinski, Lynnette AU - Mcdonald, Sheila AU - Zwicker, Jennifer AU - Tough, Suzanne PY - 2024/6/25 TI - Digital and Hybrid Pediatric and Youth Mental Health Program Implementation Challenges During the Pandemic: Literature Review With a Knowledge Translation and Theoretical Lens Analysis JO - JMIR Pediatr Parent SP - e55100 VL - 7 KW - mental health KW - knowledge translation KW - KT KW - flourishing KW - youth KW - teenagers KW - mindfulness KW - positive psychology KW - telehealth KW - implementation KW - knowledge dissemination KW - pandemic KW - COVID-19 KW - service delivery N2 - Background: The pandemic brought unprecedented challenges for child and youth mental health. There was a rise in depression, anxiety, and symptoms of suicidal ideation. Objective: The aims of this knowledge synthesis were to gain a deeper understanding of what types of mental health knowledge translation (KT) programs, mental health first aid training, and positive psychology interventions were developed and evaluated for youth mental health. Methods: We undertook a literature review of PubMed and MEDLINE for relevant studies on youth mental health including digital and hybrid programs undertaken during the pandemic (2020-2022). Results: A total of 60 studies were included in this review. A few KT programs were identified that engaged with a wide range of stakeholders during the pandemic, and a few were informed by KT theories. Key challenges during the implementation of mental health programs for youth included lack of access to technology and privacy concerns. Hybrid web-based and face-to-face KT and mental health care were recommended. Providers required adequate training in using telehealth and space. Conclusions: There is an opportunity to reduce the barriers to implementing tele?mental health in youth by providing adequate technological access, Wi-Fi and stationary internet connectivity, and privacy protection. Staff gained new knowledge and training from the pandemic experience of using telehealth, which will serve as a useful foundation for the future. Future research should aim to maximize the benefits of hybrid models of tele?mental health and face-to-face sessions while working on minimizing the potential barriers that were identified. In addition, future programs could consider combining mental health first aid training with hybrid digital and face-to-face mental health program delivery along with mindfulness and resilience building in a unified model of care, knowledge dissemination, and implementation. UR - https://pediatrics.jmir.org/2024/1/e55100 UR - http://dx.doi.org/10.2196/55100 UR - http://www.ncbi.nlm.nih.gov/pubmed/38916946 ID - info:doi/10.2196/55100 ER - TY - JOUR AU - Karakachoff, Matilde AU - Goronflot, Thomas AU - Coudol, Sandrine AU - Toublant, Delphine AU - Bazoge, Adrien AU - Constant Dit Beaufils, Pacôme AU - Varey, Emilie AU - Leux, Christophe AU - Mauduit, Nicolas AU - Wargny, Matthieu AU - Gourraud, Pierre-Antoine PY - 2024/6/24 TI - Implementing a Biomedical Data Warehouse From Blueprint to Bedside in a Regional French University Hospital Setting: Unveiling Processes, Overcoming Challenges, and Extracting Clinical Insight JO - JMIR Med Inform SP - e50194 VL - 12 KW - data warehouse KW - biomedical data warehouse KW - clinical data repository KW - electronic health records KW - data reuse KW - secondary use KW - clinical routine data KW - real-world data KW - implementation report N2 - Background: Biomedical data warehouses (BDWs) have become an essential tool to facilitate the reuse of health data for both research and decisional applications. Beyond technical issues, the implementation of BDWs requires strong institutional data governance and operational knowledge of the European and national legal framework for the management of research data access and use. Objective: In this paper, we describe the compound process of implementation and the contents of a regional university hospital BDW. Methods: We present the actions and challenges regarding organizational changes, technical architecture, and shared governance that took place to develop the Nantes BDW. We describe the process to access clinical contents, give details about patient data protection, and use examples to illustrate merging clinical insights. Implementation (Results): More than 68 million textual documents and 543 million pieces of coded information concerning approximately 1.5 million patients admitted to CHUN between 2002 and 2022 can be queried and transformed to be made available to investigators. Since its creation in 2018, 269 projects have benefited from the Nantes BDW. Access to data is organized according to data use and regulatory requirements. Conclusions: Data use is entirely determined by the scientific question posed. It is the vector of legitimacy of data access for secondary use. Enabling access to a BDW is a game changer for research and all operational situations in need of data. Finally, data governance must prevail over technical issues in institution data strategy vis-ŕ-vis care professionals and patients alike. UR - https://medinform.jmir.org/2024/1/e50194 UR - http://dx.doi.org/10.2196/50194 ID - info:doi/10.2196/50194 ER - TY - JOUR AU - Seo, Woosuk AU - Park, Young Sun AU - Zhang, Zhan AU - Singh, Hardeep AU - Pasupathy, Kalyan AU - Mahajan, Prashant PY - 2024/6/21 TI - Identifying Interventions to Improve Diagnostic Safety in Emergency Departments: Protocol for a Participatory Design Study JO - JMIR Res Protoc SP - e55357 VL - 13 KW - emergency departments KW - participatory design KW - diagnostic process KW - multilevel interventions KW - sociotechnical interventions KW - mobile phone N2 - Background: Emergency departments (EDs) are complex and fast-paced clinical settings where a diagnosis is made in a time-, information-, and resource-constrained context. Thus, it is predisposed to suboptimal diagnostic outcomes, leading to errors and subsequent patient harm. Arriving at a timely and accurate diagnosis is an activity that occurs after an effective collaboration between the patient or caregiver and the clinical team within the ED. Interventions such as novel sociotechnical solutions are needed to mitigate errors and risks. Objective: This study aims to identify challenges that frontline ED health care providers and patients face in the ED diagnostic process and involve them in co-designing technological interventions to enhance diagnostic excellence. Methods: We will conduct separate sessions with ED health care providers and patients, respectively, to assess various design ideas and use a participatory design (PD) approach for technological interventions to improve ED diagnostic safety. In the sessions, various intervention ideas will be presented to participants through storyboards. Based on a preliminary interview study with ED patients and health care providers, we created intervention storyboards that illustrate different care contexts in which ED health care providers or patients experience challenges and show how each intervention would address the specific challenge. By facilitating participant group discussion, we will reveal the overlap between the needs of the design research team observed during fieldwork and the needs perceived by target users (ie, participants) in their own experience to gain their perspectives and assessment on each idea. After the group discussions, participants will rank the ideas and co-design to improve our interventions. Data sources will include audio and video recordings, design sketches, and ratings of intervention design ideas from PD sessions. The University of Michigan Institutional Review Board approved this study. This foundational work will help identify the needs and challenges of key stakeholders in the ED diagnostic process and develop initial design ideas, specifically focusing on sociotechnological ideas for patient-, health care provider?, and system-level interventions for improving patient safety in EDs. Results: The recruitment of participants for ED health care providers and patients is complete. We are currently preparing for PD sessions. The first results from design sessions with health care providers will be reported in fall 2024. Conclusions: The study findings will provide unique insights for designing sociotechnological interventions to support ED diagnostic processes. By inviting frontline health care providers and patients into the design process, we anticipate obtaining unique insights into the ED diagnostic process and designing novel sociotechnical interventions to enhance patient safety. Based on this study?s collected data and intervention ideas, we will develop prototypes of multilevel interventions that can be tested and subsequently implemented for patients, health care providers, or hospitals as a system. International Registered Report Identifier (IRRID): DERR1-10.2196/55357 UR - https://www.researchprotocols.org/2024/1/e55357 UR - http://dx.doi.org/10.2196/55357 UR - http://www.ncbi.nlm.nih.gov/pubmed/38904990 ID - info:doi/10.2196/55357 ER - TY - JOUR AU - Bolinger, Elaina AU - Tyl, Benoit PY - 2024/6/17 TI - Key Considerations for Designing Clinical Studies to Evaluate Digital Health Solutions JO - J Med Internet Res SP - e54518 VL - 26 KW - evidence generation KW - clinical robustness KW - clinical trials KW - digital health KW - solutions KW - digital health solutions KW - DHS KW - health care system KW - patients KW - patient KW - individuals KW - individual KW - healthcare system KW - control arm adaptations KW - randomization methods KW - real-world data KW - platform research UR - https://www.jmir.org/2024/1/e54518 UR - http://dx.doi.org/10.2196/54518 UR - http://www.ncbi.nlm.nih.gov/pubmed/38885020 ID - info:doi/10.2196/54518 ER - TY - JOUR AU - Steinman, Lesley AU - Chadwick, Kelly AU - Chavez Santos, Erica AU - Sravanam, Sruthi AU - Johnson, Snowy Selisha AU - Rensema, Elspeth AU - Mayotte, Caitlin AU - Denison, Paige AU - Lorig, Kate PY - 2024/6/13 TI - Remote Evidence-Based Programs for Health Promotion to Support Older Adults During the COVID-19 Pandemic and Beyond: Mixed Methods Outcome Evaluation JO - JMIR Aging SP - e52069 VL - 7 KW - older adults KW - health equity KW - rural KW - chronic disease KW - outcome evaluation KW - behavior change KW - technology KW - community based KW - evidence based KW - health promotion KW - mobile phone N2 - Background: Evidence-based programs (EBPs) for health promotion were developed to reach older adults where they live, work, pray, and play. When the COVID-19 pandemic placed a disproportionate burden on older adults living with chronic conditions and the community-based organizations that support them, these in-person programs shifted to remote delivery. While EBPs have demonstrated effectiveness when delivered in person, less is known about outcomes when delivered remotely. Objective: This study evaluated changes in remote EBP participants? health and well-being in a national mixed methods outcome evaluation in January 1, 2021, to March 31, 2022. Methods: We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for equity framework to guide the evaluation. We purposively sampled for diverse remote EBP delivery modes and delivery organizations, staff, and traditionally underserved older adults, including people of color and rural dwellers. We included 5 EBPs for self-management, falls prevention, and physical activity: videoconferencing (Chronic Disease Self-Management Program, Diabetes Self-Management Program, and EnhanceFitness), telephone plus mailed materials (Chronic Pain Self-Management Program), and enhanced self-directed mailed materials (Walk With Ease). Participant and provider data included validated surveys, in-depth interviews, and open-ended survey questions. We used descriptive statistics to characterize the sample and the magnitude of change and paired t tests (2-tailed) and the Fisher exact test to test for change in outcomes between enrollment and 6-month follow-up. Thematic analysis was used to identify similarities and differences in outcomes within and across programs. Joint display tables facilitated the integration of quantitative and qualitative findings. Results: A total of 586 older adults, 198 providers, and 37 organizations providing EBPs participated in the evaluation. Of the 586 older adults, 289 (49.3%) provided follow-up outcome data. The mean age of the EBP participants was 65.4 (SD 12.0) years. Of the 289 EBP participants, 241 (83.4%) were female, 108 (37.3%) were people of color, 113 (39.1%) lived alone, and 99 (34.3%) were experiencing financial hardship. In addition, the participants reported a mean of 2.5 (SD 1.7) chronic conditions. Overall, the remote EBP participants showed statistically significant improvements in health, energy, sleep quality, loneliness, depressive symptoms, and technology anxiety. Qualitatively, participants shared improvements in knowledge, attitudes, and skills for healthier living; reduced their social isolation and loneliness; and gained better access to programs. Three-fourths of the providers (149/198, 75.2%) felt that effectiveness was maintained when switching from in-person to remote delivery. Conclusions: The findings suggest that participating in remote EBPs can improve health, social, and technological outcomes of interest for older adults and providers, with benefits extending to policy makers. Future policy and practice can better support remote EBP delivery as one model for health promotion, improving access for all older adults. UR - https://aging.jmir.org/2024/1/e52069 UR - http://dx.doi.org/10.2196/52069 UR - http://www.ncbi.nlm.nih.gov/pubmed/38869932 ID - info:doi/10.2196/52069 ER - TY - JOUR AU - Shen, Hongxia AU - van der Kleij, Rianne AU - van der Boog, M. Paul J. AU - Chavannes, H. Niels PY - 2024/6/13 TI - Developing a Tailored eHealth Self-Management Intervention for Patients With Chronic Kidney Disease in China: Intervention Mapping Approach JO - JMIR Form Res SP - e48605 VL - 8 KW - eHealth KW - self-management KW - intervention mapping KW - chronic kidney disease KW - intervention development KW - mobile phone N2 - Background: Chronic kidney disease (CKD) is a major public health concern. Adequate self-management skills are vital to reduce CKD burden, optimize patient health outcomes, and control health care expenditures. Using eHealth to support CKD self-management has the potential to promote healthy behaviors and improve health outcomes of patients with CKD. However, knowledge of the implementation of such interventions in general, and in China specifically, is still limited. Objective: This study aims to develop a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) eHealth self-management intervention. Methods: We used an intervention mapping approach. In phase 1, a systematic review and 2 qualitative studies were conducted to examine the needs, beliefs, and perceptions of patients with CKD and health care professionals regarding CKD self-management and eHealth interventions. Afterward, key factors gathered from the aforementioned studies were categorized following the 5 domains of the Consolidated Framework for Implementation Research (CFIR). In phase 2, we specified program outcomes, performance objectives, determinants, theory-based methods, and practical strategies. Knowledge obtained from previous results was combined to complement core components of the MD self-management intervention and adapt them for Chinese patients with CKD. Additionally, the CFIR?Expert Recommendations for Implementing Change Matching Tool was pragmatically used to generate a list of potential implementation strategies to address the key factors influencing the implementation of eHealth CKD self-management interventions, and implementation strategies were discussed and finalized with the intervention monitoring group. Results: An overview of the CFIR domains showed the essential factors influencing the implementation of eHealth CKD self-management interventions in Chinese settings, including ?knowledge and beliefs? in the domain ?individual characteristics,? ?quality and advantage of eHealth intervention? in the domain ?intervention characteristics,? ?compatibility? in the domain ?inner setting,? and ?cultural context? in the domain ?outer setting.? To ensure the effectiveness of the Dutch MD?based self-management intervention, we did not change the core self-management intervention components of MD that underlie its effectiveness, such as self-monitoring. We identified surface-level cultural adaptations involving customizing intervention content, messages, and approaches to the observable cultural characteristics of the local population to enhance the intervention?s appeal, receptivity, and feasibility, such as providing video or voice call options to support interactions with health care professionals. Furthermore, the adapted modules such as Knowledge Center and My Self-Monitoring were developed in a mobile health app. Conclusions: Our study resulted in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China that has the potential to optimize patients? self-management skills and improve health status and quality of life. Moreover, our study?s research approach and results can inform future research on the tailoring and translation of evidence-based, eHealth self-management interventions to various contexts. Trial Registration: ClinicalTrials.gov NCT04212923; https://classic.clinicaltrials.gov/ct2/show/NCT04212923 UR - https://formative.jmir.org/2024/1/e48605 UR - http://dx.doi.org/10.2196/48605 UR - http://www.ncbi.nlm.nih.gov/pubmed/38869943 ID - info:doi/10.2196/48605 ER - TY - JOUR AU - Dickerson, S. Suzanne AU - George, J. Saliyah AU - Ventuneac, Ana AU - Dharia, Arpan AU - Talal, H. Andrew PY - 2024/6/12 TI - Care Integration for Hepatitis C Virus Treatment Through Facilitated Telemedicine Within Opioid Treatment Programs: Qualitative Study JO - J Med Internet Res SP - e53049 VL - 26 KW - hepatitis C virus KW - integrated treatment KW - facilitated telemedicine KW - substance users KW - people with opioid use disorder KW - opioid KW - opioids KW - telemedicine KW - telehealth KW - eHealth KW - e-health KW - ICT KW - substance use KW - substance abuse KW - HCV KW - hepatitis KW - liver KW - interview KW - interviews KW - qualitative KW - hermeneutic KW - phenomenological KW - implementation KW - integration KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - addict KW - addiction KW - addictions KW - addicts KW - hepatic N2 - Background: Telemedicine has the potential to remove geographic and temporal obstacles to health care access. Whether and how telemedicine can increase health care access for underserved populations remains an open question. To address this issue, we integrated facilitated telemedicine encounters for the management of hepatitis C virus (HCV), a highly prevalent condition among people with opioid use disorder (OUD), into opioid treatment programs (OTPs). In New York State, OTPs are methadone-dispensing centers that provide patient-centered, evidence-based treatment for OUD. We investigated the integration and impact of facilitated telemedicine into OTP workflows in these settings. Objective: This study aims to understand OTP staff experiences with integrating facilitated telemedicine for HCV treatment into OTPs, including best practices and lessons learned. Methods: We conducted semistructured interviews with 45 OTP staff members (13 clinical, 12 administrative, 6 physicians, and 14 support staff members) at least one year after the implementation of facilitated telemedicine for HCV management. We used hermeneutic phenomenological analysis to understand OTP staff experiences. Results: We identified 4 overarching themes illustrating the successful integration of facilitated telemedicine for HCV care into OTPs. First, integration requires an understanding of the challenges, goals, and values of the OTP. As OTP staff learned about new, highly effective HCV therapies, they valued an HCV cure as a ?win? for their patients and were excited about the potential to eliminate a highly prevalent infectious disease. Second, the integration of facilitated telemedicine into OTPs fosters social support and reinforces relationships between patients and OTP staff. OTP staff appreciated the ability to have ?eyes on? patients during telemedicine encounters to assess body language, a necessary component of OUD management. Third, participants described high levels of interprofessional collaboration as a care team that included the blurring of lines between disciplines working toward a common goal of improving patient care. Study case managers were integrated into OTP workflows and established communication channels to improve patient outcomes. Fourth, administrators endorsed the sustained and future expansion of facilitated telemedicine to address comorbidities. Conclusions: OTP staff were highly enthusiastic about facilitated telemedicine for an underserved population. They described high levels of collaboration and integration comparable to relevant integrative frameworks. When situated within OTPs, facilitated telemedicine is a high-value application of telemedicine that provides support for underserved populations necessary for high-quality health care. These experiences support sustaining and scaling facilitated telemedicine in comparable settings and evaluating its ability to address other comorbidities. Trial Registration: ClinicalTrials.gov NCT02933970; https://clinicaltrials.gov/study/NCT02933970 UR - https://www.jmir.org/2024/1/e53049 UR - http://dx.doi.org/10.2196/53049 UR - http://www.ncbi.nlm.nih.gov/pubmed/38865703 ID - info:doi/10.2196/53049 ER - TY - JOUR AU - Landis-Lewis, Zach AU - Andrews, A. Chris AU - Gross, A. Colin AU - Friedman, P. Charles AU - Shah, J. Nirav PY - 2024/6/11 TI - Exploring Anesthesia Provider Preferences for Precision Feedback: Preference Elicitation Study JO - JMIR Med Educ SP - e54071 VL - 10 KW - audit and feedback KW - dashboard KW - motivation KW - visualization KW - anesthesia care KW - anesthesia KW - feedback KW - engagement KW - effectiveness KW - precision feedback KW - experimental design KW - design KW - clinical practice KW - motivational KW - performance KW - performance data N2 - Background: Health care professionals must learn continuously as a core part of their work. As the rate of knowledge production in biomedicine increases, better support for health care professionals? continuous learning is needed. In health systems, feedback is pervasive and is widely considered to be essential for learning that drives improvement. Clinical quality dashboards are one widely deployed approach to delivering feedback, but engagement with these systems is commonly low, reflecting a limited understanding of how to improve the effectiveness of feedback about health care. When coaches and facilitators deliver feedback for improving performance, they aim to be responsive to the recipient?s motivations, information needs, and preferences. However, such functionality is largely missing from dashboards and feedback reports. Precision feedback is the delivery of high-value, motivating performance information that is prioritized based on its motivational potential for a specific recipient, including their needs and preferences. Anesthesia care offers a clinical domain with high-quality performance data and an abundance of evidence-based quality metrics. Objective: The objective of this study is to explore anesthesia provider preferences for precision feedback. Methods: We developed a test set of precision feedback messages with balanced characteristics across 4 performance scenarios. We created an experimental design to expose participants to contrasting message versions. We recruited anesthesia providers and elicited their preferences through analysis of the content of preferred messages. Participants additionally rated their perceived benefit of preferred messages to clinical practice on a 5-point Likert scale. Results: We elicited preferences and feedback message benefit ratings from 35 participants. Preferences were diverse across participants but largely consistent within participants. Participants? preferences were consistent for message temporality (?=.85) and display format (?=.80). Ratings of participants? perceived benefit to clinical practice of preferred messages were high (mean rating 4.27, SD 0.77). Conclusions: Health care professionals exhibited diverse yet internally consistent preferences for precision feedback across a set of performance scenarios, while also giving messages high ratings of perceived benefit. A ?one-size-fits-most approach? to performance feedback delivery would not appear to satisfy these preferences. Precision feedback systems may hold potential to improve support for health care professionals? continuous learning by accommodating feedback preferences. UR - https://mededu.jmir.org/2024/1/e54071 UR - http://dx.doi.org/10.2196/54071 ID - info:doi/10.2196/54071 ER - TY - JOUR AU - Moreno Arellano, April AU - Shih, Huan-ju AU - Williams, S. Karmen PY - 2024/6/11 TI - Bringing the Public Health Informatics and Technology Workforce Together: The PHIAT Conference JO - Online J Public Health Inform SP - e55377 VL - 16 KW - public health informatics KW - health informatics KW - technology KW - health technology KW - digital health KW - digital intervention KW - digital interventions KW - conference KW - health conference KW - health conferences KW - public health workforce KW - public health worker KW - public health workers KW - PHIAT Conference KW - PHIAT KW - public health KW - health surveillance UR - https://ojphi.jmir.org/2024/1/e55377 UR - http://dx.doi.org/10.2196/55377 UR - http://www.ncbi.nlm.nih.gov/pubmed/38861316 ID - info:doi/10.2196/55377 ER - TY - JOUR AU - Martin, Tobias AU - Veldeman, Sarah AU - Großmann, Heidrun AU - Fuchs-Frohnhofen, Paul AU - Czaplik, Michael AU - Follmann, Andreas PY - 2024/6/6 TI - Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study JO - JMIR Aging SP - e55471 VL - 7 KW - telemedicine KW - televisits KW - telehealth KW - eHealth KW - electronic health KW - older adult care KW - nursing homes KW - change management KW - implementation science KW - technology transfer KW - innovation transfer KW - long-term adoption KW - COVID-19 crisis KW - postpandemic KW - coronavirus KW - digitalization N2 - Background: There is growing evidence that telemedicine can improve the access to and quality of health care for nursing home residents. However, it is still unclear how to best manage and guide the implementation process to ensure long-term adoption, especially in the context of a decline in telemedicine use after the COVID-19 crisis. Objective: This study aims to identify and address major challenges for the implementation of televisits among residents in a nursing home, their caring nurses, and their treating general practitioners (GPs). It also evaluated the impact of televisits on the nurses? workload and their nursing practice. Methods: A telemedical system with integrated medical devices was introduced in 2 nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use until March 2023. Regular evaluation was based on a mixed methods approach combining rigorous qualitative approaches with quantitative measurements. Results: In the first phase during the COVID-19 pandemic, both nursing homes achieved short-term adoption. In the postpandemic phase, an action-oriented approach made it possible to identify barriers and take control actions for long-term adoption. The implementation of asynchronous visits, strong leadership, and sustained training of the nurses were critical elements in achieving long-term implementation in 1 nursing home. The implementation led to enhanced clinical skills, higher professional recognition, and less psychological distress among the nursing staff. Televisits resulted in a modest increase in time demands for the nursing staff compared to organizing in-person home visits with the GPs. Conclusions: Focusing on health care workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine. UR - https://aging.jmir.org/2024/1/e55471 UR - http://dx.doi.org/10.2196/55471 UR - http://www.ncbi.nlm.nih.gov/pubmed/38842915 ID - info:doi/10.2196/55471 ER - TY - JOUR AU - Rzewuska Díaz, Magdalena AU - Locock, Louise AU - Keen, Andrew AU - Melvin, Mike AU - Myhill, Anthony AU - Ramsay, Craig PY - 2024/6/4 TI - Implementation of a Web-Based Outpatient Asynchronous Consultation Service: Mixed Methods Study JO - J Med Internet Res SP - e48092 VL - 26 KW - outpatient care KW - teleconsultation KW - asynchronous communication KW - implementation KW - mixed methods research KW - qualitative research KW - hospital data N2 - Background: Asynchronous outpatient patient-to-provider communication is expanding in UK health care, requiring evaluation. During the pandemic, Aberdeen Royal Infirmary in Scotland expanded its outpatient asynchronous consultation service from dermatology (deployed in May 2020) to gastroenterology and pain management clinics. Objective: We conducted a mixed methods study using staff, patient, and public perspectives and National Health Service (NHS) numerical data to obtain a rounded picture of innovation as it happened. Methods: Focus groups (3 web-based and 1 face-to-face; n=22) assessed public readiness for this service, and 14 interviews with staff focused on service design and delivery. The service?s effects were examined using NHS Grampian service use data, a patient satisfaction survey (n=66), and 6 follow-up patient interviews. Survey responses were descriptively analyzed. Demographics, acceptability, nonattendance rates, and appointment outcomes of users were compared across levels of area deprivation in which they live and medical specialties. Interviews and focus groups underwent theory-informed thematic analysis. Results: Staff anticipated a simple technical system transfer from dermatology to other receptive medical specialties, but despite a favorable setting and organizational assistance, it was complicated. Key implementation difficulties included pandemic-induced technical integration delays, misalignment with existing administrative processes, and discontinuity in project management. The pain management clinic began asynchronous consultations (digital appointments) in December 2021, followed by the gastroenterology clinic in February 2022. Staff quickly learned how to explain and use this service. It was thought to function better for pain management as it fitted preexisting practices. From May to September 2022, the dermatology (adult and pediatric), gastroenterology, and pain management clinics offered 1709 appointments to a range of patients (n=1417). Digital appointments reduced travel by an estimated 44,712 miles (~71,956.81 km) compared to the face-to-face mode. The deprivation profile of people who chose to use this service closely mirrored that of NHS Grampian?s population overall. There was no evidence that deprivation impacted whether digital appointment users subsequently received treatment. Only 18% (12/66) of survey respondents were unhappy or very unhappy with being offered a digital appointment. The benefits mentioned included better access, convenience, decreased travel and waiting time, information sharing, and clinical flexibility. Overall, patients, the public, and staff recognized its potential as an NHS service but highlighted informed choice and flexibility. Better communication?including the use of the term assessment instead of appointment?may increase patient acceptance. Conclusions: Asynchronous pain management and gastroenterology consultations are viable and acceptable. Implementing this service is easiest when existing administrative processes face minimal disruption, although continuous support is needed. This study can inform practical strategies for supporting staff in adopting asynchronous consultations (eg, preparing for nonlinearity and addressing task issues). Patients need clear explanations and access to technical support, along with varied consultation options, to ensure digital inclusion. UR - https://www.jmir.org/2024/1/e48092 UR - http://dx.doi.org/10.2196/48092 UR - http://www.ncbi.nlm.nih.gov/pubmed/38833695 ID - info:doi/10.2196/48092 ER - TY - JOUR AU - Nxumalo, Thembelenkosini Celenkosini AU - Pillay, Pavitra AU - Mchunu, Gladness Gugu PY - 2024/6/3 TI - The Durban University of Technology Faculty of Health Sciences Decentralized Clinical Training Project: Protocol for an Implementation Study in KwaZulu-Natal, South Africa JO - JMIR Res Protoc SP - e52243 VL - 13 KW - decentralized clinical training programs KW - curriculum KW - clinical education KW - health science education KW - university of technology KW - pedagogy KW - transformative education KW - teaching KW - higher education KW - South Africa N2 - Background: The Durban University of Technology (DUT) Faculty of Health Sciences (FHS) in KwaZulu-Natal, South Africa, is embarking on a project to implement a Decentralized Clinical Training Program (DCTP). The DUT FHS DCTP project is being conducted in response to the growing demands of students requiring clinical service placements as part of work-integrated learning. The project is also geared toward responding to existing gaps in current practices related to the implementation of a DCTP, which has mainly been through traditional universities providing training to medical, optometry, occupational therapy, and physiotherapy students. In South Africa, a DCTP is yet to be implemented within the context of a university of technology; it is yet to be implemented within health science faculties that offer undergraduate health science programs in mainstream biomedicine and alternative and complementary disciplines. Objective: We aim to design, pilot, and establish an effective DCTP at the DUT FHS in KwaZulu-Natal, South Africa. Methods: Participatory action research comprising various designs?namely, appreciative inquiry, qualitative case study design, phenomenography, and descriptive qualitative study design?will be used to conduct the study. Data will be collected using individual interviews, focus group discussions, nominal group technique, consensus methodology, and narrative inquiry. Study participants will include various internal and external stakeholders of the DUT, namely, academic staff; students; key informants from universities currently using successfully established DCTPs; academic support staff; staff working in human resources, finance, procurement, and accounting; and experts in other disciplines such as engineering and information systems. Overall, 4 undergraduate health science programs?namely, Radiography, Medical Orthotics and Prosthetics, Clinical Technology, and Emergency Medical Care and Rescue?will be part of the project?s pilot phase. Findings from the project?s pilot phase will be used to inform scale-up in the other undergraduate programs in the DUT FHS. The project is being implemented as part of the university?s strategic objective of devising innovative curricula and pedagogical practices to improve the mastery, skill set, and competence of health science graduates. Results: The study has currently commenced with the situational analysis, consisting of engagement with external stakeholders implementing DCTPs. The data to be generated from the completion of the situational analysis are anticipated to be published in 2024. Conclusions: This project is envisioned to facilitate collaboration among the universities of technology, traditional universities, Ministry of Health, and private sector for clinical placement of undergraduate health science students in health establishments that are away from the university, thereby exposing them to real-life experiences related to health care. This will facilitate authentic learning experiences that will contribute to improved competencies of graduates in relation to the health needs of society and the multiple realities of the South African health system. International Registered Report Identifier (IRRID): PRR1-10.2196/52243 UR - https://www.researchprotocols.org/2024/1/e52243 UR - http://dx.doi.org/10.2196/52243 UR - http://www.ncbi.nlm.nih.gov/pubmed/38829695 ID - info:doi/10.2196/52243 ER - TY - JOUR AU - Bunt, Lance AU - Greeff, Japie AU - Taylor, Estelle PY - 2024/5/31 TI - Enhancing Serious Game Design: Expert-Reviewed, Stakeholder-Centered Framework JO - JMIR Serious Games SP - e48099 VL - 12 KW - serious games KW - stakeholder theory KW - enterprise architecture KW - serious game development KW - design framework N2 - Background: Traditional serious game design methods often overlook stakeholder needs. This study integrates stakeholder theory and enterprise architecture (EA), along with the Architecture Development Method, to propose a novel framework for serious game design. Crafted to aid practitioners, researchers, and specialists in leveraging resources more effectively, the framework is validated through a design science research methodology. Expert reviews have further refined its features, making it a robust tool for enhancing serious game design and implementation. Objective: This paper introduces a framework for designing serious games, covering stakeholder analysis, requirements gathering, and design implementation planning. It highlights the importance of expert review in validating and refining the framework, ensuring its effectiveness and reliability for use in serious game design. Through critical assessment by experts, the framework is optimized for practical application by practitioners, researchers, and specialists in the field, ensuring its utility in enhancing serious game development. The next step will be to validate the framework empirically by applying it to a serious game development project. Methods: We developed and validated a conceptual framework for serious game design by synthesizing stakeholder theory and EA through literature review, concept mapping, and theory development by way of a design science research approach. The framework is iteratively refined and validated via expert review, drawing on insights from professionals experienced in serious games, stakeholder theory, and EA. This method ensures the framework?s practical relevance and effectiveness in addressing real-world design challenges. Results: An expert review by 29 serious game practitioners validated the framework?s success in stakeholder management, confirming its stakeholder-centered effectiveness. Although the experts praised its structured approach, they suggested clearer guidance for game design elements. In addition, the experts, while acknowledging the framework?s complexity, saw its depth as valuable for efficient management. The consensus calls for a refined balance between detailed functionality and user-friendly design, with the framework?s impact on stakeholder capabilities revealing a spectrum of professional needs. Conclusions: This paper presents a framework for creating effective and organizationally aligned serious games. Evaluated across execution, practical, and EA levels, it is logical but varies in ease of understanding, with experts calling for more accessibility at the EA level. It enhances stakeholder efficiency and management but is criticized for rigidity and a need for flexibility. Recommendations include streamlining the framework, enhancing clarity, reducing administrative tasks, and incorporating clear guidelines on technology use, motivational elements, and operational tools. This aims to help stakeholders produce more targeted and adaptable game designs. The next iteration will be developed after application to a project and team feedback. UR - https://games.jmir.org/2024/1/e48099 UR - http://dx.doi.org/10.2196/48099 UR - http://www.ncbi.nlm.nih.gov/pubmed/38820585 ID - info:doi/10.2196/48099 ER - TY - JOUR AU - Heider, M. Paul AU - Meystre, M. Stéphane PY - 2024/5/28 TI - An Extensible Evaluation Framework Applied to Clinical Text Deidentification Natural Language Processing Tools: Multisystem and Multicorpus Study JO - J Med Internet Res SP - e55676 VL - 26 KW - natural language processing KW - evaluation methodology KW - deidentification KW - privacy protection KW - de-identification KW - secondary use KW - patient privacy N2 - Background: Clinical natural language processing (NLP) researchers need access to directly comparable evaluation results for applications such as text deidentification across a range of corpus types and the means to easily test new systems or corpora within the same framework. Current systems, reported metrics, and the personally identifiable information (PII) categories evaluated are not easily comparable. Objective: This study presents an open-source and extensible end-to-end framework for comparing clinical NLP system performance across corpora even when the annotation categories do not align. Methods: As a use case for this framework, we use 6 off-the-shelf text deidentification systems (ie, CliniDeID, deid from PhysioNet, MITRE Identity Scrubber Toolkit [MIST], NeuroNER, National Library of Medicine [NLM] Scrubber, and Philter) across 3 standard clinical text corpora for the task (2 of which are publicly available) and 1 private corpus (all in English), with annotation categories that are not directly analogous. The framework is built on shell scripts that can be extended to include new systems, corpora, and performance metrics. We present this open tool, multiple means for aligning PII categories during evaluation, and our initial timing and performance metric findings. Code for running this framework with all settings needed to run all pairs are available via Codeberg and GitHub. Results: From this case study, we found large differences in processing speed between systems. The fastest system (ie, MIST) processed an average of 24.57 (SD 26.23) notes per second, while the slowest (ie, CliniDeID) processed an average of 1.00 notes per second. No system uniformly outperformed the others at identifying PII across corpora and categories. Instead, a rich tapestry of performance trade-offs emerged for PII categories. CliniDeID and Philter prioritize recall over precision (with an average recall 6.9 and 11.2 points higher, respectively, for partially matching spans of text matching any PII category), while the other 4 systems consistently have higher precision (with MIST?s precision scoring 20.2 points higher, NLM Scrubber scoring 4.4 points higher, NeuroNER scoring 7.2 points higher, and deid scoring 17.1 points higher). The macroaverage recall across corpora for identifying names, one of the more sensitive PII categories, included deid (48.8%) and MIST (66.9%) at the low end and NeuroNER (84.1%), NLM Scrubber (88.1%), and CliniDeID (95.9%) at the high end. A variety of metrics across categories and corpora are reported with a wider variety (eg, F2-score) available via the tool. Conclusions: NLP systems in general and deidentification systems and corpora in our use case tend to be evaluated in stand-alone research articles that only include a limited set of comparators. We hold that a single evaluation pipeline across multiple systems and corpora allows for more nuanced comparisons. Our open pipeline should reduce barriers to evaluation and system advancement. UR - https://www.jmir.org/2024/1/e55676 UR - http://dx.doi.org/10.2196/55676 UR - http://www.ncbi.nlm.nih.gov/pubmed/38805692 ID - info:doi/10.2196/55676 ER - TY - JOUR AU - Timpka, Toomas PY - 2024/5/24 TI - Time for Medicine and Public Health to Leave Platform X JO - JMIR Med Educ SP - e53810 VL - 10 KW - internet KW - social media KW - medical informatics KW - knowledge translation KW - digital technology KW - clinical decision support KW - health services research KW - public health KW - digital health KW - perspective KW - medicine UR - https://mededu.jmir.org/2024/1/e53810 UR - http://dx.doi.org/10.2196/53810 ID - info:doi/10.2196/53810 ER - TY - JOUR AU - Stevens, R. Elizabeth AU - Xu, Lynn AU - Kwon, JaeEun AU - Tasneem, Sumaiya AU - Henning, Natalie AU - Feldthouse, Dawn AU - Kim, Ji Eun AU - Hess, Rachel AU - Dauber-Decker, L. Katherine AU - Smith, D. Paul AU - Halm, Wendy AU - Gautam-Goyal, Pranisha AU - Feldstein, A. David AU - Mann, M. Devin PY - 2024/5/23 TI - Barriers to Implementing Registered Nurse?Driven Clinical Decision Support for Antibiotic Stewardship: Retrospective Case Study JO - JMIR Form Res SP - e54996 VL - 8 KW - integrated clinical prediction rules KW - EHR KW - electronic health record KW - implementation KW - barriers KW - acute respiratory infections KW - antibiotics KW - CDS KW - clinical decision support KW - decision support KW - antibiotic KW - prescribe KW - prescription KW - acute respiratory infection KW - barrier KW - effectiveness KW - registered nurse KW - RN KW - RN-driven intervention KW - personnel availability KW - workflow variability KW - infrastructure KW - infrastructures KW - law KW - laws KW - policy KW - policies KW - clinical-care setting KW - clinical setting KW - electronic health records KW - RN-driven KW - antibiotic stewardship KW - retrospective analysis KW - Consolidated Framework for Implementation Research KW - CFIR KW - CDS-based intervention KW - urgent care KW - New York KW - chart review KW - interview KW - interviews KW - staff change KW - staff changes KW - RN shortage KW - RN shortages KW - turnover KW - health system KW - nurse KW - nurses KW - researcher KW - researchers N2 - Background: Up to 50% of antibiotic prescriptions for upper respiratory infections (URIs) are inappropriate. Clinical decision support (CDS) systems to mitigate unnecessary antibiotic prescriptions have been implemented into electronic health records, but their use by providers has been limited. Objective: As a delegation protocol, we adapted a validated electronic health record?integrated clinical prediction rule (iCPR) CDS-based intervention for registered nurses (RNs), consisting of triage to identify patients with low-acuity URI followed by CDS-guided RN visits. It was implemented in February 2022 as a randomized controlled stepped-wedge trial in 43 primary and urgent care practices within 4 academic health systems in New York, Wisconsin, and Utah. While issues were pragmatically addressed as they arose, a systematic assessment of the barriers to implementation is needed to better understand and address these barriers. Methods: We performed a retrospective case study, collecting quantitative and qualitative data regarding clinical workflows and triage-template use from expert interviews, study surveys, routine check-ins with practice personnel, and chart reviews over the first year of implementation of the iCPR intervention. Guided by the updated CFIR (Consolidated Framework for Implementation Research), we characterized the initial barriers to implementing a URI iCPR intervention for RNs in ambulatory care. CFIR constructs were coded as missing, neutral, weak, or strong implementation factors. Results: Barriers were identified within all implementation domains. The strongest barriers were found in the outer setting, with those factors trickling down to impact the inner setting. Local conditions driven by COVID-19 served as one of the strongest barriers, impacting attitudes among practice staff and ultimately contributing to a work infrastructure characterized by staff changes, RN shortages and turnover, and competing responsibilities. Policies and laws regarding scope of practice of RNs varied by state and institutional application of those laws, with some allowing more clinical autonomy for RNs. This necessitated different study procedures at each study site to meet practice requirements, increasing innovation complexity. Similarly, institutional policies led to varying levels of compatibility with existing triage, rooming, and documentation workflows. These workflow conflicts were compounded by limited available resources, as well as an implementation climate of optional participation, few participation incentives, and thus low relative priority compared to other clinical duties. Conclusions: Both between and within health care systems, significant variability existed in workflows for patient intake and triage. Even in a relatively straightforward clinical workflow, workflow and cultural differences appreciably impacted intervention adoption. Takeaways from this study can be applied to other RN delegation protocol implementations of new and innovative CDS tools within existing workflows to support integration and improve uptake. When implementing a system-wide clinical care intervention, considerations must be made for variability in culture and workflows at the state, health system, practice, and individual levels. Trial Registration: ClinicalTrials.gov NCT04255303; https://clinicaltrials.gov/ct2/show/NCT04255303 UR - https://formative.jmir.org/2024/1/e54996 UR - http://dx.doi.org/10.2196/54996 UR - http://www.ncbi.nlm.nih.gov/pubmed/38781006 ID - info:doi/10.2196/54996 ER - TY - JOUR AU - MacPherson, Megan AU - Rourke, Sarah PY - 2024/5/22 TI - The Power of Rapid Reviews for Bridging the Knowledge-to-Action Gap in Evidence-Based Virtual Health Care JO - J Med Internet Res SP - e54821 VL - 26 KW - virtual health care KW - rapid reviews KW - evidence synthesis KW - evidence-informed decision-making KW - knowledge translation UR - https://www.jmir.org/2024/1/e54821 UR - http://dx.doi.org/10.2196/54821 UR - http://www.ncbi.nlm.nih.gov/pubmed/38776542 ID - info:doi/10.2196/54821 ER - TY - JOUR AU - Jayasinghe, Thisakya Randi AU - Ahern, Susannah AU - Maharaj, D. Ashika AU - Romero, Lorena AU - Ruseckaite, Rasa PY - 2024/5/21 TI - Identifying Existing Guidelines, Frameworks, Checklists, and Recommendations for Implementing Patient-Reported Outcome Measures: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e52572 VL - 13 KW - patient-reported outcome measures KW - patient-reported outcomes KW - quality of life KW - clinical quality registry KW - guidelines KW - frameworks KW - recommendations KW - scoping review KW - patient perspectives KW - patient perspective KW - patient-reported outcome KW - patient-reported KW - clinical setting KW - clinical registry KW - registry KW - systematic review N2 - Background: Implementing patient-reported outcome measures (PROMs) to measure and evaluate health outcomes is increasing worldwide. Along with this emerging trend, it is important to identify which guidelines, frameworks, checklists, and recommendations exist, and if and how they have been used in implementing PROMs, especially in clinical quality registries (CQRs). Objective: This review aims to identify existing publications, as well as publications that discuss the application of actual guidelines, frameworks, checklists, and recommendations on PROMs? implementation for various purposes such as clinical trials, clinical practice, and CQRs. In addition, the identified publications will be used to guide the development of a new guideline for PROMs? implementation in CQRs, which is the aim of the broader project. Methods: A literature search of the databases MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials will be conducted since the inception of the databases, in addition to using Google Scholar and gray literature to identify literature for the scoping review. Predefined inclusion and exclusion criteria will be used for all phases of screening. Existing publications of guidelines, frameworks, checklists, recommendations, and publications discussing the application of those methodologies for implementing PROMs in clinical trials, clinical practice, and CQRs will be included in the final review. Data relating to bibliographic information, aim, the purpose of PROMs use (clinical trial, practice, or registries), name of guideline, framework, checklist and recommendations, the rationale for development, and their purpose and implications will be extracted. Additionally, for publications of actual methodologies, aspects or domains of PROMs? implementation will be extracted. A narrative synthesis of included publications will be conducted. Results: The electronic database searches were completed in March 2024. Title and abstract screening, full-text screening, and data extraction will be completed in May 2024. The review is expected to be completed by the end of August 2024. Conclusions: The findings of this scoping review will provide evidence on any existing methodologies and tools for PROMs? implementation in clinical trials, clinical practice, and CQRs. It is anticipated that the publications will help us guide the development of a new guideline for PROMs? implementation in CQRs. Trial Registration: PROSPERO CRD42022366085; https://tinyurl.com/bdesk98x International Registered Report Identifier (IRRID): DERR1-10.2196/52572 UR - https://www.researchprotocols.org/2024/1/e52572 UR - http://dx.doi.org/10.2196/52572 UR - http://www.ncbi.nlm.nih.gov/pubmed/38771621 ID - info:doi/10.2196/52572 ER - TY - JOUR AU - Ray, Jessica AU - Finn, Benjamin Emily AU - Tyrrell, Hollyce AU - Aloe, F. Carlin AU - Perrin, M. Eliana AU - Wood, T. Charles AU - Miner, S. Dean AU - Grout, Randall AU - Michel, J. Jeremy AU - Damschroder, J. Laura AU - Sharifi, Mona PY - 2024/5/21 TI - User-Centered Framework for Implementation of Technology (UFIT): Development of an Integrated Framework for Designing Clinical Decision Support Tools Packaged With Tailored Implementation Strategies JO - J Med Internet Res SP - e51952 VL - 26 KW - user-centered design KW - implementation science KW - clinical decision support KW - human factors KW - implementation KW - decision support KW - develop KW - development KW - framework KW - frameworks KW - design KW - user-centered KW - digital health KW - health technology KW - health technologies KW - need KW - needs KW - tailor KW - tailoring KW - guidance KW - guideline KW - guidelines KW - pediatric KW - pediatrics KW - child KW - children KW - obese KW - obesity KW - weight KW - overweight KW - primary care N2 - Background: Electronic health record?based clinical decision support (CDS) tools can facilitate the adoption of evidence into practice. Yet, the impact of CDS beyond single-site implementation is often limited by dissemination and implementation barriers related to site- and user-specific variation in workflows and behaviors. The translation of evidence-based CDS from initial development to implementation in heterogeneous environments requires a framework that assures careful balancing of fidelity to core functional elements with adaptations to ensure compatibility with new contexts. Objective: This study aims to develop and apply a framework to guide tailoring and implementing CDS across diverse clinical settings. Methods: In preparation for a multisite trial implementing CDS for pediatric overweight or obesity in primary care, we developed the User-Centered Framework for Implementation of Technology (UFIT), a framework that integrates principles from user-centered design (UCD), human factors/ergonomics theories, and implementation science to guide both CDS adaptation and tailoring of related implementation strategies. Our transdisciplinary study team conducted semistructured interviews with pediatric primary care clinicians and a diverse group of stakeholders from 3 health systems in the northeastern, midwestern, and southeastern United States to inform and apply the framework for our formative evaluation. Results: We conducted 41 qualitative interviews with primary care clinicians (n=21) and other stakeholders (n=20). Our workflow analysis found 3 primary ways in which clinicians interact with the electronic health record during primary care well-child visits identifying opportunities for decision support. Additionally, we identified differences in practice patterns across contexts necessitating a multiprong design approach to support a variety of workflows, user needs, preferences, and implementation strategies. Conclusions: UFIT integrates theories and guidance from UCD, human factors/ergonomics, and implementation science to promote fit with local contexts for optimal outcomes. The components of UFIT were used to guide the development of Improving Pediatric Obesity Practice Using Prompts, an integrated package comprising CDS for obesity or overweight treatment with tailored implementation strategies. Trial Registration: ClinicalTrials.gov NCT05627011; https://clinicaltrials.gov/study/NCT05627011 UR - https://www.jmir.org/2024/1/e51952 UR - http://dx.doi.org/10.2196/51952 UR - http://www.ncbi.nlm.nih.gov/pubmed/38771622 ID - info:doi/10.2196/51952 ER - TY - JOUR AU - Yanovitzky, Itzhak AU - Stahlman, Gretchen AU - Quow, Justine AU - Ackerman, Matthew AU - Perry, Yehuda AU - Kim, Miriam PY - 2024/5/16 TI - National Public Health Dashboards: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e52843 VL - 13 KW - dashboard KW - scoping review KW - public health KW - design KW - development KW - implementation KW - evaluation KW - user need KW - protocol KW - data dashboards KW - audiences KW - audience KW - systematic treatment KW - public health data dashboards KW - PRISMA-ScR KW - snowballing techniques KW - gray literature sources KW - evidence-informed framework KW - framework KW - COVID-19 KW - pandemic N2 - Background: The COVID-19 pandemic highlighted the importance of robust public health data systems and the potential utility of data dashboards for ensuring access to critical public health data for diverse groups of stakeholders and decision makers. As dashboards are becoming ubiquitous, it is imperative to consider how they may be best integrated with public health data systems and the decision-making routines of diverse audiences. However, additional progress on the continued development, improvement, and sustainability of these tools requires the integration and synthesis of a largely fragmented scholarship regarding the purpose, design principles and features, successful implementation, and decision-making supports provided by effective public health data dashboards across diverse users and applications. Objective: This scoping review aims to provide a descriptive and thematic overview of national public health data dashboards including their purpose, intended audiences, health topics, design elements, impact, and underlying mechanisms of use and usefulness of these tools in decision-making processes. It seeks to identify gaps in the current literature on the topic and provide the first-of-its-kind systematic treatment of actionability as a critical design element of public health data dashboards. Methods: The scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The review considers English-language, peer-reviewed journal papers, conference proceedings, book chapters, and reports that describe the design, implementation, and evaluation of a public health dashboard published between 2000 and 2023. The search strategy covers scholarly databases (CINAHL, PubMed, Medline, and Web of Science) and gray literature sources and uses snowballing techniques. An iterative process of testing for and improving intercoder reliability was implemented to ensure that coders are properly trained to screen documents according to the inclusion criteria prior to beginning the full review of relevant papers. Results: The search process initially identified 2544 documents, including papers located via databases, gray literature searching, and snowballing. Following the removal of duplicate documents (n=1416), nonrelevant items (n=839), and items classified as literature reviews and background information (n=73), 216 documents met the inclusion criteria: US case studies (n=90) and non-US case studies (n=126). Data extraction will focus on key variables, including public health data characteristics; dashboard design elements and functionalities; intended users, usability, logistics, and operation; and indicators of usefulness and impact reported. Conclusions: The scoping review will analyze the goals, design, use, usefulness, and impact of public health data dashboards. The review will also inform the continued development and improvement of these tools by analyzing and synthesizing current practices and lessons emerging from the literature on the topic and proposing a theory-grounded and evidence-informed framework for designing, implementing, and evaluating public health data dashboards. International Registered Report Identifier (IRRID): DERR1-10.2196/52843 UR - https://www.researchprotocols.org/2024/1/e52843 UR - http://dx.doi.org/10.2196/52843 UR - http://www.ncbi.nlm.nih.gov/pubmed/38753428 ID - info:doi/10.2196/52843 ER - TY - JOUR AU - Elser, Alexander AU - Lange, Marina AU - Kopkow, Christian AU - Schäfer, Georg Axel PY - 2024/5/15 TI - Barriers and Facilitators to the Implementation of Virtual Reality Interventions for People With Chronic Pain: Scoping Review JO - JMIR XR Spatial Comput SP - e53129 VL - 1 KW - virtual reality KW - VR KW - chronic pain KW - implementation science KW - scoping review KW - barriers KW - facilitators N2 - Background: Chronic pain is a growing health problem worldwide with a significant impact on individuals and societies. In regard to treatment, there is a gap between guideline recommendations and common practice in health care, especially concerning cognitive and psychological interventions. Virtual reality (VR) may provide a way to improve this situation. A growing body of evidence indicates that VR therapy has positive effects on pain and physical function. However, there is limited knowledge about barriers and facilitators to the implementation of VR interventions for people with chronic pain in health care settings. Objective: The aim of this study was to identify and analyze the barriers and facilitators involved in implementing VR interventions for people with chronic pain. Methods: We conducted a scoping review of the German and English literature using the MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, PEDro, LILACS, and Web of Science (inception to November 2023) databases, including quantitative, qualitative, and mixed methods studies reporting barriers and facilitators to the implementation of VR interventions for people with chronic pain, as reported by patients or health care professionals. Two reviewers systematically screened the abstracts and full texts of retrieved articles according to the inclusion criteria. All mentioned barriers and facilitators were extracted and categorized according to the Theoretical Domains Framework (TDF). Results: The database search resulted in 1864 records after removal of duplicates. From the 14 included studies, 30 barriers and 33 facilitators from the patient perspective and 2 facilitators from the health care professional perspective were extracted. Barriers reported by people with chronic pain were most frequently assigned to the TDF domains environmental context (60%) and skills (16.7%). Most facilitators were found in three domains for both the patients and health care professionals: beliefs about consequences (30.3%), emotions (18.2%), and environmental context (18.2%). Conclusions: The findings of this review can inform the development of strategies for future implementations of VR interventions for people with chronic pain. Additionally, further research should address knowledge gaps about the perspective of health care professionals regarding the implementation of VR interventions for people with chronic pain. UR - https://xr.jmir.org/2024/1/e53129 UR - http://dx.doi.org/10.2196/53129 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53129 ER - TY - JOUR AU - Arsenault-Lapierre, Genevieve AU - Lemay-Compagnat, Alexandra AU - Guillette, Maxime AU - Couturier, Yves AU - Massamba, Victoria AU - Dufour, Isabelle AU - Maubert, Eric AU - Fournier, Christine AU - Denis, Julie AU - Morin, Caroline AU - Vedel, Isabelle PY - 2024/5/8 TI - Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations JO - JMIR Form Res SP - e55064 VL - 8 KW - dashboard KW - learning health system KW - health policy KW - dementia care KW - health care regionalization KW - dementia KW - Alzheimer disease KW - qualitative KW - collaborative KW - focus group KW - primary care KW - implementation KW - attitude KW - opinion KW - perception KW - perspective KW - service KW - health care management N2 - Background: Health organizations face the critical task of executing and overseeing comprehensive health care. To address the challenges associated with this task, evidence-based dashboards have emerged as valuable tools. Since 2016, the regional health organizations of Quebec, Canada, have been responsible for ensuring implementation of the Quebec Alzheimer Plan (QAP), a provincial plan that aims to reinforce the capacity of primary care services to detect, diagnose, and treat persons with dementia. Despite the provincial scope of the QAP, the diverse material and human resources across regions introduce variability in the interest, utility, and specific needs associated with these dashboards. Objective: The aim of this study was to assess the interest and utility of dashboards to support the QAP implementation, as well as to determine the needs for improving these aspects according to the perspectives of various types of professionals involved across regions. Methods: An evaluative study using qualitative methods was conducted within a collaborative research approach involving different stakeholders, including the ministerial advisor and the four project managers responsible for supporting the implementation of the QAP, as well as researchers/scientific advisors. To support these organizations, we developed tailored, 2-page paper dashboards, detailing quantitative data on the prevalence of dementia, the use of health services by persons with dementia, and achievements and challenges of the QAP implementation in each organization?s jurisdiction. We then conducted 23 focus groups with the managers and leading clinicians involved in the implementation of the QAP of each regional health organization. Real-time notes were taken using a structured observation grid. Content analysis was conducted according to different regions (organizations with university mandates or nearby organizations, labeled ?university/peripheral?; organizations for which only part of the territory is in rural areas, labeled ?mixed?; and organizations in remote or isolated areas, labeled ?remote/isolated?) and according to different types of participants (managers, leading clinicians, and other participants). Results: Participants from organizations in all regions expressed interest in these dashboards and found them useful in several ways. However, they highlighted the need for indicators on orphan patients and other health care providers. Differences between regions were observed, particularly in the interest in continuity of care in university/peripheral regions and the need for diagnostic tools adapted to the culture in remote/isolated regions. Conclusions: These dashboards support the implementation of an Alzheimer Plan and contribute to the emergence of a learning health care system culture. This project allows each region to increase its monitoring capacity for the implementation of the QAP and facilitates reflection among individuals locally carrying out the implementation. The perspectives expressed will guide the preparation of the next iteration of the dashboards. UR - https://formative.jmir.org/2024/1/e55064 UR - http://dx.doi.org/10.2196/55064 UR - http://www.ncbi.nlm.nih.gov/pubmed/38717803 ID - info:doi/10.2196/55064 ER - TY - JOUR AU - Iqbal, Mujtaba Fahad AU - Aggarwal, Ravi AU - Joshi, Meera AU - King, Dominic AU - Martin, Guy AU - Khan, Sadia AU - Wright, Mike AU - Ashrafian, Hutan AU - Darzi, Ara PY - 2024/5/6 TI - Barriers to and Facilitators of Key Stakeholders Influencing Successful Digital Implementation of Remote Monitoring Solutions: Mixed Methods Analysis JO - JMIR Hum Factors SP - e49769 VL - 11 KW - implementation science KW - health plan implementation KW - mobile health KW - health care industry KW - stakeholder KW - COVID-19 KW - remote monitoring KW - digital tools KW - digital health KW - pandemic KW - virtual wards KW - virtual ward KW - health care delivery KW - telemedicine KW - telehealth KW - wearables KW - wearable KW - technology KW - United Kingdom KW - UK KW - digital services N2 - Background: Implementation of remote monitoring solutions and digital alerting tools in health care has historically been challenging, despite the impetus provided by the COVID-19 pandemic. To date, a health systems?based approach to systematically describe barriers and facilitators across multiple domains has not been undertaken. Objective: We aimed to undertake a comprehensive mixed methods analysis of barriers and facilitators for successful implementation of remote monitoring and digital alerting tools in complex health organizations. Methods: A mixed methods approach using a modified Technology Acceptance Model questionnaire and semistructured interviews mapped to the validated fit among humans, organizations, and technology (HOT-fit) framework was undertaken. Likert frequency responses and deductive thematic analyses were performed. Results: A total of 11 participants responded to the questionnaire and 18 participants to the interviews. Key barriers and facilitators could be mapped onto 6 dimensions, which incorporated aspects of digitization: system use (human), user satisfaction (human), environment (organization), structure (organization), information and service quality (technology), and system quality (technology). Conclusions: The recommendations proposed can enhance the potential for future remote sensing solutions to be more successfully integrated in health care practice, resulting in more successful use of ?virtual wards.? Trial Registration: ClinicalTrials.gov NCT05321004; https://www.clinicaltrials.gov/study/NCT05321004 UR - https://humanfactors.jmir.org/2024/1/e49769 UR - http://dx.doi.org/10.2196/49769 UR - http://www.ncbi.nlm.nih.gov/pubmed/37338929 ID - info:doi/10.2196/49769 ER - TY - JOUR AU - Ambrosio, Graca Maria Da AU - Lachman, M. Jamie AU - Zinzer, Paula AU - Gwebu, Hlengiwe AU - Vyas, Seema AU - Vallance, Inge AU - Calderon, Francisco AU - Gardner, Frances AU - Markle, Laurie AU - Stern, David AU - Facciola, Chiara AU - Schley, Anne AU - Danisa, Nompumelelo AU - Brukwe, Kanyisile AU - Melendez-Torres, GJ PY - 2024/5/3 TI - A Factorial Randomized Controlled Trial to Optimize User Engagement With a Chatbot-Led Parenting Intervention: Protocol for the ParentText Optimisation Trial JO - JMIR Res Protoc SP - e52145 VL - 13 KW - parenting intervention KW - chatbot-led public health intervention KW - engagement KW - implementation science KW - mobile phone N2 - Background: Violence against children (VAC) is a serious public health concern with long-lasting adverse effects. Evidence-based parenting programs are one effective means to prevent VAC; however, these interventions are not scalable in their typical in-person group format, especially in low- and middle-income countries where the need is greatest. While digital delivery, including via chatbots, offers a scalable and cost-effective means to scale up parenting programs within these settings, it is crucial to understand the key pillars of user engagement to ensure their effective implementation. Objective: This study aims to investigate the most effective and cost-effective combination of external components to optimize user engagement with ParentText, an open-source chatbot-led parenting intervention to prevent VAC in Mpumalanga, South Africa. Methods: This study will use a mixed methods design incorporating a 2 × 2 factorial cluster-randomized controlled trial and qualitative interviews. Parents of adolescent girls (32 clusters, 120 participants [60 parents and 60 girls aged 10 to 17 years] per cluster; N=3840 total participants) will be recruited from the Ehlanzeni and Nkangala districts of Mpumalanga. Clusters will be randomly assigned to receive 1 of the 4 engagement packages that include ParentText alone or combined with in-person sessions and a facilitated WhatsApp support group. Quantitative data collected will include pretest-posttest parent- and adolescent-reported surveys, facilitator-reported implementation data, and digitally tracked engagement data. Qualitative data will be collected from parents and facilitators through in-person or over-the-phone individual semistructured interviews and used to expand the interpretation and understanding of the quantitative findings. Results: Recruitment and data collection started in August 2023 and were finalized in November 2023. The total number of participants enrolled in the study is 1009, with 744 caregivers having completed onboarding to the chatbot-led intervention. Female participants represent 92.96% (938/1009) of the sample population, whereas male participants represent 7.03% (71/1009). The average participant age is 43 (SD 9) years. Conclusions: The ParentText Optimisation Trial is the first study to rigorously test engagement with a chatbot-led parenting intervention in a low- or middle-income country. The results of this study will inform the final selection of external delivery components to support engagement with ParentText in preparation for further evaluation in a randomized controlled trial in 2024. Trial Registration: Open Science Framework (OSF); https://doi.org/10.17605/OSF.IO/WFXNE International Registered Report Identifier (IRRID): DERR1-10.2196/52145 UR - https://www.researchprotocols.org/2024/1/e52145 UR - http://dx.doi.org/10.2196/52145 UR - http://www.ncbi.nlm.nih.gov/pubmed/38700935 ID - info:doi/10.2196/52145 ER - TY - JOUR AU - El Emam, Khaled AU - Leung, I. Tiffany AU - Malin, Bradley AU - Klement, William AU - Eysenbach, Gunther PY - 2024/5/2 TI - Consolidated Reporting Guidelines for Prognostic and Diagnostic Machine Learning Models (CREMLS) JO - J Med Internet Res SP - e52508 VL - 26 KW - reporting guidelines KW - machine learning KW - predictive models KW - diagnostic models KW - prognostic models KW - artificial intelligence KW - editorial policy UR - https://www.jmir.org/2024/1/e52508 UR - http://dx.doi.org/10.2196/52508 UR - http://www.ncbi.nlm.nih.gov/pubmed/38696776 ID - info:doi/10.2196/52508 ER - TY - JOUR AU - Green, Shaw Sara AU - Lee, Sung-Jae AU - Chahin, Samantha AU - Pooler-Burgess, Meardith AU - Green-Jones, Monique AU - Gurung, Sitaji AU - Outlaw, Y. Angulique AU - Naar, Sylvie PY - 2024/5/2 TI - Regulatory Issues in Electronic Health Records for Adolescent HIV Research: Strategies and Lessons Learned JO - JMIR Form Res SP - e46420 VL - 8 KW - electronic health record KW - HIV KW - pragmatic trial KW - regulatory KW - EHR KW - pre-exposure prophylaxis KW - retention KW - attrition KW - dropout KW - legal KW - regulation KW - adherence KW - ethic KW - review board KW - implementation KW - data use KW - privacy N2 - Background: Electronic health records (EHRs) are a cost-effective approach to provide the necessary foundations for clinical trial research. The ability to use EHRs in real-world clinical settings allows for pragmatic approaches to intervention studies with the emerging adult HIV population within these settings; however, the regulatory components related to the use of EHR data in multisite clinical trials poses unique challenges that researchers may find themselves unprepared to address, which may result in delays in study implementation and adversely impact study timelines, and risk noncompliance with established guidance. Objective: As part of the larger Adolescent Trials Network (ATN) for HIV/AIDS Interventions Protocol 162b (ATN 162b) study that evaluated clinical-level outcomes of an intervention including HIV treatment and pre-exposure prophylaxis services to improve retention within the emerging adult HIV population, the objective of this study is to highlight the regulatory process and challenges in the implementation of a multisite pragmatic trial using EHRs to assist future researchers conducting similar studies in navigating the often time-consuming regulatory process and ensure compliance with adherence to study timelines and compliance with institutional and sponsor guidelines. Methods: Eight sites were engaged in research activities, with 4 sites selected from participant recruitment venues as part of the ATN, who participated in the intervention and data extraction activities, and an additional 4 sites were engaged in data management and analysis. The ATN 162b protocol team worked with site personnel to establish the necessary regulatory infrastructure to collect EHR data to evaluate retention in care and viral suppression, as well as para-data on the intervention component to assess the feasibility and acceptability of the mobile health intervention. Methods to develop this infrastructure included site-specific training activities and the development of both institutional reliance and data use agreements. Results: Due to variations in site-specific activities, and the associated regulatory implications, the study team used a phased approach with the data extraction sites as phase 1 and intervention sites as phase 2. This phased approach was intended to address the unique regulatory needs of all participating sites to ensure that all sites were properly onboarded and all regulatory components were in place. Across all sites, the regulatory process spanned 6 months for the 4 data extraction and intervention sites, and up to 10 months for the data management and analysis sites. Conclusions: The process for engaging in multisite clinical trial studies using EHR data is a multistep, collaborative effort that requires proper advanced planning from the proposal stage to adequately implement the necessary training and infrastructure. Planning, training, and understanding the various regulatory aspects, including the necessity of data use agreements, reliance agreements, external institutional review board review, and engagement with clinical sites, are foremost considerations to ensure successful implementation and adherence to pragmatic trial timelines and outcomes. UR - https://formative.jmir.org/2024/1/e46420 UR - http://dx.doi.org/10.2196/46420 UR - http://www.ncbi.nlm.nih.gov/pubmed/38696775 ID - info:doi/10.2196/46420 ER - TY - JOUR AU - Owens-Jasey, Constance AU - Chen, Jinying AU - Xu, Ran AU - Angier, Heather AU - Huebschmann, G. Amy AU - Ito Fukunaga, Mayuko AU - Chaiyachati, H. Krisda AU - Rendle, A. Katharine AU - Robien, Kim AU - DiMartino, Lisa AU - Amante, J. Daniel AU - Faro, M. Jamie AU - Kepper, M. Maura AU - Ramsey, T. Alex AU - Bressman, Eric AU - Gold, Rachel PY - 2024/4/30 TI - Implementation of Health IT for Cancer Screening in US Primary Care: Scoping Review JO - JMIR Cancer SP - e49002 VL - 10 KW - cancer prevention KW - health information technology KW - implementation KW - implementation strategies KW - scoping review N2 - Background: A substantial percentage of the US population is not up to date on guideline-recommended cancer screenings. Identifying interventions that effectively improve screening rates would enhance the delivery of such screening. Interventions involving health IT (HIT) show promise, but much remains unknown about how HIT is optimized to support cancer screening in primary care. Objective: This scoping review aims to identify (1) HIT-based interventions that effectively support guideline concordance in breast, cervical, and colorectal cancer screening provision and follow-up in the primary care setting and (2) barriers or facilitators to the implementation of effective HIT in this setting. Methods: Following scoping review guidelines, we searched MEDLINE, CINAHL Plus, Web of Science, and IEEE Xplore databases for US-based studies from 2015 to 2021 that featured HIT targeting breast, colorectal, and cervical cancer screening in primary care. Studies were dual screened using a review criteria checklist. Data extraction was guided by the following implementation science frameworks: the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework; the Expert Recommendations for Implementing Change taxonomy; and implementation strategy reporting domains. It was also guided by the Integrated Technology Implementation Model that incorporates theories of both implementation science and technology adoption. Reporting was guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Results: A total of 101 studies met the inclusion criteria. Most studies (85/101, 84.2%) involved electronic health record?based HIT interventions. The most common HIT function was clinical decision support, primarily used for panel management or at the point of care. Most studies related to HIT targeting colorectal cancer screening (83/101, 82.2%), followed by studies related to breast cancer screening (28/101, 27.7%), and cervical cancer screening (19/101, 18.8%). Improvements in cancer screening were associated with HIT-based interventions in most studies (36/54, 67% of colorectal cancer?relevant studies; 9/14, 64% of breast cancer?relevant studies; and 7/10, 70% of cervical cancer?relevant studies). Most studies (79/101, 78.2%) reported on the reach of certain interventions, while 17.8% (18/101) of the included studies reported on the adoption or maintenance. Reported barriers and facilitators to HIT adoption primarily related to inner context factors of primary care settings (eg, staffing and organizational policies that support or hinder HIT adoption). Implementation strategies for HIT adoption were reported in 23.8% (24/101) of the included studies. Conclusions: There are substantial evidence gaps regarding the effectiveness of HIT-based interventions, especially those targeting guideline-concordant breast and colorectal cancer screening in primary care. Even less is known about how to enhance the adoption of technologies that have been proven effective in supporting breast, colorectal, or cervical cancer screening. Research is needed to ensure that the potential benefits of effective HIT-based interventions equitably reach diverse primary care populations. UR - https://cancer.jmir.org/2024/1/e49002 UR - http://dx.doi.org/10.2196/49002 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687595 ID - info:doi/10.2196/49002 ER - TY - JOUR AU - Hellstrand Tang, Ulla AU - Smith, Frida AU - Karilampi, Leyla Ulla AU - Gremyr, Andreas PY - 2024/4/26 TI - Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations: Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool JO - JMIR Hum Factors SP - e50889 VL - 11 KW - digital KW - bottom-up innovation KW - complexity KW - eHealth KW - health care KW - nonadoption, abandonment, scale-up, spread, and sustainability complexity assessment tool KW - NASSS-CAT KW - mobile phone N2 - Background: New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations. Objective: This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up. Methods: A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges. Results: The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization?s readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization?s system and its setting. Conclusions: Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations. UR - https://humanfactors.jmir.org/2024/1/e50889 UR - http://dx.doi.org/10.2196/50889 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669076 ID - info:doi/10.2196/50889 ER - TY - JOUR AU - Aggarwal, Monica AU - Hutchison, G. Brian AU - Kokorelias, M. Kristina AU - Ramsden, R. Vivian AU - Ivers, M. Noah AU - Pinto, Andrew AU - Uphsur, G. Ross E. AU - Wong, T. Sabrina AU - Pimlott, Nick AU - Slade, Steve PY - 2024/4/23 TI - The Conceptualization and Measurement of Research Impact in Primary Health Care: Protocol for a Rapid Scoping Review JO - JMIR Res Protoc SP - e55860 VL - 13 KW - research impact KW - primary health care KW - measurement KW - definition KW - concept KW - development KW - implementation KW - health policy KW - policy KW - health service KW - rapid review KW - review KW - research KW - policies KW - societal KW - productivity KW - literature database N2 - Background: The generation of research evidence and knowledge in primary health care (PHC) is crucial for informing the development and implementation of interventions and innovations and driving health policy, health service improvements, and potential societal changes. PHC research has broad effects on patients, practices, services, population health, community, and policy formulation. The in-depth exploration of the definition and measures of research impact within PHC is essential for broadening our understanding of research impact in the discipline and how it compares to other health services research. Objective: The objectives of the study are (1) to understand the conceptualizations and measures of research impact within the realm of PHC and (2) to identify methodological frameworks for evaluation and research impact and the benefits and challenges of using these approaches. The forthcoming review seeks to guide future research endeavors and enhance methodologies used in assessing research impact within PHC. Methods: The protocol outlines the rapid review and environmental scan approach that will be used to explore research impact in PHC and will be guided by established frameworks such as the Canadian Academy of Health Sciences Impact Framework and the Canadian Health Services and Policy Research Alliance. The rapid review follows scoping review guidelines (PRISMA-ScR; Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews). The environmental scan will be done by consulting with professional organizations, academic institutions, information science, and PHC experts. The search strategy will involve multiple databases, citation and forward citation searching, and manual searches of gray literature databases, think tank websites, and relevant catalogs. We will include gray and scientific literature focusing explicitly on research impact in PHC from high-income countries using the World Bank classification. Publications published in English from 1978 will be considered. The collected papers will undergo a 2-stage independent review process based on predetermined inclusion criteria. The research team will extract data from selected studies based on the research questions and the CRISP (Consensus Reporting Items for Studies in Primary Care) protocol statement. The team will discuss the extracted data, enabling the identification and categorization of key themes regarding research impact conceptualization and measurement in PHC. The narrative synthesis will evolve iteratively based on the identified literature. Results: The results of this study are expected at the end of 2024. Conclusions: The forthcoming review will explore the conceptualization and measurement of research impact in PHC. The synthesis will offer crucial insights that will guide subsequent research, emphasizing the need for a standardized approach that incorporates diverse perspectives to comprehensively gauge the true impact of PHC research. Furthermore, trends and gaps in current methodologies will set the stage for future studies aimed at enhancing our understanding and measurement of research impact in PHC. International Registered Report Identifier (IRRID): PRR1-10.2196/55860 UR - https://www.researchprotocols.org/2024/1/e55860 UR - http://dx.doi.org/10.2196/55860 UR - http://www.ncbi.nlm.nih.gov/pubmed/38652900 ID - info:doi/10.2196/55860 ER - TY - JOUR AU - Pannunzio, Valeria AU - Morales Ornelas, Cristina Hosana AU - Gurung, Pema AU - van Kooten, Robert AU - Snelders, Dirk AU - van Os, Hendrikus AU - Wouters, Michel AU - Tollenaar, Rob AU - Atsma, Douwe AU - Kleinsmann, Maaike PY - 2024/4/22 TI - Patient and Staff Experience of Remote Patient Monitoring?What to Measure and How: Systematic Review JO - J Med Internet Res SP - e48463 VL - 26 KW - remote patient monitoring KW - telemonitoring KW - patient experience KW - staff experience KW - monitoring KW - intervention KW - health outcome KW - adherence KW - patient monitoring N2 - Background: Patient and staff experience is a vital factor to consider in the evaluation of remote patient monitoring (RPM) interventions. However, no comprehensive overview of available RPM patient and staff experience?measuring methods and tools exists. Objective: This review aimed at obtaining a comprehensive set of experience constructs and corresponding measuring instruments used in contemporary RPM research and at proposing an initial set of guidelines for improving methodological standardization in this domain. Methods: Full-text papers reporting on instances of patient or staff experience measuring in RPM interventions, written in English, and published after January 1, 2011, were considered for eligibility. By ?RPM interventions,? we referred to interventions including sensor-based patient monitoring used for clinical decision-making; papers reporting on other kinds of interventions were therefore excluded. Papers describing primary care interventions, involving participants under 18 years of age, or focusing on attitudes or technologies rather than specific interventions were also excluded. We searched 2 electronic databases, Medline (PubMed) and EMBASE, on February 12, 2021.We explored and structured the obtained corpus of data through correspondence analysis, a multivariate statistical technique. Results: In total, 158 papers were included, covering RPM interventions in a variety of domains. From these studies, we reported 546 experience-measuring instances in RPM, covering the use of 160 unique experience-measuring instruments to measure 120 unique experience constructs. We found that the research landscape has seen a sizeable growth in the past decade, that it is affected by a relative lack of focus on the experience of staff, and that the overall corpus of collected experience measures can be organized in 4 main categories (service system related, care related, usage and adherence related, and health outcome related). In the light of the collected findings, we provided a set of 6 actionable recommendations to RPM patient and staff experience evaluators, in terms of both what to measure and how to measure it. Overall, we suggested that RPM researchers and practitioners include experience measuring as part of integrated, interdisciplinary data strategies for continuous RPM evaluation. Conclusions: At present, there is a lack of consensus and standardization in the methods used to measure patient and staff experience in RPM, leading to a critical knowledge gap in our understanding of the impact of RPM interventions. This review offers targeted support for RPM experience evaluators by providing a structured, comprehensive overview of contemporary patient and staff experience measures and a set of practical guidelines for improving research quality and standardization in this domain. UR - https://www.jmir.org/2024/1/e48463 UR - http://dx.doi.org/10.2196/48463 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648090 ID - info:doi/10.2196/48463 ER - TY - JOUR AU - Huguet, Nathalie AU - Chen, Jinying AU - Parikh, B. Ravi AU - Marino, Miguel AU - Flocke, A. Susan AU - Likumahuwa-Ackman, Sonja AU - Bekelman, Justin AU - DeVoe, E. Jennifer PY - 2024/4/22 TI - Applying Machine Learning Techniques to Implementation Science JO - Online J Public Health Inform SP - e50201 VL - 16 KW - implementation science KW - machine learning KW - implementation strategies KW - techniques KW - implementation KW - prediction KW - adaptation KW - acceptance KW - challenges KW - scientist UR - https://ojphi.jmir.org/2024/1/e50201 UR - http://dx.doi.org/10.2196/50201 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648094 ID - info:doi/10.2196/50201 ER - TY - JOUR AU - Shulha, Michael AU - Hovdebo, Jordan AU - D?Souza, Vinita AU - Thibault, Francis AU - Harmouche, Rola PY - 2024/4/16 TI - Integrating Explainable Machine Learning in Clinical Decision Support Systems: Study Involving a Modified Design Thinking Approach JO - JMIR Form Res SP - e50475 VL - 8 KW - explainable machine learning KW - XML KW - design thinking approach KW - NASSS framework KW - clinical decision support KW - clinician engagement KW - clinician-facing interface KW - clinician trust in machine learning KW - COVID-19 KW - chest x-ray KW - severity prediction N2 - Background: Though there has been considerable effort to implement machine learning (ML) methods for health care, clinical implementation has lagged. Incorporating explainable machine learning (XML) methods through the development of a decision support tool using a design thinking approach is expected to lead to greater uptake of such tools. Objective: This work aimed to explore how constant engagement of clinician end users can address the lack of adoption of ML tools in clinical contexts due to their lack of transparency and address challenges related to presenting explainability in a decision support interface. Methods: We used a design thinking approach augmented with additional theoretical frameworks to provide more robust approaches to different phases of design. In particular, in the problem definition phase, we incorporated the nonadoption, abandonment, scale-up, spread, and sustainability of technology in health care (NASSS) framework to assess these aspects in a health care network. This process helped focus on the development of a prognostic tool that predicted the likelihood of admission to an intensive care ward based on disease severity in chest x-ray images. In the ideate, prototype, and test phases, we incorporated a metric framework to assess physician trust in artificial intelligence (AI) tools. This allowed us to compare physicians? assessments of the domain representation, action ability, and consistency of the tool. Results: Physicians found the design of the prototype elegant, and domain appropriate representation of data was displayed in the tool. They appreciated the simplified explainability overlay, which only displayed the most predictive patches that cumulatively explained 90% of the final admission risk score. Finally, in terms of consistency, physicians unanimously appreciated the capacity to compare multiple x-ray images in the same view. They also appreciated the ability to toggle the explainability overlay so that both options made it easier for them to assess how consistently the tool was identifying elements of the x-ray image they felt would contribute to overall disease severity. Conclusions: The adopted approach is situated in an evolving space concerned with incorporating XML or AI technologies into health care software. We addressed the alignment of AI as it relates to clinician trust, describing an approach to wire framing and prototyping, which incorporates the use of a theoretical framework for trust in the design process itself. Moreover, we proposed that alignment of AI is dependent upon integration of end users throughout the larger design process. Our work shows the importance and value of engaging end users prior to tool development. We believe that the described approach is a unique and valuable contribution that outlines a direction for ML experts, user experience designers, and clinician end users on how to collaborate in the creation of trustworthy and usable XML-based clinical decision support tools. UR - https://formative.jmir.org/2024/1/e50475 UR - http://dx.doi.org/10.2196/50475 UR - http://www.ncbi.nlm.nih.gov/pubmed/38625728 ID - info:doi/10.2196/50475 ER - TY - JOUR AU - Segur-Ferrer, Joan AU - Moltó-Puigmartí, Carolina AU - Pastells-Peiró, Roland AU - Vivanco-Hidalgo, Maria Rosa PY - 2024/4/10 TI - Methodological Frameworks and Dimensions to Be Considered in Digital Health Technology Assessment: Scoping Review and Thematic Analysis JO - J Med Internet Res SP - e48694 VL - 26 KW - digital health KW - eHealth KW - mHealth KW - mobile health KW - AI KW - artificial intelligence KW - framework KW - health technology assessment KW - scoping review KW - technology KW - health care system KW - methodological framework KW - thematic analysis N2 - Background: Digital health technologies (dHTs) offer a unique opportunity to address some of the major challenges facing health care systems worldwide. However, the implementation of dHTs raises some concerns, such as the limited understanding of their real impact on health systems and people?s well-being or the potential risks derived from their use. In this context, health technology assessment (HTA) is 1 of the main tools that health systems can use to appraise evidence and determine the value of a given dHT. Nevertheless, due to the nature of dHTs, experts highlight the need to reconsider the frameworks used in traditional HTA. Objective: This scoping review (ScR) aimed to identify the methodological frameworks used worldwide for digital health technology assessment (dHTA); determine what domains are being considered; and generate, through a thematic analysis, a proposal for a methodological framework based on the most frequently described domains in the literature. Methods: The ScR was performed in accordance with the guidelines established in the PRISMA-ScR guidelines. We searched 7 databases for peer reviews and gray literature published between January 2011 and December 2021. The retrieved studies were screened using Rayyan in a single-blind manner by 2 independent authors, and data were extracted using ATLAS.ti software. The same software was used for thematic analysis. Results: The systematic search retrieved 3061 studies (n=2238, 73.1%, unique), of which 26 (0.8%) studies were included. From these, we identified 102 methodological frameworks designed for dHTA. These frameworks revealed great heterogeneity between them due to their different structures, approaches, and items to be considered in dHTA. In addition, we identified different wording used to refer to similar concepts. Through thematic analysis, we reduced this heterogeneity. In the first phase of the analysis, 176 provisional codes related to different assessment items emerged. In the second phase, these codes were clustered into 86 descriptive themes, which, in turn, were grouped in the third phase into 61 analytical themes and organized through a vertical hierarchy of 3 levels: level 1 formed by 13 domains, level 2 formed by 38 dimensions, and level 3 formed by 11 subdimensions. From these 61 analytical themes, we developed a proposal for a methodological framework for dHTA. Conclusions: There is a need to adapt the existing frameworks used for dHTA or create new ones to more comprehensively assess different kinds of dHTs. Through this ScR, we identified 26 studies including 102 methodological frameworks and tools for dHTA. The thematic analysis of those 26 studies led to the definition of 12 domains, 38 dimensions, and 11 subdimensions that should be considered in dHTA. UR - https://www.jmir.org/2024/1/e48694 UR - http://dx.doi.org/10.2196/48694 UR - http://www.ncbi.nlm.nih.gov/pubmed/38598288 ID - info:doi/10.2196/48694 ER - TY - JOUR AU - Tamrat, Tigest AU - Zhao, Yu AU - Schalet, Denise AU - AlSalamah, Shada AU - Pujari, Sameer AU - Say, Lale PY - 2024/4/9 TI - Exploring the Use and Implications of AI in Sexual and Reproductive Health and Rights: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e53888 VL - 13 KW - artificial intelligence KW - AI KW - sexual health KW - reproductive health KW - maternal health KW - gender KW - machine learning KW - natural language processing KW - review KW - systematic documentation KW - protocol KW - scoping review KW - electronic database KW - technical consultation KW - intervention KW - methodology KW - qualitative KW - World Health Organization KW - WHO KW - decision-making N2 - Background: Artificial intelligence (AI) has emerged as a transformative force across the health sector and has garnered significant attention within sexual and reproductive health and rights (SRHR) due to polarizing views on its opportunities to advance care and the heightened risks and implications it brings to people?s well-being and bodily autonomy. As the fields of AI and SRHR evolve, clarity is needed to bridge our understanding of how AI is being used within this historically politicized health area and raise visibility on the critical issues that can facilitate its responsible and meaningful use. Objective: This paper presents the protocol for a scoping review to synthesize empirical studies that focus on the intersection of AI and SRHR. The review aims to identify the characteristics of AI systems and tools applied within SRHR, regarding health domains, intended purpose, target users, AI data life cycle, and evidence on benefits and harms. Methods: The scoping review follows the standard methodology developed by Arksey and O?Malley. We will search the following electronic databases: MEDLINE (PubMed), Scopus, Web of Science, and CINAHL. Inclusion criteria comprise the use of AI systems and tools in sexual and reproductive health and clear methodology describing either quantitative or qualitative approaches, including program descriptions. Studies will be excluded if they focus entirely on digital interventions that do not explicitly use AI systems and tools, are about robotics or nonhuman subjects, or are commentaries. We will not exclude articles based on geographic location, language, or publication date. The study will present the uses of AI across sexual and reproductive health domains, the intended purpose of the AI system and tools, and maturity within the AI life cycle. Outcome measures will be reported on the effect, accuracy, acceptability, resource use, and feasibility of studies that have deployed and evaluated AI systems and tools. Ethical and legal considerations, as well as findings from qualitative studies, will be synthesized through a narrative thematic analysis. We will use the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) format for the publication of the findings. Results: The database searches resulted in 12,793 records when the searches were conducted in October 2023. Screening is underway, and the analysis is expected to be completed by July 2024. Conclusions: The findings will provide key insights on usage patterns and evidence on the use of AI in SRHR, as well as convey key ethical, safety, and legal considerations. The outcomes of this scoping review are contributing to a technical brief developed by the World Health Organization and will guide future research and practice in this highly charged area of work. Trial Registration: OSF Registries osf.io/ma4d9; https://osf.io/ma4d9 International Registered Report Identifier (IRRID): PRR1-10.2196/53888 UR - https://www.researchprotocols.org/2024/1/e53888 UR - http://dx.doi.org/10.2196/53888 UR - http://www.ncbi.nlm.nih.gov/pubmed/38593433 ID - info:doi/10.2196/53888 ER - TY - JOUR AU - McLaren, E. Jaye AU - Hoang-Gia, Dat AU - Dorisca, Eugenia AU - Hartz, Stephanie AU - Dang, Stuti AU - Moo, Lauren PY - 2024/4/4 TI - Development and Evaluation of a Clinician-Vetted Dementia Caregiver Resources Website: Mixed Methods Approach JO - JMIR Form Res SP - e54168 VL - 8 KW - Alzheimer disease KW - caregiver education KW - dementia KW - interdisciplinary KW - older adults KW - virtual resources KW - website development N2 - Background: About 11 million Americans are caregivers for the 6.7 million Americans currently living with dementia. They provide over 18 billion hours of unpaid care per year, yet most have no formal dementia education or support. It is extremely difficult for clinicians to keep up with the demand for caregiver education, especially as dementia is neurodegenerative in nature, requiring different information at different stages of the disease process. In this digital age, caregivers often seek dementia information on the internet, but clinicians lack a single, reliable compendium of expert-approved digital resources to provide to dementia caregivers. Objective: Our aim was to create a dementia caregiver resources website to serve as a hub for user-friendly, high-quality, and expert-reviewed dementia educational resources that clinicians can easily supply to family caregivers of people with dementia. Methods: An interdisciplinary website development team (representing dementia experts from occupational therapy, nursing, social work, geriatrics, and neurology) went through 6 iterative steps of website development to ensure resource selection quality and eligibility rigor. Steps included (1) resource collection, (2) creation of eligibility criteria, (3) resource organization by topic, (4) additional content identification, (5) finalize resource selection, and (6) website testing and launch. Website visits were tracked, and a 20-item survey about website usability and utility was sent to Veterans Affairs tele-geriatrics interdisciplinary specialty care groups. Results: Following website development, the dementia caregiver resource website was launched in February 2022. Over the first 9 months, the site averaged 1100 visits per month. The 3 subcategories with the highest number of visits were ?general dementia information,? ?activities of daily living,? and ?self-care and support.? Most (44/45, 98%) respondents agreed or strongly agreed that the website was easy to navigate, and all respondents agreed or strongly agreed that the resources were useful. Conclusions: The iterative process of creating the dementia caregiver resources website included continuous identification, categorization, and prioritization of resources, followed by clinician feedback on website usability, accessibility, and suggestions for improvement. The website received thousands of visits and positive clinician reviews in its first 9 months. Results demonstrate that an expert-vetted, nationally, and remotely available resource website allows for easy access to dementia education for clinicians to provide for their patients and caregivers. This process of website development can serve as a model for other clinical subspecialty groups seeking to create a comprehensive educational resource for populations who lack easy access to specialty care. UR - https://formative.jmir.org/2024/1/e54168 UR - http://dx.doi.org/10.2196/54168 UR - http://www.ncbi.nlm.nih.gov/pubmed/38573761 ID - info:doi/10.2196/54168 ER - TY - JOUR AU - Russo, Sara AU - Caruso, Rosario AU - Conte, Gianluca AU - Magon, Arianna AU - Vangone, Ida AU - Bascape', Barbara AU - Maga, Giulia AU - Pasek, Malgorzata AU - Arrigoni, Cristina PY - 2024/3/29 TI - Development of a Core Outcome Set for Family and Community Nursing: Protocol for a Delphi Study JO - JMIR Res Protoc SP - e51084 VL - 13 KW - clinical knowledge KW - core outcomes set KW - Delphi survey KW - family and community nurse KW - health interventions KW - health promotion KW - primary care KW - stakeholder engagement N2 - Background: Family and community nurses (FCNs) play a crucial role in delivering primary care to patients within their homes and communities. A key aspect of their role involves various health interventions, which are influenced by their unique competencies, such as health promotion, advanced clinical knowledge, and strong interpersonal skills. However, it is essential to understand which specific health outcomes these interventions impact to better understand the relationship between FCNs? skills and the health results. Objective: This study aims to outline the steps we will take to develop a set of core outcomes. These outcomes will be particularly sensitive to the health interventions carried out by FCNs, providing a clearer picture of their practice?s impact. Methods: A Delphi survey will be used for this research, conducted from January to December 2024. The process will involve 5 steps and input from 3 stakeholder categories. These stakeholders will help identify a preliminary list of outcomes that will form the basis of our core outcome set (COS). Results: This guideline will be beneficial for a wide range of stakeholders involved in COS development, including COS developers, trialists, systematic reviewers, journal editors, policy makers, and patient groups. As of January 2024, we have successfully completed the first stage of the study, with the stakeholder group approving the reported outcomes and assigning participant lists for each stakeholder group. Conclusions: This study will provide a roadmap for identifying the key health outcomes influenced by the interventions of FCNs. The multistakeholder, multiphase approach will ensure a comprehensive and inclusive process. Ultimately, the findings will enhance our understanding of FCNs? impact on health outcomes, leading to more effective primary care strategies and policies. International Registered Report Identifier (IRRID): PRR1-10.2196/51084 UR - https://www.researchprotocols.org/2024/1/e51084 UR - http://dx.doi.org/10.2196/51084 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551623 ID - info:doi/10.2196/51084 ER - TY - JOUR AU - Strumann, Christoph AU - Pfau, Lisa AU - Wahle, Laila AU - Schreiber, Raphael AU - Steinhäuser, Jost PY - 2024/3/26 TI - Designing and Implementation of a Digitalized Intersectoral Discharge Management System and Its Effect on Readmissions: Mixed Methods Approach JO - J Med Internet Res SP - e47133 VL - 26 KW - digitalization KW - intersectoral KW - discharge management KW - readmission KW - mixed methods design N2 - Background: Digital transformation offers new opportunities to improve the exchange of information between different health care providers, including inpatient, outpatient and care facilities. As information is especially at risk of being lost when a patient is discharged from a hospital, digital transformation offers great opportunities to improve intersectoral discharge management. However, most strategies for improvement have focused on structures within the hospital. Objective: This study aims to evaluate the implementation of a digitalized discharge management system, the project ?Optimizing instersectoral discharge management? (SEKMA, derived from the German Sektorübergreifende Optimierung des Entlassmanagements), and its impact on the readmission rate. Methods: A mixed methods design was used to evaluate the implementation of a digitalized discharge management system and its impact on the readmission rate. After the implementation, the congruence between the planned (logic model) and the actual intervention was evaluated using a fidelity analysis. Finally, bivariate and multivariate analyses were used to evaluate the effectiveness of the implementation on the readmission rate. For this purpose, a difference-in-difference approach was adopted based on routine data of hospital admissions between April 2019 and August 2019 and between April 2022 and August 2022. The department of vascular surgery served as the intervention group, in which the optimized discharge management was implemented in April 2022. The departments of internal medicine and cardiology formed the control group. Results: Overall, 26 interviews were conducted, and we explored 21 determinants, which can be categorized into 3 groups: ?optimization potential,? ?barriers,? and ?enablers.? On the basis of these results, 19 strategies were developed to address the determinants, including a lack of networking among health care providers, digital information transmission, and user-unfriendliness. On the basis of these strategies, which were prioritized by 11 hospital physicians, a logic model was formulated. Of the 19 strategies, 7 (37%; eg, electronic discharge letter, providing mobile devices to the hospital?s social service, and generating individual medication plans in the format of the national medication plan) have been implemented in SEKMA. A survey on the fidelity of the application of the implemented strategies showed that 3 of these strategies were not yet widely applied. No significant effect of SEKMA on readmissions was observed in the routine data of 14,854 hospital admissions (P=.20). Conclusions: This study demonstrates the potential of optimizing intersectoral collaboration for patient care. Although a significant effect of SEKMA on readmissions has not yet been observed, creating a digital ecosystem that connects different health care providers seems to be a promising approach to ensure secure and fast networking of the sectors. The described intersectoral optimization of discharge management provides a structured template for the implementation of a similar local digital care networking infrastructure in other care regions in Germany and other countries with a similarly fragmented health care system. UR - https://www.jmir.org/2024/1/e47133 UR - http://dx.doi.org/10.2196/47133 UR - http://www.ncbi.nlm.nih.gov/pubmed/38530343 ID - info:doi/10.2196/47133 ER - TY - JOUR AU - Raggi, Alberto AU - Bernard, M. Renaldo AU - Toppo, Claudia AU - Sabariego, Carla AU - Salvador Carulla, Luis AU - Lukersmith, Sue AU - Hakkaart-van Roijen, Leona AU - Merecz-Kot, Dorota AU - Olaya, Beatriz AU - Antunes Lima, Rodrigo AU - Gutiérrez-Marín, Desirée AU - Vorstenbosch, Ellen AU - Curatoli, Chiara AU - Cacciatore, Martina PY - 2024/3/15 TI - The EMPOWER Occupational e?Mental Health Intervention Implementation Checklist to Foster e?Mental Health Interventions in the Workplace: Development Study JO - J Med Internet Res SP - e48504 VL - 26 KW - implementation KW - workplace KW - mental health KW - well-being KW - digital health KW - mobile health KW - mHealth KW - eHealth KW - e?mental health KW - stakeholder consultation KW - intervention KW - occupational KW - stakeholders KW - consultation KW - barrier KW - checklist N2 - Background: Occupational e?mental health (OeMH) interventions significantly reduce the burden of mental health conditions. The successful implementation of OeMH interventions is influenced by many implementation strategies, barriers, and facilitators across contexts, which, however, are not systematically tracked. One of the reasons is that international consensus on documenting and reporting the implementation of OeMH interventions is lacking. There is a need for practical guidance on the key factors influencing the implementation of interventions that organizations should consider. Stakeholder consultations secure a valuable source of information about these key strategies, barriers, and facilitators that are relevant to successful implementation of OeMH interventions. Objective: The objective of this study was to develop a brief checklist to guide the implementation of OeMH interventions. Methods: Based on the results of a recently published systematic review, we drafted a comprehensive checklist with a wide set of strategies, barriers, and facilitators that were identified as relevant for the implementation of OeMH interventions. We then used a 2-stage stakeholder consultation process to refine the draft checklist to a brief and practical checklist comprising key implementation factors. In the first stage, stakeholders evaluated the relevance and feasibility of items on the draft checklist using a web-based survey. The list of items comprised 12 facilitators presented as statements addressing ?elements that positively affect implementation? and 17 barriers presented as statements addressing ?concerns toward implementation.? If a strategy was deemed relevant, respondents were asked to rate it using a 4-point Likert scale ranging from ?very difficult to implement? to ?very easy to implement.? In the second stage, stakeholders were interviewed to elaborate on the most relevant barriers and facilitators shortlisted from the first stage. The interview mostly focused on the relevance and priority of strategies and factors affecting OeMH intervention implementation. In the interview, the stakeholders? responses to the open survey?s questions were further explored. The final checklist included strategies ranked as relevant and feasible and the most relevant facilitators and barriers, which were endorsed during either the survey or the interviews. Results: In total, 26 stakeholders completed the web-based survey (response rate=24.8%) and 4 stakeholders participated in individual interviews. The OeMH intervention implementation checklist comprised 28 items, including 9 (32.1%) strategies, 8 (28.6%) barriers, and 11 (39.3%) facilitators. There was widespread agreement between findings from the survey and interviews, the most outstanding exception being the idea of proposing OeMH interventions as benefits for employees. Conclusions: Through our 2-stage stakeholder consultation, we developed a brief checklist that provides organizations with a guide for the implementation of OeMH interventions. Future research should empirically validate the effectiveness and usefulness of the checklist. UR - https://www.jmir.org/2024/1/e48504 UR - http://dx.doi.org/10.2196/48504 UR - http://www.ncbi.nlm.nih.gov/pubmed/38488846 ID - info:doi/10.2196/48504 ER - TY - JOUR AU - Ames, L. Meghan AU - Karlsen, C. Micaela AU - Sundermeir, M. Samantha AU - Durrwachter, Neve AU - Hemmingson, A. Tyler AU - Reznar, M. Melissa AU - Staffier, Livingston Kara AU - Weeks, Bruce AU - Gittelsohn, Joel PY - 2024/3/13 TI - Lifestyle Medicine Implementation in 8 Health Systems: Protocol for a Multiple Case Study Investigation JO - JMIR Res Protoc SP - e51562 VL - 13 KW - healthy lifestyle KW - implementation science KW - lifestyle medicine KW - multiple case study KW - noncommunicable diseases KW - prevention KW - qualitative methods N2 - Background: Lifestyle medicine (LM) is the use of therapeutic lifestyle changes (including a whole-food, plant-predominant eating pattern; regular physical activity; restorative sleep; stress management; avoidance of risky substances; and positive social connection) to prevent and treat chronic illness. Despite growing evidence, LM is still not widely implemented in health care settings. Potential challenges to LM implementation include lack of clinician training, staffing concerns, and misalignment of LM services with fee-for-service reimbursement, but the full range of factors facilitating or obstructing its implementation and long-term success are not yet understood. To learn important lessons for success and failure, it is crucial to understand the experiences of different LM programs. Objective: This study aims to describe in depth the protocol used to identify barriers and facilitators impacting the implementation of LM in health systems. Methods: The study team comprises team members at the American College of Lifestyle Medicine (ACLM), including staff and researchers with expertise in public health, LM, and qualitative research. We recruited health systems that were members of the ACLM Health Systems Council. From among 15 self-nominating health systems, we selected 7 to represent a diversity of geographic location, type, size, expertise, funding, patients, and LM services. Partway through the study, we recruited 1 additional contrasting health system to serve as a negative case. For each case, we conducted in-depth interviews, document reviews, site visits (limited due to the COVID-19 pandemic), and study team debriefs. Interviews lasted 45-90 minutes and followed a semistructured interview guide, loosely based on the Consolidated Framework for Implementation Research (CFIR) model. We are constructing detailed case narrative reports for each health system that are subsequently used in cross-case analyses to develop a contextually rich and detailed understanding of various predetermined and emergent topics. Cross-case analyses will draw on a variety of methodologies, including in-depth case familiarization, inductive or deductive coding, and thematic analysis, to identify cross-cutting themes. Results: The study team has completed data collection for all 8 participating health systems, including 68 interviews and 1 site visit. We are currently drafting descriptive case narratives, which will be disseminated to participating health systems for member checking and shared broadly as applied vignettes. We are also conducting cross-case analyses to identify critical facilitators and barriers, explore clinician training strategies to facilitate LM implementation, and develop an explanatory model connecting practitioner adoption of LM and experiences of burnout. Conclusions: This protocol paper offers real-world insights into research methods and practices to identify barriers and facilitators to the implementation of LM in health systems. Findings can advise LM implementation across various health system contexts. Methodological limitations and lessons learned can guide the execution of other studies with similar methodologies. International Registered Report Identifier (IRRID): DERR1-10.2196/51562 UR - https://www.researchprotocols.org/2024/1/e51562 UR - http://dx.doi.org/10.2196/51562 UR - http://www.ncbi.nlm.nih.gov/pubmed/38320320 ID - info:doi/10.2196/51562 ER - TY - JOUR AU - Jensen, Hřpfner Lili Worre AU - Rahbek, Ole AU - Lauritsen, Kildahl Rikke Emilie AU - Kold, Sřren AU - Dinesen, Birthe PY - 2024/3/8 TI - Health Care Professionals? Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study JO - JMIR Hum Factors SP - e53391 VL - 11 KW - CFIR KW - Consolidated Framework for Implementation Research KW - digital communication KW - hospital discharge KW - implementation science KW - interdisciplinary communication KW - orthopedic surgery KW - patient-provider communication KW - postoperative care KW - qualitative research KW - text messaging N2 - Background: Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs? needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice. Objective: This study aimed to (1) investigate HCPs? perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2). Methods: We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs. Results: HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption. Conclusions: eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources. UR - https://humanfactors.jmir.org/2024/1/e53391 UR - http://dx.doi.org/10.2196/53391 UR - http://www.ncbi.nlm.nih.gov/pubmed/38457798 ID - info:doi/10.2196/53391 ER - TY - JOUR AU - Abd-alrazaq, Alaa AU - Nashwan, J. Abdulqadir AU - Shah, Zubair AU - Abujaber, Ahmad AU - Alhuwail, Dari AU - Schneider, Jens AU - AlSaad, Rawan AU - Ali, Hazrat AU - Alomoush, Waleed AU - Ahmed, Arfan AU - Aziz, Sarah PY - 2024/3/5 TI - Machine Learning?Based Approach for Identifying Research Gaps: COVID-19 as a Case Study JO - JMIR Form Res SP - e49411 VL - 8 KW - research gaps KW - research gap KW - research topic KW - research topics KW - scientific literature KW - literature review KW - machine learning KW - COVID-19 KW - BERTopic KW - topic clustering KW - text analysis KW - BERT KW - NLP KW - natural language processing KW - review methods KW - review methodology KW - SARS-CoV-2 KW - coronavirus KW - COVID N2 - Background: Research gaps refer to unanswered questions in the existing body of knowledge, either due to a lack of studies or inconclusive results. Research gaps are essential starting points and motivation in scientific research. Traditional methods for identifying research gaps, such as literature reviews and expert opinions, can be time consuming, labor intensive, and prone to bias. They may also fall short when dealing with rapidly evolving or time-sensitive subjects. Thus, innovative scalable approaches are needed to identify research gaps, systematically assess the literature, and prioritize areas for further study in the topic of interest. Objective: In this paper, we propose a machine learning?based approach for identifying research gaps through the analysis of scientific literature. We used the COVID-19 pandemic as a case study. Methods: We conducted an analysis to identify research gaps in COVID-19 literature using the COVID-19 Open Research (CORD-19) data set, which comprises 1,121,433 papers related to the COVID-19 pandemic. Our approach is based on the BERTopic topic modeling technique, which leverages transformers and class-based term frequency-inverse document frequency to create dense clusters allowing for easily interpretable topics. Our BERTopic-based approach involves 3 stages: embedding documents, clustering documents (dimension reduction and clustering), and representing topics (generating candidates and maximizing candidate relevance). Results: After applying the study selection criteria, we included 33,206 abstracts in the analysis of this study. The final list of research gaps identified 21 different areas, which were grouped into 6 principal topics. These topics were: ?virus of COVID-19,? ?risk factors of COVID-19,? ?prevention of COVID-19,? ?treatment of COVID-19,? ?health care delivery during COVID-19,? ?and impact of COVID-19.? The most prominent topic, observed in over half of the analyzed studies, was ?the impact of COVID-19.? Conclusions: The proposed machine learning?based approach has the potential to identify research gaps in scientific literature. This study is not intended to replace individual literature research within a selected topic. Instead, it can serve as a guide to formulate precise literature search queries in specific areas associated with research questions that previous publications have earmarked for future exploration. Future research should leverage an up-to-date list of studies that are retrieved from the most common databases in the target area. When feasible, full texts or, at minimum, discussion sections should be analyzed rather than limiting their analysis to abstracts. Furthermore, future studies could evaluate more efficient modeling algorithms, especially those combining topic modeling with statistical uncertainty quantification, such as conformal prediction. UR - https://formative.jmir.org/2024/1/e49411 UR - http://dx.doi.org/10.2196/49411 UR - http://www.ncbi.nlm.nih.gov/pubmed/38441952 ID - info:doi/10.2196/49411 ER - TY - JOUR AU - Grosjean, Julien AU - Benis, Arriel AU - Dufour, Jean-Charles AU - Lejeune, Émeline AU - Disson, Flavien AU - Dahamna, Badisse AU - Cieslik, Hélčne AU - Léguillon, Romain AU - Faure, Matthieu AU - Dufour, Frank AU - Staccini, Pascal AU - Darmoni, Jacques Stéfan PY - 2024/3/4 TI - Sharing Digital Health Educational Resources in a One-Stop Shop Portal: Tutorial on the Catalog and Index of Digital Health Teaching Resources (CIDHR) Semantic Search Engine JO - JMIR Med Educ SP - e48393 VL - 10 KW - digital health KW - medical informatics KW - medical education KW - search engine KW - knowledge management KW - semantic web KW - language KW - teaching KW - vocabulary KW - controlled KW - students KW - educational personnel KW - French KW - curriculum N2 - Background: Access to reliable and accurate digital health web-based resources is crucial. However, the lack of dedicated search engines for non-English languages, such as French, is a significant obstacle in this field. Thus, we developed and implemented a multilingual, multiterminology semantic search engine called Catalog and Index of Digital Health Teaching Resources (CIDHR). CIDHR is freely accessible to everyone, with a focus on French-speaking resources. CIDHR has been initiated to provide validated, high-quality content tailored to the specific needs of each user profile, be it students or professionals. Objective: This study?s primary aim in developing and implementing the CIDHR is to improve knowledge sharing and spreading in digital health and health informatics and expand the health-related educational community, primarily French speaking but also in other languages. We intend to support the continuous development of initial (ie, bachelor level), advanced (ie, master and doctoral levels), and continuing training (ie, professionals and postgraduate levels) in digital health for health and social work fields. The main objective is to describe the development and implementation of CIDHR. The hypothesis guiding this research is that controlled vocabularies dedicated to medical informatics and digital health, such as the Medical Informatics Multilingual Ontology (MIMO) and the concepts structuring the French National Referential on Digital Health (FNRDH), to index digital health teaching and learning resources, are effectively increasing the availability and accessibility of these resources to medical students and other health care professionals. Methods: First, resource identification is processed by medical librarians from websites and scientific sources preselected and validated by domain experts and surveyed every week. Then, based on MIMO and FNRDH, the educational resources are indexed for each related knowledge domain. The same resources are also tagged with relevant academic and professional experience levels. Afterward, the indexed resources are shared with the digital health teaching and learning community. The last step consists of assessing CIDHR by obtaining informal feedback from users. Results: Resource identification and evaluation processes were executed by a dedicated team of medical librarians, aiming to collect and curate an extensive collection of digital health teaching and learning resources. The resources that successfully passed the evaluation process were promptly included in CIDHR. These resources were diligently indexed (with MIMO and FNRDH) and tagged for the study field and degree level. By October 2023, a total of 371 indexed resources were available on a dedicated portal. Conclusions: CIDHR is a multilingual digital health education semantic search engine and platform that aims to increase the accessibility of educational resources to the broader health care?related community. It focuses on making resources ?findable,? ?accessible,? ?interoperable,? and ?reusable? by using a one-stop shop portal approach. CIDHR has and will have an essential role in increasing digital health literacy. UR - https://mededu.jmir.org/2024/1/e48393 UR - http://dx.doi.org/10.2196/48393 UR - http://www.ncbi.nlm.nih.gov/pubmed/38437007 ID - info:doi/10.2196/48393 ER - TY - JOUR AU - Hood, Nicole AU - Benbow, Nanette AU - Jaggi, Chandni AU - Whitby, Shamaya AU - Sullivan, Sean Patrick AU - PY - 2024/2/26 TI - AIDSVu Cities? Progress Toward HIV Care Continuum Goals: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e49381 VL - 10 KW - HIV KW - epidemiology KW - surveillance KW - HIV care continuum KW - cities KW - HIV public health KW - HIV prevention KW - diagnosis KW - HIV late diagnosis N2 - Background: Public health surveillance data are critical to understanding the current state of the HIV and AIDS epidemics. Surveillance data provide significant insight into patterns within and progress toward achieving targets for each of the steps in the HIV care continuum. Such targets include those outlined in the National HIV/AIDS Strategy (NHAS) goals. If these data are disseminated, they can be used to prioritize certain steps in the continuum, geographic locations, and groups of people. Objective: We sought to develop and report indicators of progress toward the NHAS goals for US cities and to characterize progress toward those goals with categorical metrics. Methods: Health departments used standardized SAS code to calculate care continuum indicators from their HIV surveillance data to ensure comparability across jurisdictions. We report 2018 descriptive statistics for continuum steps (timely diagnosis, linkage to medical care, receipt of medical care, and HIV viral load suppression) for 36 US cities and their progress toward 2020 NHAS goals as of 2018. Indicators are reported categorically as met or surpassed the goal, within 25% of attaining the goal, or further than 25% from achieving the goal. Results: Cities were closest to meeting NHAS goals for timely diagnosis compared to the goals for linkage to care, receipt of care, and viral load suppression, with all cities (n=36, 100%) within 25% of meeting the goal for timely diagnosis. Only 8% (n=3) of cities were >25% from achieving the goal for receipt of care, but 69% (n=25) of cities were >25% from achieving the goal for viral suppression. Conclusions: Display of progress with graphical indicators enables communication of progress to stakeholders. AIDSVu analyses of HIV surveillance data facilitate cities? ability to benchmark their progress against that of other cities with similar characteristics. By identifying peer cities (eg, cities with analogous populations or similar NHAS goal concerns), the public display of indicators can promote dialogue between cities with comparable challenges and opportunities. UR - https://publichealth.jmir.org/2024/1/e49381 UR - http://dx.doi.org/10.2196/49381 UR - http://www.ncbi.nlm.nih.gov/pubmed/38407961 ID - info:doi/10.2196/49381 ER - TY - JOUR AU - Fritz, Johanna AU - von Heideken Wĺgert, Petra AU - Gusdal, K. Annelie AU - Johansson-Pajala, Rose-Marie AU - Eklund, Caroline PY - 2024/2/26 TI - Determinants of Implementing an Information and Communication Technology Tool for Social Interaction Among Older People: Qualitative Content Analysis of Social Services Personnel Perspectives JO - JMIR Aging SP - e43999 VL - 7 KW - information and communication technology KW - implementation KW - determinants KW - social isolation KW - loneliness KW - organization KW - digitalization KW - facilitators KW - barriers KW - older people N2 - Background: Older people are particularly vulnerable to social isolation and loneliness, which can lead to ill-health, both mentally and physically. Information and communication technology (ICT) can supplement health and social care and improve health among the vulnerable, older adult population. When ICT is used specifically for communication with others, it is associated with reduced loneliness in older populations. Research is sparse on how the implementation of ICT, used specifically for communication among older people in social services, can be performed. It is recommended to consider the determinants of implementation, that is, barriers to and facilitators of implementation. Determinants related to older people using ICT tools are reported in several studies. To the best of our knowledge, studies investigating the determinants related to the social services perspective are lacking. Objective: This study aims to explore the determinants of implementing the Fik@ room, a new, co-designed, and research-based ICT tool for social interaction among older people, from a social services personnel perspective. Methods: This study used an exploratory, qualitative design. An ICT tool called the Fik@ room was tested in an intervention study conducted in 2021 in 2 medium-sized municipalities in Sweden. Informants in this study were municipal social services personnel with experience of implementing this specific ICT tool in social services. We conducted a participatory workshop consisting of 2 parts, with 9 informants divided into 2 groups. We analyzed the data using qualitative content analysis with an inductive approach. Results: The results included 7 categories of determinants for implementing the ICT tool. Being able to introduce the ICT tool in an appropriate manner concerns the personnel?s options for introducing and supporting the ICT tool, including their competencies in using digital equipment. Organizational structure concerns a structure for communication within the organization. Leadership concerns engagement and enthusiasm as driving forces for implementation. The digital maturity of the social services personnel concerns the personnel?s skills and attitudes toward using digital equipment. Resources concern time and money. IT support concerns accessibility, and legal liability concerns possibilities to fulfill legal responsibilities. Conclusions: The results show that implementation involves an entire organization at varying degrees. Regardless of how much each level within the organization comes into direct contact with the ICT tool, all levels need to be involved to create the necessary conditions for successful implementation. The prerequisites for the implementation of an ICT tool will probably change depending on the digital maturity of future generations. As this study only included 9 informants, the results should be handled with care. The study was performed during the COVID-19 pandemic, which has probably affected the results. UR - https://aging.jmir.org/2024/1/e43999 UR - http://dx.doi.org/10.2196/43999 UR - http://www.ncbi.nlm.nih.gov/pubmed/38407955 ID - info:doi/10.2196/43999 ER - TY - JOUR AU - Castiglione, Angela Sonia AU - Lavoie-Tremblay, Mélanie AU - Kilpatrick, Kelley AU - Gifford, Wendy AU - Semenic, Elizabeth Sonia PY - 2024/2/19 TI - Exploring Shared Implementation Leadership of Point of Care Nursing Leadership Teams on Inpatient Hospital Units: Protocol for a Collective Case Study JO - JMIR Res Protoc SP - e54681 VL - 13 KW - case study KW - evidence-based practices KW - implementation leadership KW - inpatient hospital units KW - nursing leadership KW - point of care N2 - Background: Nursing leadership teams at the point of care (POC), consisting of both formal and informal leaders, are regularly called upon to support the implementation of evidence-based practices (EBPs) in hospital units. However, current conceptualizations of effective leadership for successful implementation typically focus on the behaviors of individual leaders in managerial roles. Little is known about how multiple nursing leaders in formal and informal roles share implementation leadership (IL), representing an important knowledge gap. Objective: This study aims to explore shared IL among formal and informal nursing leaders in inpatient hospital units. The central research question is as follows: How is IL shared among members of POC nursing leadership teams on inpatient hospital units? The subquestions are as follows: (1) What IL behaviors are enacted and shared by formal and informal leaders? (2) What social processes enable shared IL by formal and informal leaders? and (3) What factors influence shared IL in nursing leadership teams? Methods: We will use a collective case study approach to describe and generate an in-depth understanding of shared IL in nursing. We will select nursing leadership teams on 2 inpatient hospital units that have successfully implemented an EBP as instrumental cases. We will construct data through focus groups and individual interviews with key informants (leaders, unit staff, and senior nurse leaders), review of organizational documents, and researcher-generated field notes. We have developed a conceptual framework of shared IL to guide data analysis, which describes effective IL behaviors, formal and informal nursing leaders? roles at the POC, and social processes generating shared leadership and influencing contextual factors. We will use the Framework Method to systematically generate data matrices from deductive and inductive thematic analysis of each case. We will then generate assertions about shared IL following a cross-case analysis. Results: The study protocol received research ethics approval (2022-8408) on February 24, 2022. Data collection began in June 2022, and we have recruited 2 inpatient hospital units and 25 participants. Data collection was completed in December 2023, and data analysis is ongoing. We anticipate findings to be published in a peer-reviewed journal by late 2024. Conclusions: The anticipated results will shed light on how multiple and diverse members of the POC nursing leadership team enact and share IL. This study addresses calls to advance knowledge in promoting effective implementation of EBPs to ensure high-quality health care delivery by further developing the concept of shared IL in a nursing context. We will identify strategies to strengthen shared IL in nursing leadership teams at the POC, informing future intervention studies. International Registered Report Identifier (IRRID): DERR1-10.2196/54681 UR - https://www.researchprotocols.org/2024/1/e54681 UR - http://dx.doi.org/10.2196/54681 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373024 ID - info:doi/10.2196/54681 ER - TY - JOUR AU - Ji, Jia AU - Hou, Yongshuai AU - Chen, Xinyu AU - Pan, Youcheng AU - Xiang, Yang PY - 2024/2/8 TI - Vision-Language Model for Generating Textual Descriptions From Clinical Images: Model Development and Validation Study JO - JMIR Form Res SP - e32690 VL - 8 KW - clinical image KW - radiology report generation KW - vision-language model KW - multistage fine-tuning KW - prior knowledge N2 - Background: The automatic generation of radiology reports, which seeks to create a free-text description from a clinical radiograph, is emerging as a pivotal intersection between clinical medicine and artificial intelligence. Leveraging natural language processing technologies can accelerate report creation, enhancing health care quality and standardization. However, most existing studies have not yet fully tapped into the combined potential of advanced language and vision models. Objective: The purpose of this study was to explore the integration of pretrained vision-language models into radiology report generation. This would enable the vision-language model to automatically convert clinical images into high-quality textual reports. Methods: In our research, we introduced a radiology report generation model named ClinicalBLIP, building upon the foundational InstructBLIP model and refining it using clinical image-to-text data sets. A multistage fine-tuning approach via low-rank adaptation was proposed to deepen the semantic comprehension of the visual encoder and the large language model for clinical imagery. Furthermore, prior knowledge was integrated through prompt learning to enhance the precision of the reports generated. Experiments were conducted on both the IU X-RAY and MIMIC-CXR data sets, with ClinicalBLIP compared to several leading methods. Results: Experimental results revealed that ClinicalBLIP obtained superior scores of 0.570/0.365 and 0.534/0.313 on the IU X-RAY/MIMIC-CXR test sets for the Metric for Evaluation of Translation with Explicit Ordering (METEOR) and the Recall-Oriented Understudy for Gisting Evaluation (ROUGE) evaluations, respectively. This performance notably surpasses that of existing state-of-the-art methods. Further evaluations confirmed the effectiveness of the multistage fine-tuning and the integration of prior information, leading to substantial improvements. Conclusions: The proposed ClinicalBLIP model demonstrated robustness and effectiveness in enhancing clinical radiology report generation, suggesting significant promise for real-world clinical applications. UR - https://formative.jmir.org/2024/1/e32690 UR - http://dx.doi.org/10.2196/32690 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329788 ID - info:doi/10.2196/32690 ER - TY - JOUR AU - Rouleau, Genevičve AU - Wu, Kelly AU - Ramamoorthi, Karishini AU - Boxall, Cherish AU - Liu, H. Rebecca AU - Maloney, Shelagh AU - Zelmer, Jennifer AU - Scott, Ted AU - Larsen, Darren AU - Wijeysundera, C. Harindra AU - Ziegler, Daniela AU - Bhatia, Sacha AU - Kishimoto, Vanessa AU - Steele Gray, Carolyn AU - Desveaux, Laura PY - 2024/2/5 TI - Mapping Theories, Models, and Frameworks to Evaluate Digital Health Interventions: Scoping Review JO - J Med Internet Res SP - e51098 VL - 26 KW - digital health interventions KW - evaluation KW - implementation KW - integrated knowledge translation, theories KW - models KW - frameworks KW - scoping review N2 - Background: Digital health interventions (DHIs) are a central focus of health care transformation efforts, yet their uptake in practice continues to fall short of their potential. In order to achieve their desired outcomes and impact, DHIs need to reach their target population and need to be used. Many factors can rapidly intersect between this dynamic of users and interventions. The application of theories, models, and frameworks (TMFs) can facilitate the systematic understanding and explanation of the complex interactions between users, practices, technology, and health system factors that underpin research questions. There remains a gap in our understanding of how TMFs have been applied to guide the evaluation of DHIs with real-world health system operations. Objective: This study aims to map TMFs used in studies to guide the evaluation of DHIs. The objectives are to (1) describe the TMFs and the constructs they target, (2) identify how TMFs have been prospectively used (ie, their roles) in primary studies to evaluate DHIs, and (3) to reflect on the relevance and utility of our findings for knowledge users. Methods: This scoping review was conducted in partnership with knowledge users using an integrated knowledge translation approach. We included papers (eg, reports; empirical quantitative, qualitative, and mixed methods studies; conference proceedings; and dissertations) if primary insights resulting from the application of TMFs were presented. Any type of DHI was eligible. Papers published from 2000 and onward were mainly identified from the following databases: MEDLINE (Ovid), CINAHL Complete (EBSCOhost), PsycINFO (Ovid), EBM Reviews (Ovid), and Embase (Ovid). Results: A total of 156 studies published between 2000 and 2022 were included. A total of 68 distinct TMFs were identified across 85 individual studies. In more than half (85/156, 55%) of the included studies, 1 of following 6 prevailing TMFs were reported: Consolidated Framework for Implementation Research (n=39); the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework (n=17); the Technology of Acceptance Model (n=16); the Unified Theory on Acceptance and Use of Technology (n=12); the Diffusion of Innovation Theory (n=10); and Normalization Process Theory (n=9). The most common intended roles of the 6 TMFs were to inform data collection (n=86), to inform data analysis (n=69), and to identify key constructs that may serve as barriers and facilitators (n=52). Conclusions: As TMFs are most often reported to be applied to support data collection and analysis, researchers should consider more clearly synthesizing key insights as practical use cases to both increase the relevance and digestibility of their findings. There is also a need to adapt or develop guidelines for better reporting DHIs and the use of TMFs to guide evaluation. Hence, it would contribute to ensuring ongoing technology transformation efforts are evidence and theory informed rather than anecdotally driven. UR - https://www.jmir.org/2024/1/e51098 UR - http://dx.doi.org/10.2196/51098 UR - http://www.ncbi.nlm.nih.gov/pubmed/38315515 ID - info:doi/10.2196/51098 ER - TY - JOUR AU - Recsky, Chantelle AU - Rush, L. Kathy AU - MacPhee, Maura AU - Stowe, Megan AU - Blackburn, Lorraine AU - Muniak, Allison AU - Currie, M. Leanne PY - 2024/2/5 TI - Clinical Informatics Team Members? Perspectives on Health Information Technology Safety After Experiential Learning and Safety Process Development: Qualitative Descriptive Study JO - JMIR Form Res SP - e53302 VL - 8 KW - informatics KW - community health services KW - knowledge translation KW - qualitative research KW - patient safety N2 - Background: Although intended to support improvement, the rapid adoption and evolution of technologies in health care can also bring about unintended consequences related to safety. In this project, an embedded researcher with expertise in patient safety and clinical education worked with a clinical informatics team to examine safety and harm related to health information technologies (HITs) in primary and community care settings. The clinical informatics team participated in learning activities around relevant topics (eg, human factors, high reliability organizations, and sociotechnical systems) and cocreated a process to address safety events related to technology (ie, safety huddles and sociotechnical analysis of safety events). Objective: This study aimed to explore clinical informaticians? experiences of incorporating safety practices into their work. Methods: We used a qualitative descriptive design and conducted web-based focus groups with clinical informaticians. Thematic analysis was used to analyze the data. Results: A total of 10 informants participated. Barriers to addressing safety and harm in their context included limited prior knowledge of HIT safety, previous assumptions and perspectives, competing priorities and organizational barriers, difficulty with the reporting system and processes, and a limited number of reports for learning. Enablers to promoting safety and mitigating harm included participating in learning sessions, gaining experience analyzing reported events, participating in safety huddles, and role modeling and leadership from the embedded researcher. Individual outcomes included increased ownership and interest in HIT safety, the development of a sociotechnical systems perspective, thinking differently about safety, and increased consideration for user perspectives. Team outcomes included enhanced communication within the team, using safety events to inform future work and strategic planning, and an overall promotion of a culture of safety. Conclusions: As HITs are integrated into care delivery, it is important for clinical informaticians to recognize the risks related to safety. Experiential learning activities, including reviewing safety event reports and participating in safety huddles, were identified as particularly impactful. An HIT safety learning initiative is a feasible approach for clinical informaticians to become more knowledgeable and engaged in HIT safety issues in their work. UR - https://formative.jmir.org/2024/1/e53302 UR - http://dx.doi.org/10.2196/53302 UR - http://www.ncbi.nlm.nih.gov/pubmed/38315544 ID - info:doi/10.2196/53302 ER - TY - JOUR AU - Sowan, Azizeh AU - Chinman, Matthew PY - 2024/1/31 TI - Model for Doctor of Nursing Practice Projects Based on Cross-Fertilization Between Improvement and Implementation Sciences: Protocol for Quality Improvement and Program Evaluation Studies JO - JMIR Res Protoc SP - e54213 VL - 13 KW - quality improvement KW - implementation KW - Doctor of Nursing Practice KW - model KW - methodology KW - Nursing KW - Doctor of Nursing KW - hybrid approach KW - implementation sciences KW - scholarship KW - scholars KW - Nursing Practice Program KW - nursing program N2 - Background: Hundreds of nursing professionals graduate each year from Doctor of Nursing Practice (DNP) programs, entrusted with roles as practice scholars and leaders. Graduates are tasked to lead multidisciplinary knowledge implementation projects to improve safety, quality, and key performance metrics. Nevertheless, there is a continued lack of agreement and faculty dissatisfaction with the format, focus, and results of the DNP graduation projects. The use of a wide range of models and methodologies from different sciences for knowledge implementation introduces challenges to DNP students; affects the scientific rigor of the projects; and results in the overuse, superficial use, or misuse of the models. Quality improvement (QI) and program evaluation studies are substantial investments that may lead to waste and even harm if not well conducted. Traditional QI methodologies, commonly used in DNP projects, were found to be uncertain in improving health care outcomes. The complexity of health care systems calls for cross-fertilization between improvement and implementation sciences to improve health care outcomes. Objective: This study describes the development, implementation, and evaluation of a hybrid model for QI and program evaluation studies to guide scholarship in the DNP program. Methods: The hybrid model was based on cross-fertilization between improvement and implementation sciences. The model adapted the Getting to Outcome (GTO) and Knowledge to Action (KTA) models as the overarching process models for knowledge implementation. Within each phase of the GTO and KTA models, expected barriers and facilitators for the implementation and adoption of innovation were identified based on the CFIR (Consolidated Framework for Implementation Research). Accordingly, strategies to facilitate the implementation and adoption of innovations were identified based on a refined list of implementation strategies and QI tools. The choice of these models was based on the top 5 criteria for selecting implementation science theories and frameworks. Seven DNP students used the hybrid model to conduct QI projects. Students evaluated their experiences by responding to a Qualtrics survey. Results: The hybrid model encouraged a comprehensive systematic way of thinking, provided tools essential to implementation success, emphasized the need for adaptability in implementation, maintained rigor in QI, and guided the sustainability of change initiatives. Some of the challenges faced by students included finding reliable and valid measures, attaining and maintaining staff buy-in, and competing organizational priorities. Conclusions: Cross-fertilization between improvement and implementation sciences provided a roadmap and systematic thinking for successful QI projects in the DNP program. The integration of the CFIR with the GTO or KTA process models, enforced by the use of evidence-based implementation strategies and QI tools, reflected the complexity of health care systems and emphasized the need for adaptability in implementation. International Registered Report Identifier (IRRID): RR1-10.2196/54213 UR - https://www.researchprotocols.org/2024/1/e54213 UR - http://dx.doi.org/10.2196/54213 UR - http://www.ncbi.nlm.nih.gov/pubmed/38294860 ID - info:doi/10.2196/54213 ER - TY - JOUR AU - Bauernschmidt, Dorothee AU - Wittmann, Janina AU - Hirt, Julian AU - Meyer, Gabriele AU - Bieber, Anja PY - 2024/1/25 TI - The Implementation Success of Technology-Based Counseling in Dementia Care: Scoping Review JO - JMIR Aging SP - e51544 VL - 7 KW - implementation success KW - implementation outcomes KW - counseling KW - technology KW - dementia N2 - Background: Implementing technology-based counseling as a complex intervention in dementia care poses challenges such as adaptation to stakeholders? needs and limited resources. While studies have examined the effectiveness of technology-based counseling, its successful implementation remains largely unexplored. Objective: We aimed to review the knowledge about the implementation success of technology-based counseling interventions for people with dementia and their informal caregivers. Methods: We conducted a scoping review and systematically searched CINAHL, the Cochrane Library including the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and Web of Science Core Collection databases (April 2021) in combination with citation searching and web searching (November 2021). Studies reporting on technology-based counseling interventions for people with dementia or their informal caregivers were included, irrespective of the design. We used the conceptual framework for implementation outcomes to operationalize implementation success and applied the outcomes acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability as categories to inform data extraction. We identified dimensions within the categories and synthesized results narratively and graphically. Results: We included 52 publications reporting on 27 technology-based counseling interventions. The studies were conducted in 9 countries and published between 1993 and 2021. As the design of the included studies varied, the number of participants and the type of data reported varied as well. The intervention programs were heterogeneous and ranged from single counseling interventions (such as helpline services) to counseling as part of a multicomponent program. Telephone, email, videoconferencing, social media (respectively chats), and web-based platforms were used for delivering counseling. We found data on appropriateness for all interventions and data on acceptability for most interventions, describing aspects such as consumer-perceived usefulness and helpfulness of services, as well as satisfaction. Information on the other categories of adoption, feasibility, fidelity, implementation cost, penetration, and sustainability was fragmented. Conclusions: The scope and depth of information on conceptual categories of the implementation success of technology-based counseling for people with dementia and informal caregivers varied. The data only partially covered the concept of implementation success, which highlights the need for a systematic evaluation accompanying the implementation. The application of theoretical approaches for implementation and adherence to the framework for developing and evaluating complex interventions are required to promote the implementation of complex interventions and to comprehensively assess implementation success. Trial Registration: PROSPERO CRD42021245473; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=245473 UR - https://aging.jmir.org/2024/1/e51544 UR - http://dx.doi.org/10.2196/51544 UR - http://www.ncbi.nlm.nih.gov/pubmed/38271050 ID - info:doi/10.2196/51544 ER - TY - JOUR AU - Hwang, Hyeyoung AU - De Gagne, C. Jennie AU - Yoo, Leeho AU - Lee, Miji AU - Jo, Kyung Hye AU - Kim, Ju-eun PY - 2024/1/9 TI - Exploring Nursing Research Culture in Clinical Practice: Qualitative Ethnographic Study JO - Asian Pac Isl Nurs J SP - e50703 VL - 8 KW - clinical nursing research KW - ethnography KW - evidence-based nursing KW - nursing research KW - qualitative research N2 - Background: Cultivating a positive research culture is considered the key to facilitating the utilization of research findings. In the realm of clinical nursing research, nurses conducting research may find the utilization of findings challenging due to the lack of a positive research culture. Objective: This study aims to identify and describe the sociocultural context of nursing research in a clinical setting at a Korean tertiary hospital. Methods: We included participant observation and ethnographic interviews with 6 registered nurses working in a medical-surgical unit in a Korean tertiary hospital who had experience conducting nursing research in clinical settings in this qualitative ethnographic study. The study was conducted from April 2022 to May 2022. Data analysis was conducted using Spradley?s ethnographic approach, which includes domain analysis, taxonomic analysis, componential analysis, and theme analysis, and occurred concurrently with data collection. Results: The overarching theme identified for nursing research culture in clinical practice was the development of a driving force for growth within the clinical environment. This theme encompasses (1) balancing positive and negative influences in the research process, (2) fostering transformational change for both nurses and patients, and (3) promoting complementary communication among nurses. Conclusions: Clinical research plays a vital role in nursing practice that requires a balance of supportive elements, such as patient-driven research questions and hospital research support, with practical challenges such as shift work and high work intensity. This study found that a positive clinical nursing research culture can serve as a unifying bridge, connecting researchers, patients, who serve as both the origin and ultimate beneficiaries of research, and hospitals that facilitate research endeavors. Future research should explore whether the themes derived from this study fully reflect a clinical nursing research culture comprising patients, nurses, and the hospital environment and determine what requirements are needed to establish such a nursing research culture. UR - https://apinj.jmir.org/2024/1/e50703 UR - http://dx.doi.org/10.2196/50703 UR - http://www.ncbi.nlm.nih.gov/pubmed/38194262 ID - info:doi/10.2196/50703 ER - TY - JOUR AU - Légaré, France AU - G V Mochcovitch, Diogo AU - de Carvalho Corôa, Roberta AU - Gogovor, Amédé AU - Ben Charif, Ali AU - Cameron, Cynthia AU - Plamondon, Annie AU - Cimon, Marie AU - Guay-Bélanger, Sabrina AU - Roch, Genevičve AU - Dumas Pilon, Maxine AU - Paquette, Jean-Sébastien AU - McLean, D. Robert K. AU - Milat, Andrew PY - 2023/12/28 TI - Spontaneous Scaling of a Primary Care Innovation in Real-Life Conditions: Protocol for a Case Study JO - JMIR Res Protoc SP - e54855 VL - 12 KW - scaling KW - spread KW - primary care KW - spontaneous KW - knowledge translation KW - implementation science KW - scaling science N2 - Background: Scaling effective primary care innovations to benefit more people is of interest to decision makers. However, we know little about how promising innovations are being scaled ?spontaneously,? that is, without deliberate guidance. Objective: We aim to observe, document, and analyze how, in real-life conditions, 1 primary care innovation spontaneously scales up across Quebec, Canada. Methods: We will conduct a participative study using a descriptive single-case study. It will be guided by the McLean and Gargani principles for scaling and reported according to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. Informed by an integrated knowledge translation approach, our steering committee will include patient users throughout the project. Inspired by the Quebec College of Family Physician?s ?Dragons? Den? primary care program, we will identify a promising primary care innovation that is being or will be scaled spontaneously. We will interview the innovation team about their scaling experiences every month for 1 year. We will conduct interviews and focus groups with decision makers, health care providers, and end users in the innovation team and the target site about their experience of both scaling and receiving the scaled innovation and document meetings as nonparticipant observers. Interview transcripts and documentary data will be analyzed to (1) compare the spontaneous scaling plan and implementation with the McLean and Gargani principles for scaling and (2) determine how it was consistent with or diverged from the 4 McLean and Gargani guiding principles: justification, optimal scale, coordination, and dynamic evaluation. Results: This study was funded in March 2020 by the Canadian Institutes of Health Research. Recruitment began in November 2023 and data collection began in December 2023. Results are expected to be published in the first quarter of 2024. Conclusions: Our study will advance the science of scaling by providing practical evidence?based material about scaling health and social care innovations in real-world settings using the 4 guiding principles of McLean and Gargani. International Registered Report Identifier (IRRID): PRR1-10.2196/54855 UR - https://www.researchprotocols.org/2023/1/e54855 UR - http://dx.doi.org/10.2196/54855 UR - http://www.ncbi.nlm.nih.gov/pubmed/38032757 ID - info:doi/10.2196/54855 ER - TY - JOUR AU - Smith, A. Katharine AU - Ostinelli, G. Edoardo AU - Ede, Roger AU - Allard, Lisa AU - Thomson, Michaela AU - Hewitt, Kiran AU - Brown, Petra AU - Zangani, Caroline AU - Jenkins, Matthew AU - Hinze, Verena AU - Ma, George AU - Pothulu, Prajnesh AU - Henshall, Catherine AU - Malhi, S. Gin AU - Every-Palmer, Susanna AU - Cipriani, Andrea PY - 2023/12/22 TI - Assessing the Impact of Evidence-Based Mental Health Guidance During the COVID-19 Pandemic: Systematic Review and Qualitative Evaluation JO - JMIR Ment Health SP - e52901 VL - 10 KW - evidence synthesis KW - guidelines KW - mental health KW - systematic review KW - focus group KW - survey KW - COVID-19 KW - pandemic KW - digital health KW - eHealth KW - mobile phone N2 - Background: During the COVID-19 pandemic, the Oxford Precision Psychiatry Lab (OxPPL) developed open-access web-based summaries of mental health care guidelines (OxPPL guidance) in key areas such as digital approaches and telepsychiatry, suicide and self-harm, domestic violence and abuse, perinatal care, and vaccine hesitancy and prioritization in the context of mental illness, to inform timely clinical decision-making. Objective: This study aimed to evaluate the practice of creating evidence-based health guidelines during health emergencies using the OxPPL guidance as an example. An international network of clinical sites and colleagues (in Australia, New Zealand, and the United Kingdom) including clinicians, researchers, and experts by experience aimed to (1) evaluate the clinical impact of the OxPPL guidance, as an example of an evidence-based summary of guidelines; (2) review the literature for other evidence-based summaries of COVID-19 guidelines regarding mental health care; and (3) produce a framework for response to future global health emergencies. Methods: The impact and clinical utility of the OxPPL guidance were assessed using clinicians? feedback via an international survey and focus groups. A systematic review (protocol registered on Open Science Framework) identified summaries or syntheses of guidelines for mental health care during and after the COVID-19 pandemic and assessed the accuracy of the methods used in the OxPPL guidance by identifying any resources that the guidance had not included. Results: Overall, 80.2% (146/182) of the clinicians agreed or strongly agreed that the OxPPL guidance answered important clinical questions, 73.1% (133/182) stated that the guidance was relevant to their service, 59.3% (108/182) said that the guidelines had or would have a positive impact on their clinical practice, 42.9% (78/182) that they had shared or would share the guidance, and 80.2% (146/182) stated that the methodology could be used during future health crises. The focus groups found that the combination of evidence-based knowledge, clinical viewpoint, and visibility was crucial for clinical implementation. The systematic review identified 2543 records, of which 2 syntheses of guidelines met all the inclusion criteria, but only 1 (the OxPPL guidance) used evidence-based methodology. The review showed that the OxPPL guidance had included the majority of eligible guidelines, but 6 were identified that had not been included. Conclusions: The study identified an unmet need for web-based, evidence-based mental health care guidance during the COVID-19 pandemic. The OxPPL guidance was evaluated by clinicians as having a real-world clinical impact. Robust evidence-based methodology and expertise in mental health are necessary, but easy accessibility is also needed, and digital technology can materially help. Further health emergencies are inevitable and now is the ideal time to prepare, including addressing the training needs of clinicians, patients, and carers, especially in areas such as telepsychiatry and digital mental health. For future planning, guidance should be widely disseminated on an international platform, with allocated resources to support adaptive updates. UR - https://mental.jmir.org/2023/1/e52901 UR - http://dx.doi.org/10.2196/52901 UR - http://www.ncbi.nlm.nih.gov/pubmed/38133912 ID - info:doi/10.2196/52901 ER - TY - JOUR AU - Coumoundouros, Chelsea AU - El Arab, Adel Rabie AU - Farrand, Paul AU - Hamilton, Alexander AU - Sanderman, Robbert AU - von Essen, Louise AU - Woodford, Joanne PY - 2023/11/17 TI - Potential Implementers? Perspectives on the Development and Implementation of an e?Mental Health Intervention for Caregivers of Adults With Chronic Kidney Disease: Qualitative Interview Study JO - JMIR Hum Factors SP - e51461 VL - 10 KW - health care professional KW - implementation KW - informal caregiver KW - chronic kidney disease KW - e?mental health KW - Consolidated Framework for Implementation Research N2 - Background: e?Mental health interventions can improve access to mental health support for caregivers of people living with chronic kidney disease (CKD). However, implementation challenges often prevent effective interventions from being put into practice. To develop an e?mental health intervention for caregivers of people living with CKD that is optimized for future implementation, it is important to engage professionals that may endorse or deliver the intervention (ie, potential implementers) during intervention development. Objective: This study aims to explore the perspectives of potential implementers working in kidney care, in mental health care, or at nonprofit organizations regarding the design and implementation of an e?mental health intervention for caregivers of people living with CKD. Methods: Potential implementers (N=18) were recruited via National Health Service Trusts, email, and social media advertisements to participate in semistructured video interviews. Interview questions were informed by the Consolidated Framework for Implementation Research (CFIR). Data were analyzed using a deductive analysis approach using the CFIR, with inductive coding applied to relevant data not captured by the framework. Results: A total of 29 generic categories, related to 17 CFIR constructs, were identified. The perceived fit between the intervention and implementation context (ie, existing service delivery models and work routines) and existing social networks among potential implementers were perceived as important factors in enhancing implementation potential. However, a need for capacity building among potential implementers to create systems to support the identification and referral of caregivers to an e?mental health intervention was identified. Equity concerns were raised regarding the intervention, highlighting the importance of incorporating an equity lens during intervention design to enhance accessibility and adoption. Conclusions: Potential implementers provided valuable insights into key design and implementation factors to help inform the development of an e?mental health intervention for caregivers of people living with CKD. Incorporating their feedback can help ensure the intervention is acceptable and inform the selection of future implementation strategies to enhance the implementation potential of the intervention. Potential implementers should continue to be engaged throughout intervention development. UR - https://humanfactors.jmir.org/2023/1/e51461 UR - http://dx.doi.org/10.2196/51461 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792676 ID - info:doi/10.2196/51461 ER - TY - JOUR AU - Shin, Danielle Hwayeon AU - Zaheer, Juveria AU - Torous, John AU - Strudwick, Gillian PY - 2023/11/9 TI - Designing Implementation Strategies for a Digital Suicide Safety Planning Intervention in a Psychiatric Emergency Department: Protocol for a Multimethod Research Project JO - JMIR Res Protoc SP - e50643 VL - 12 KW - implementation science KW - suicide prevention KW - eHealth KW - mental health KW - health informatics KW - integrated knowledge translation KW - co-design KW - research protocol KW - mobile phone N2 - Background: Suicide prevention is currently a national health priority in Canada. Emergency departments (EDs) are critical settings for suicide prevention, and in our local psychiatric ED at the Centre for Addiction and Mental Health, we plan to embed an app-based tool called the Hope app to support suicide safety planning intervention. The app is free and available on app stores, and usability tests have been completed. As a next step to embed this new tool into the routine clinical workflow, research is needed to assess determinants of and design strategies for implementation with the end goal of routinization. Objective: The purpose of this 2-phased research is to implement the app in the routine clinical workflow in our local psychiatric ED. The specific objectives are as follows: (1) understanding ED clinicians? perceptions and experience of implementing the app in routine practice and identifying barriers to and facilitators of implementation (phase 1) and (2) using findings and outputs from phase 1 and collaborating with service users, families, and ED clinicians to co-design implementation strategies for the app (phase 2). Methods: We will use an integrated knowledge translation approach throughout this project. In phase 1, we will conduct interviews with ED clinicians to identify implementation determinants using a behavior change framework. In phase 2, a co-design team comprising clinicians, ED service users, and families will design implementation strategies that align with the determinants identified in phase 1. Results: This protocol presents detailed information about the entire structure of the 2-phased research project. Ethics approval for conducting the qualitative descriptive study (phase 1) has been obtained, and the recruitment and data collection processes will be completed no later than December 2023. Ethics approval for phase 2 is underway. Conclusions: Involving multiple knowledge user groups early in the research and decision-making process is crucial for successful implementation. Although co-designing is commonly practiced during innovation development, there is often a misconception that the responsibility for implementing what has been designed falls on others. This research aims to fill this methodological gap in the health informatics literature. By the end of this project, we will have developed theory-informed implementation strategies to support Centre for Addiction and Mental Health ED clinicians in adopting the Hope app to complete safety planning intervention. These strategies, guided by a behavior change framework, will target clinicians? behavior change and seamlessly integrate the app into the routine clinical workflow. In addition, this research project will provide recommendations on how to involve multiple knowledge user groups and offer insights into how the methodology used can be adapted to other areas within the health informatics literature. International Registered Report Identifier (IRRID): PRR1-10.2196/50643 UR - https://www.researchprotocols.org/2023/1/e50643 UR - http://dx.doi.org/10.2196/50643 UR - http://www.ncbi.nlm.nih.gov/pubmed/37943582 ID - info:doi/10.2196/50643 ER - TY - JOUR AU - Rego, Sílvia AU - Henriques, Rita Ana AU - Serra, Silvério Sofia AU - Costa, Teresa AU - Rodrigues, Maria Ana AU - Nunes, Francisco PY - 2023/10/26 TI - Methods for the Clinical Validation of Digital Endpoints: Protocol for a Scoping Review Abstract JO - JMIR Res Protoc SP - e47119 VL - 12 KW - digital endpoint KW - digital biomarker KW - mobile health technologies KW - mobile health KW - mHealth KW - remote monitoring KW - wearable technology KW - scoping review KW - review method KW - validate KW - validation KW - outcome measure KW - sensor KW - wearable N2 - Background: Clinical trials often use digital technologies to collect data continuously outside the clinic and use the derived digital endpoints as trial endpoints. Digital endpoints are also being developed to support diagnosis, monitoring, or therapeutic interventions in clinical care. However, clinical validation stands as a significant challenge, as there are no specific guidelines orienting the validation of digital endpoints. Objective: This paper presents the protocol for a scoping review that aims to map the existing methods for the clinical validation of digital endpoints. Methods: The scoping review will comprise searches from the electronic literature databases MEDLINE (PubMed), Scopus (including conference proceedings), Embase, IEEE (Institute of Electrical and Electronics Engineers) Xplore, ACM (Association for Computing Machinery) Digital Library, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science Core Collection (including conference proceedings), and Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports. We will also include various sources of gray literature with search terms related to digital endpoints. The methodology will adhere to the Joanna Briggs Institute Scoping Review and the Guidance for Conducting Systematic Scoping Reviews. Results: A search for reviews on the existing evidence related to this topic was conducted and has shown that no such review was previously undertaken. This review will provide a systematic assessment of the literature on methods for the clinical validation of digital endpoints and highlight any potential need for harmonization or reporting of methods. The results will include the methods for the clinical validation of digital endpoints according to device, digital endpoint, and clinical application goal of digital endpoints. The study started in January 2023 and is expected to end by December 2023, with results to be published in a peer-reviewed journal. Conclusions: A scoping review of methodologies that validate digital endpoints is necessary. This review will be unique in its breadth since it will comprise digital endpoints collected from several devices and not focus on a specific disease area. The results of our work should help guide researchers in choosing validation methods, identify potential gaps in the literature, or inform the development of novel methods to optimize the clinical validation of digital endpoints. Resolving these gaps is the key to presenting evidence in a consistent way to regulators and other parties and obtaining regulatory acceptance of digital endpoints for patient benefit. International Registered Report Identifier (IRRID): PRR1-10.2196/47119 UR - https://www.researchprotocols.org/2023/1/e47119 UR - http://dx.doi.org/10.2196/47119 UR - http://www.ncbi.nlm.nih.gov/pubmed/37883152 ID - info:doi/10.2196/47119 ER - TY - JOUR AU - Solomon, Jeffrey AU - Dauber-Decker, Katherine AU - Richardson, Safiya AU - Levy, Sera AU - Khan, Sundas AU - Coleman, Benjamin AU - Persaud, Rupert AU - Chelico, John AU - King, D'Arcy AU - Spyropoulos, Alex AU - McGinn, Thomas PY - 2023/10/19 TI - Integrating Clinical Decision Support Into Electronic Health Record Systems Using a Novel Platform (EvidencePoint): Developmental Study JO - JMIR Form Res SP - e44065 VL - 7 KW - clinical decision support system KW - cloud based KW - decision support KW - development KW - EHR KW - electronic health record KW - evidence-based medicine KW - health information technology KW - platform KW - user-centered design N2 - Background: Through our work, we have demonstrated how clinical decision support (CDS) tools integrated into the electronic health record (EHR) assist providers in adopting evidence-based practices. This requires confronting technical challenges that result from relying on the EHR as the foundation for tool development; for example, the individual CDS tools need to be built independently for each different EHR. Objective: The objective of our research was to build and implement an EHR-agnostic platform for integrating CDS tools, which would remove the technical constraints inherent in relying on the EHR as the foundation and enable a single set of CDS tools that can work with any EHR. Methods: We developed EvidencePoint, a novel, cloud-based, EHR-agnostic CDS platform, and we will describe the development of EvidencePoint and the deployment of its initial CDS tools, which include EHR-integrated applications for clinical use cases such as prediction of hospitalization survival for patients with COVID-19, venous thromboembolism prophylaxis, and pulmonary embolism diagnosis. Results: The results below highlight the adoption of the CDS tools, the International Medical Prevention Registry on Venous Thromboembolism-D-Dimer, the Wells? criteria, and the Northwell COVID-19 Survival (NOCOS), following development, usability testing, and implementation. The International Medical Prevention Registry on Venous Thromboembolism-D-Dimer CDS was used in 5249 patients at the 2 clinical intervention sites. The intervention group tool adoption was 77.8% (4083/5249 possible uses). For the NOCOS tool, which was designed to assist with triaging patients with COVID-19 for hospital admission in the event of constrained hospital resources, the worst-case resourcing scenario never materialized and triaging was never required. As a result, the NOCOS tool was not frequently used, though the EvidencePoint platform?s flexibility and customizability enabled the tool to be developed and deployed rapidly under the emergency conditions of the pandemic. Adoption rates for the Wells? criteria tool will be reported in a future publication. Conclusions: The EvidencePoint system successfully demonstrated that a flexible, user-friendly platform for hosting CDS tools outside of a specific EHR is feasible. The forthcoming results of our outcomes analyses will demonstrate the adoption rate of EvidencePoint tools as well as the impact of behavioral economics ?nudges? on the adoption rate. Due to the EHR-agnostic nature of EvidencePoint, the development process for additional forms of CDS will be simpler than traditional and cumbersome IT integration approaches and will benefit from the capabilities provided by the core system of EvidencePoint. UR - https://formative.jmir.org/2023/1/e44065 UR - http://dx.doi.org/10.2196/44065 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856193 ID - info:doi/10.2196/44065 ER - TY - JOUR AU - Fernando, Manasha AU - Abell, Bridget AU - Tyack, Zephanie AU - Donovan, Thomasina AU - McPhail, M. Steven AU - Naicker, Sundresan PY - 2023/10/18 TI - Using Theories, Models, and Frameworks to Inform Implementation Cycles of Computerized Clinical Decision Support Systems in Tertiary Health Care Settings: Scoping Review JO - J Med Internet Res SP - e45163 VL - 25 KW - computerized clinical decision support systems KW - CDSS KW - implementation science KW - hospital KW - theories KW - models KW - frameworks KW - mobile phone N2 - Background: Computerized clinical decision support systems (CDSSs) are essential components of modern health system service delivery, particularly within acute care settings such as hospitals. Theories, models, and frameworks may assist in facilitating the implementation processes associated with CDSS innovation and its use within these care settings. These processes include context assessments to identify key determinants, implementation plans for adoption, promoting ongoing uptake, adherence, and long-term evaluation. However, there has been no prior review synthesizing the literature regarding the theories, models, and frameworks that have informed the implementation and adoption of CDSSs within hospitals. Objective: This scoping review aims to identify the theory, model, and framework approaches that have been used to facilitate the implementation and adoption of CDSSs in tertiary health care settings, including hospitals. The rationales reported for selecting these approaches, including the limitations and strengths, are described. Methods: A total of 5 electronic databases were searched (CINAHL via EBSCOhost, PubMed, Scopus, PsycINFO, and Embase) to identify studies that implemented or adopted a CDSS in a tertiary health care setting using an implementation theory, model, or framework. No date or language limits were applied. A narrative synthesis was conducted using full-text publications and abstracts. Implementation phases were classified according to the ?Active Implementation Framework stages?: exploration (feasibility and organizational readiness), installation (organizational preparation), initial implementation (initiating implementation, ie, training), full implementation (sustainment), and nontranslational effectiveness studies. Results: A total of 81 records (42 full text and 39 abstracts) were included. Full-text studies and abstracts are reported separately. For full-text studies, models (18/42, 43%), followed by determinants frameworks (14/42,33%), were most frequently used to guide adoption and evaluation strategies. Most studies (36/42, 86%) did not list the limitations associated with applying a specific theory, model, or framework. Conclusions: Models and related quality improvement methods were most frequently used to inform CDSS adoption. Models were not typically combined with each other or with theory to inform full-cycle implementation strategies. The findings highlight a gap in the application of implementation methods including theories, models, and frameworks to facilitate full-cycle implementation strategies for hospital CDSSs. UR - https://www.jmir.org/2023/1/e45163 UR - http://dx.doi.org/10.2196/45163 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851492 ID - info:doi/10.2196/45163 ER - TY - JOUR AU - Rambaud, Kimberly AU - van Woerden, Simon AU - Palumbo, Leonardo AU - Salvi, Cristiana AU - Smallwood, Catherine AU - Rockenschaub, Gerald AU - Okoliyski, Michail AU - Marinova, Lora AU - Fomaidi, Galina AU - Djalalova, Malika AU - Faruqui, Nabiha AU - Melo Bianco, Viviane AU - Mosquera, Mario AU - Spasov, Ivaylo AU - Totskaya, Yekaterina PY - 2023/10/10 TI - Building a Chatbot in a Pandemic JO - J Med Internet Res SP - e42960 VL - 25 KW - COVID-19 KW - chatbots KW - evidence-based communication channels KW - conversational agent KW - user-centered KW - health promotion KW - digital health intervention KW - online health information KW - digital health tool KW - health communication UR - https://www.jmir.org/2023/1/e42960 UR - http://dx.doi.org/10.2196/42960 UR - http://www.ncbi.nlm.nih.gov/pubmed/37074958 ID - info:doi/10.2196/42960 ER - TY - JOUR AU - Ardito, Vittoria AU - Cappellaro, Giulia AU - Compagni, Amelia AU - Petracca, Francesco AU - Preti, Maria Luigi PY - 2023/9/12 TI - Implementation of Machine Learning Applications in Health Care Organizations: Protocol for a Systematic Review of Empirical Studies JO - JMIR Res Protoc SP - e47971 VL - 12 KW - artificial intelligence KW - barriers KW - facilitators KW - health care organization KW - implementation KW - machine learning N2 - Background: An increasing interest in machine learning (ML) has been observed among scholars and health care professionals. However, while ML-based applications have been shown to be effective and have the potential to change the delivery of patient care, their implementation in health care organizations is complex. There are several challenges that currently hamper the uptake of ML in daily practice, and there is currently limited knowledge on how these challenges have been addressed in empirical studies on implemented ML-based applications. Objective: The aim of this systematic literature review is twofold: (1) to map the ML-based applications implemented in health care organizations, with a focus on investigating the organizational dimensions that are relevant in the implementation process; and (2) to analyze the processes and strategies adopted to foster a successful uptake of ML. Methods: We developed this protocol following the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. The search was conducted on 3 databases (PubMed, Scopus, and Web of Science), considering a 10-year time frame (2013-2023). The search strategy was built around 4 blocks of keywords (artificial intelligence, implementation, health care, and study type). Based on the detailed inclusion criteria defined, only empirical studies documenting the implementation of ML-based applications used by health care professionals in clinical settings will be considered. The study protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews). Results: The review is ongoing and is expected to be completed by September 2023. Data analysis is currently underway, and the first results are expected to be submitted for publication in November 2023. The study was funded by the European Union within the Multilayered Urban Sustainability Action (MUSA) project. Conclusions: ML-based applications involving clinical decision support and automation of clinical tasks present unique traits that add several layers of complexity compared with earlier health technologies. Our review aims at contributing to the existing literature by investigating the implementation of ML from an organizational perspective and by systematizing a conspicuous amount of information on factors influencing implementation. International Registered Report Identifier (IRRID): DERR1-10.2196/47971 UR - https://www.researchprotocols.org/2023/1/e47971 UR - http://dx.doi.org/10.2196/47971 UR - http://www.ncbi.nlm.nih.gov/pubmed/37698910 ID - info:doi/10.2196/47971 ER - TY - JOUR AU - Klement, William AU - El Emam, Khaled PY - 2023/8/31 TI - Consolidated Reporting Guidelines for Prognostic and Diagnostic Machine Learning Modeling Studies: Development and Validation JO - J Med Internet Res SP - e48763 VL - 25 KW - machine learning KW - prognostic models KW - prediction models KW - reporting guidelines KW - reproducibility guidelines KW - diagnostic KW - prognostic KW - model evaluation KW - model training N2 - Background: The reporting of machine learning (ML) prognostic and diagnostic modeling studies is often inadequate, making it difficult to understand and replicate such studies. To address this issue, multiple consensus and expert reporting guidelines for ML studies have been published. However, these guidelines cover different parts of the analytics lifecycle, and individually, none of them provide a complete set of reporting requirements. Objective: We aimed to consolidate the ML reporting guidelines and checklists in the literature to provide reporting items for prognostic and diagnostic ML in in-silico and shadow mode studies. Methods: We conducted a literature search that identified 192 unique peer-reviewed English articles that provide guidance and checklists for reporting ML studies. The articles were screened by their title and abstract against a set of 9 inclusion and exclusion criteria. Articles that were filtered through had their quality evaluated by 2 raters using a 9-point checklist constructed from guideline development good practices. The average ? was 0.71 across all quality criteria. The resulting 17 high-quality source papers were defined as having a quality score equal to or higher than the median. The reporting items in these 17 articles were consolidated and screened against a set of 6 inclusion and exclusion criteria. The resulting reporting items were sent to an external group of 11 ML experts for review and updated accordingly. The updated checklist was used to assess the reporting in 6 recent modeling papers in JMIR AI. Feedback from the external review and initial validation efforts was used to improve the reporting items. Results: In total, 37 reporting items were identified and grouped into 5 categories based on the stage of the ML project: defining the study details, defining and collecting the data, modeling methodology, model evaluation, and explainability. None of the 17 source articles covered all the reporting items. The study details and data description reporting items were the most common in the source literature, with explainability and methodology guidance (ie, data preparation and model training) having the least coverage. For instance, a median of 75% of the data description reporting items appeared in each of the 17 high-quality source guidelines, but only a median of 33% of the data explainability reporting items appeared. The highest-quality source articles tended to have more items on reporting study details. Other categories of reporting items were not related to the source article quality. We converted the reporting items into a checklist to support more complete reporting. Conclusions: Our findings supported the need for a set of consolidated reporting items, given that existing high-quality guidelines and checklists do not individually provide complete coverage. The consolidated set of reporting items is expected to improve the quality and reproducibility of ML modeling studies. UR - https://www.jmir.org/2023/1/e48763 UR - http://dx.doi.org/10.2196/48763 UR - http://www.ncbi.nlm.nih.gov/pubmed/37651179 ID - info:doi/10.2196/48763 ER - TY - JOUR AU - Inau, Thea Esther AU - Sack, Jean AU - Waltemath, Dagmar AU - Zeleke, Alamirrew Atinkut PY - 2023/8/28 TI - Initiatives, Concepts, and Implementation Practices of the Findable, Accessible, Interoperable, and Reusable Data Principles in Health Data Stewardship: Scoping Review JO - J Med Internet Res SP - e45013 VL - 25 KW - data stewardship KW - findable, accessible, interoperable, and reusable data principles KW - FAIR data principles KW - health research KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses KW - PRISMA KW - qualitative analysis KW - scoping review KW - information retrieval KW - health information exchange N2 - Background: Thorough data stewardship is a key enabler of comprehensive health research. Processes such as data collection, storage, access, sharing, and analytics require researchers to follow elaborate data management strategies properly and consistently. Studies have shown that findable, accessible, interoperable, and reusable (FAIR) data leads to improved data sharing in different scientific domains. Objective: This scoping review identifies and discusses concepts, approaches, implementation experiences, and lessons learned in FAIR initiatives in health research data. Methods: The Arksey and O?Malley stage-based methodological framework for scoping reviews was applied. PubMed, Web of Science, and Google Scholar were searched to access relevant publications. Articles written in English, published between 2014 and 2020, and addressing FAIR concepts or practices in the health domain were included. The 3 data sources were deduplicated using a reference management software. In total, 2 independent authors reviewed the eligibility of each article based on defined inclusion and exclusion criteria. A charting tool was used to extract information from the full-text papers. The results were reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: A total of 2.18% (34/1561) of the screened articles were included in the final review. The authors reported FAIRification approaches, which include interpolation, inclusion of comprehensive data dictionaries, repository design, semantic interoperability, ontologies, data quality, linked data, and requirement gathering for FAIRification tools. Challenges and mitigation strategies associated with FAIRification, such as high setup costs, data politics, technical and administrative issues, privacy concerns, and difficulties encountered in sharing health data despite its sensitive nature were also reported. We found various workflows, tools, and infrastructures designed by different groups worldwide to facilitate the FAIRification of health research data. We also uncovered a wide range of problems and questions that researchers are trying to address by using the different workflows, tools, and infrastructures. Although the concept of FAIR data stewardship in the health research domain is relatively new, almost all continents have been reached by at least one network trying to achieve health data FAIRness. Documented outcomes of FAIRification efforts include peer-reviewed publications, improved data sharing, facilitated data reuse, return on investment, and new treatments. Successful FAIRification of data has informed the management and prognosis of various diseases such as cancer, cardiovascular diseases, and neurological diseases. Efforts to FAIRify data on a wider variety of diseases have been ongoing since the COVID-19 pandemic. Conclusions: This work summarises projects, tools, and workflows for the FAIRification of health research data. The comprehensive review shows that implementing the FAIR concept in health data stewardship carries the promise of improved research data management and transparency in the era of big data and open research publishing. International Registered Report Identifier (IRRID): RR2-10.2196/22505 UR - https://www.jmir.org/2023/1/e45013 UR - http://dx.doi.org/10.2196/45013 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639292 ID - info:doi/10.2196/45013 ER - TY - JOUR AU - Wilson, Sarah AU - Tolley, Clare AU - Mc Ardle, Riona AU - Beswick, Emily AU - Slight, P. Sarah PY - 2023/8/22 TI - Key Considerations When Developing and Implementing Digital Technology for Early Detection of Dementia-Causing Diseases Among Health Care Professionals: Qualitative Study JO - J Med Internet Res SP - e46711 VL - 25 KW - qualitative KW - health care professional KW - early detection of disease KW - dementia KW - digital technology KW - early detection of dementia KW - digital health KW - health care worker KW - digital tool N2 - Background: The World Health Organization (WHO) promotes using digital technologies to accelerate global attainment of health and well-being. This has led to a growth in research exploring the use of digital technology to aid early detection and preventative interventions for dementia-causing diseases such as Alzheimer disease. The opinions and perspectives of health care professionals must be incorporated into the development and implementation of technology to promote its successful adoption in clinical practice. Objective: This study aimed to explore health care professionals? perspectives on the key considerations of developing and implementing digital technologies for the early detection of dementia-causing diseases in the National Health Service (NHS). Methods: Health care professionals with patient-facing roles in primary or secondary care settings in the NHS were recruited through various web-based NHS clinical networks. Participants were interviewed to explore their experiences of the current dementia diagnostic practices, views on early detection and use of digital technology to aid these practices, and the challenges of implementing such interventions in health care. An inductive thematic analysis approach was applied to identify central concepts and themes in the interviews, allowing the data to determine our themes. A list of central concepts and themes was applied systematically to the whole data set using NVivo (version 1.6.1; QSR International). Using the constant comparison technique, the researchers moved backward and forward between these data and evolving explanations until a fit was made. Results: Eighteen semistructured interviews were conducted, with 11 primary and 7 secondary care health care professionals. We identified 3 main categories of considerations relevant to health care service users, health care professionals, and the digital health technology itself. Health care professionals recognized the potential of using digital technology to collect real-time data and the possible benefits of detecting dementia-causing diseases earlier if an effective intervention were available. However, some were concerned about postdetection management, questioning the point of an early detection of dementia-causing diseases if an effective intervention cannot be provided and feared this would only lead to increased anxiety in patients. Health care professionals also expressed mixed opinions on who should be screened for early detection. Some suggested it should be available to everyone to mitigate the chance of excluding those who are not in touch with their health care or are digitally excluded. Others were concerned about the resources that would be required to make the technology available to everyone. Conclusions: This study highlights the need to design digital health technology in a way that is accessible to all and does not add burden to health care professionals. Further work is needed to ensure inclusive strategies are used in digital research to promote health equity. UR - https://www.jmir.org/2023/1/e46711 UR - http://dx.doi.org/10.2196/46711 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606986 ID - info:doi/10.2196/46711 ER - TY - JOUR AU - Nan, Jingwen AU - Xu, Li-Qun PY - 2023/8/21 TI - Designing Interoperable Health Care Services Based on Fast Healthcare Interoperability Resources: Literature Review JO - JMIR Med Inform SP - e44842 VL - 11 KW - Health level 7 Fast Healthcare Interoperability Resources KW - HL7 FHIR KW - interoperability KW - literature review KW - practice guideline KW - mobile phone N2 - Background: With the advent of the digital economy and the aging population, the demand for diversified health care services and innovative care delivery models has been overwhelming. This trend has accelerated the urgency to implement effective and efficient data exchange and service interoperability, which underpins coordinated care services among tiered health care institutions, improves the quality of oversight of regulators, and provides vast and comprehensive data collection to support clinical medicine and health economics research, thus improving the overall service quality and patient satisfaction. To meet this demand and facilitate the interoperability of IT systems of stakeholders, after years of preparation, Health Level 7 formally introduced, in 2014, the Fast Healthcare Interoperability Resources (FHIR) standard. It has since continued to evolve. FHIR depends on the Implementation Guide (IG) to ensure feasibility and consistency while developing an interoperable health care service. The IG defines rules with associated documentation on how FHIR resources are used to tackle a particular problem. However, a gap remains between IGs and the process of building actual services because IGs are rules without specifying concrete methods, procedures, or tools. Thus, stakeholders may feel it nontrivial to participate in the ecosystem, giving rise to the need for a more actionable practice guideline (PG) for promoting FHIR?s fast adoption. Objective: This study aimed to propose a general FHIR PG to facilitate stakeholders in the health care ecosystem to understand FHIR and quickly develop interoperable health care services. Methods: We selected a collection of FHIR-related papers about the latest studies or use cases on designing and building FHIR-based interoperable health care services and tagged each use case as belonging to 1 of the 3 dominant innovation feature groups that are also associated with practice stages, that is, data standardization, data management, and data integration. Next, we reviewed each group?s detailed process and key techniques to build respective care services and collate a complete FHIR PG. Finally, as an example, we arbitrarily selected a use case outside the scope of the reviewed papers and mapped it back to the FHIR PG to demonstrate the effectiveness and generalizability of the PG. Results: The FHIR PG includes 2 core elements: one is a practice design that defines the responsibilities of stakeholders and outlines the complete procedure from data to services, and the other is a development architecture for practice design, which lists the available tools for each practice step and provides direct and actionable recommendations. Conclusions: The FHIR PG can bridge the gap between IGs and the process of building actual services by proposing actionable methods, procedures, and tools. It assists stakeholders in identifying participants? roles, managing the scope of responsibilities, and developing relevant modules, thus helping promote FHIR-based interoperable health care services. UR - https://medinform.jmir.org/2023/1/e44842 UR - http://dx.doi.org/10.2196/44842 UR - http://www.ncbi.nlm.nih.gov/pubmed/37603388 ID - info:doi/10.2196/44842 ER - TY - JOUR AU - Golec, Marcin AU - Kamdar, Maulik AU - Barteit, Sandra PY - 2023/8/11 TI - Comprehensive Ontology of Fibroproliferative Diseases: Protocol for a Semantic Technology Study JO - JMIR Res Protoc SP - e48645 VL - 12 KW - fibroproliferative disease KW - fibrosis KW - fibrotic disease KW - ontology KW - OWL KW - semantic technology KW - Web Ontology Language N2 - Background: Fibroproliferative or fibrotic diseases (FDs), which represent a significant proportion of age-related pathologies and account for over 40% of mortality in developed nations, are often underrepresented in focused research. Typically, these conditions are studied individually, such as chronic obstructive pulmonary disease or idiopathic pulmonary fibrosis (IPF), rather than as a collective entity, thereby limiting the holistic understanding and development of effective treatments. To address this, we propose creating and publicizing a comprehensive fibroproliferative disease ontology (FDO) to unify the understanding of FDs. Objective: This paper aims to delineate the study protocol for the creation of the FDO, foster transparency and high quality standards during its development, and subsequently promote its use once it becomes publicly available. Methods: We aim to establish an ontology encapsulating the broad spectrum of FDs, constructed in the Web Ontology Language format using the Protégé ontology editor, adhering to ontology development life cycle principles. The modeling process will leverage Protégé in accordance with a methodologically defined process, involving targeted scoping reviews of MEDLINE and PubMed information, expert knowledge, and an ontology development process. A hybrid top-down and bottom-up strategy will guide the identification of core concepts and relations, conducted by a team of domain experts based on systematic iterations of scientific literature reviews. Results: The result will be an exhaustive FDO accommodating a wide variety of crucial biomedical concepts, augmented with synonyms, definitions, and references. The FDO aims to encapsulate diverse perspectives on the FD domain, including those of clinicians, health informaticians, medical researchers, and public health experts. Conclusions: The FDO is expected to stimulate broader and more in-depth FD research by enabling reasoning, inference, and the identification of relationships between concepts for application in multiple contexts, such as developing specialized software, fostering research communities, and enhancing domain comprehension. A common vocabulary and understanding of relationships among medical professionals could potentially expedite scientific progress and the discovery of innovative solutions. The publicly available FDO will form the foundation for future research, technological advancements, and public health initiatives. International Registered Report Identifier (IRRID): PRR1-10.2196/48645 UR - https://www.researchprotocols.org/2023/1/e48645 UR - http://dx.doi.org/10.2196/48645 UR - http://www.ncbi.nlm.nih.gov/pubmed/37566458 ID - info:doi/10.2196/48645 ER - TY - JOUR AU - McKenna, Sarah AU - Piper, Sarah AU - Capon, William AU - Crowley, Alison AU - Lira, Lucas AU - LaMonica, M. Haley AU - Chong, Kyung Min AU - Scott, Elizabeth AU - Hickie, Ian AU - Iorfino, Frank PY - 2023/7/25 TI - The Polarization of Clinician and Service Staff Perspectives After the Use of Health Information Technology in Youth Mental Health Services: Implementation and Evaluation Study JO - JMIR Hum Factors SP - e42993 VL - 10 KW - mental health KW - youth KW - adolescent KW - service delivery KW - implementation science KW - digital technologies KW - measurement-based care KW - health information technology KW - information system KW - perspective KW - provider KW - health care staff KW - health care worker KW - health care professional N2 - Background: Highly personalized care is substantially improved by technology platforms that assess and track patient outcomes. However, evidence regarding how to successfully implement technology in real-world mental health settings is limited. Objective: This study aimed to naturalistically monitor how a health information technology (HIT) platform was used within 2 real-world mental health service settings to gain practical insights into how HIT can be implemented and sustained to improve mental health service delivery. Methods: An HIT (The Innowell Platform) was naturally implemented in 2 youth mental health services in Sydney, Australia. Web-based surveys (n=19) and implementation logs were used to investigate staff attitudes toward technology before and after implementation. Descriptive statistics were used to track staff attitudes over time, whereas qualitative thematic analysis was used to explore implementation log data to gain practical insights into useful implementation strategies in real-world settings. Results: After the implementation, the staff were nearly 3 times more likely to agree that the HIT would improve care for their clients (3/12, 25% agreed before the implementation compared with 7/10, 70% after the implementation). Despite this, there was also an increase in the number of staff who disagreed that the HIT would improve care (from 1/12, 8% to 2/10, 20%). There was also decreased uncertainty (from 6/12, 50% to 3/10, 30%) about the willingness of the service to implement the technology for its intended purpose, with similar increases in the number of staff who agreed and disagreed with this statement. Staff were more likely to be uncertain about whether colleagues in my service are receptive to changes in clinical processes (not sure rose from 5/12, 42% to 7/10, 70%). They were also more likely to report that their service already provides the best mental health care (agreement rose from 7/12, 58% to 8/10, 80%). After the implementation, a greater proportion of participants reported that the HIT enabled shared or collaborative decision-making with young people (2/10, 20%, compared with 1/12, 8%), enabled clients to proactively work on their mental health care through digital technologies (3/10, 30%, compared with 2/12, 16%), and improved their response to suicidal risk (4/10, 40% compared with 3/12, 25%). Conclusions: This study raises important questions about why clinicians, who have the same training and support in using technology, develop more polarized opinions on its usefulness after implementation. It seems that the uptake of HIT is heavily influenced by a clinician?s underlying beliefs and attitudes toward clinical practice in general as well as the role of technology, rather than their knowledge or the ease of use of the HIT in question. UR - https://humanfactors.jmir.org/2023/1/e42993 UR - http://dx.doi.org/10.2196/42993 UR - http://www.ncbi.nlm.nih.gov/pubmed/37490321 ID - info:doi/10.2196/42993 ER - TY - JOUR AU - Brereton, A. Tracey AU - Malik, M. Momin AU - Lifson, Mark AU - Greenwood, D. Jason AU - Peterson, J. Kevin AU - Overgaard, M. Shauna PY - 2023/7/14 TI - The Role of Artificial Intelligence Model Documentation in Translational Science: Scoping Review JO - Interact J Med Res SP - e45903 VL - 12 KW - health KW - informatics KW - artificial intelligence KW - machine learning KW - documentation KW - explainability KW - ethics KW - translational science KW - scoping review KW - medical modeling software KW - clinical decision support KW - decision support intervention N2 - Background: Despite the touted potential of artificial intelligence (AI) and machine learning (ML) to revolutionize health care, clinical decision support tools, herein referred to as medical modeling software (MMS), have yet to realize the anticipated benefits. One proposed obstacle is the acknowledged gaps in AI translation. These gaps stem partly from the fragmentation of processes and resources to support MMS transparent documentation. Consequently, the absence of transparent reporting hinders the provision of evidence to support the implementation of MMS in clinical practice, thereby serving as a substantial barrier to the successful translation of software from research settings to clinical practice. Objective: This study aimed to scope the current landscape of AI- and ML-based MMS documentation practices and elucidate the function of documentation in facilitating the translation of ethical and explainable MMS into clinical workflows. Methods: A scoping review was conducted in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. PubMed was searched using Medical Subject Headings key concepts of AI, ML, ethical considerations, and explainability to identify publications detailing AI- and ML-based MMS documentation, in addition to snowball sampling of selected reference lists. To include the possibility of implicit documentation practices not explicitly labeled as such, we did not use documentation as a key concept but as an inclusion criterion. A 2-stage screening process (title and abstract screening and full-text review) was conducted by 1 author. A data extraction template was used to record publication-related information; barriers to developing ethical and explainable MMS; available standards, regulations, frameworks, or governance strategies related to documentation; and recommendations for documentation for papers that met the inclusion criteria. Results: Of the 115 papers retrieved, 21 (18.3%) papers met the requirements for inclusion. Ethics and explainability were investigated in the context of AI- and ML-based MMS documentation and translation. Data detailing the current state and challenges and recommendations for future studies were synthesized. Notable themes defining the current state and challenges that required thorough review included bias, accountability, governance, and explainability. Recommendations identified in the literature to address present barriers call for a proactive evaluation of MMS, multidisciplinary collaboration, adherence to investigation and validation protocols, transparency and traceability requirements, and guiding standards and frameworks that enhance documentation efforts and support the translation of AI- and ML-based MMS. Conclusions: Resolving barriers to translation is critical for MMS to deliver on expectations, including those barriers identified in this scoping review related to bias, accountability, governance, and explainability. Our findings suggest that transparent strategic documentation, aligning translational science and regulatory science, will support the translation of MMS by coordinating communication and reporting and reducing translational barriers, thereby furthering the adoption of MMS. UR - https://www.i-jmr.org/2023/1/e45903 UR - http://dx.doi.org/10.2196/45903 UR - http://www.ncbi.nlm.nih.gov/pubmed/37450330 ID - info:doi/10.2196/45903 ER - TY - JOUR AU - Turnbull, Sophie AU - Walsh, E. Nicola AU - Moore, J. Andrew PY - 2023/7/5 TI - Adaptation and Implementation of a Shared Decision-Making Tool From One Health Context to Another: Partnership Approach Using Mixed Methods JO - J Med Internet Res SP - e42551 VL - 25 KW - shared decision-making KW - implementation KW - theoretical domains framework KW - qualitative KW - osteoarthritis KW - digital KW - mixed methods study KW - decision-making KW - disability KW - treatment KW - tool KW - effectiveness KW - acceptability KW - users KW - design N2 - Background: Osteoarthritis is a leading cause of pain and disability. Knee osteoarthritis accounts for nearly four-fifths of the burden of osteoarthritis internationally, and 10% of adults in the United Kingdom have the condition. Shared decision-making (SDM) supports patients to make more informed choices about treatment and care while reducing inequities in access to treatment. We evaluated the experience of a team adapting an SDM tool for knee osteoarthritis and the tool?s implementation potential within a local clinical commissioning group (CCG) area in southwest England. The tool aims to prepare patients and clinicians for SDM by providing evidence-based information about treatment options relevant to disease stage. Objective: This study aimed to explore the experiences of a team adapting an SDM tool from one health context to another and the implementation potential of the tool in the local CCG area. Methods: A partnership approach using mixed methods was used to respond to recruitment challenges and ensure that study aims could be addressed within time restrictions. A web-based survey was used to obtain clinicians? feedback on experiences of using the SDM tool. Qualitative interviews were conducted by telephone or video call with a sample of stakeholders involved in adapting and implementing the tool in the local CCG area. Survey findings were summarized as frequencies and percentages. Content analysis was conducted on qualitative data using framework analysis, and data were mapped directly to the Theoretical Domains Framework (TDF). Results: Overall, 23 clinicians completed the survey, including first-contact physiotherapists (11/23, 48%), physiotherapists (7/23, 30%), specialist physiotherapists (4/23, 17%), and a general practitioner (1/23, 4%). Eight stakeholders involved in commissioning, adapting, and implementing the SDM tool were interviewed. Participants described barriers and facilitators to the adaptation, implementation, and use of the tool. Barriers included a lack of organizational culture that supported and resourced SDM, lack of clinician buy-in and awareness of the tool, challenges with accessibility and usability, and lack of adaptation for underserved communities. Facilitators included the influence of clinical leaders? belief that SDM tools can improve patient outcomes and National Health Service resource use, clinicians? positive experiences of using the tool, and improving awareness of the tool. Themes were mapped to 13 of the 14 TDF domains. Usability issues were described, which did not map to the TDF domains. Conclusions: This study highlights barriers and facilitators to adapting and implementing tools from one health context to another. We recommend that tools selected for adaptation should have a strong evidence base, including evidence of effectiveness and acceptability in the original context. Legal advice should be sought regarding intellectual property early in the project. Existing guidance for developing and adapting interventions should be used. Co-design methods should be applied to improve adapted tools? accessibility and acceptability. UR - https://www.jmir.org/2023/1/e42551 UR - http://dx.doi.org/10.2196/42551 UR - http://www.ncbi.nlm.nih.gov/pubmed/37405845 ID - info:doi/10.2196/42551 ER - TY - JOUR AU - Fields, Beth AU - Werner, Nicole AU - Shah, N. Manish AU - Hetzel, Scott AU - Golden, P. Blair AU - Gilmore-Bykovskyi, Andrea AU - Farrar Edwards, Dorothy PY - 2023/6/22 TI - Adapting and Testing the Care Partner Hospital Assessment Tool for Use in Dementia Care: Protocol for a 2 Sequential Phase Study JO - JMIR Res Protoc SP - e46808 VL - 12 KW - dementia KW - caregiving KW - health care KW - systems KW - co-design KW - randomized control trial N2 - Background: Research and policy demonstrate the value of and need for systematically identifying and preparing care partners for their caregiving responsibilities while their family member or friend living with dementia is hospitalized. The Care Partner Hospital Assessment Tool (CHAT) has undergone content and face validation and has been endorsed as appropriate by clinicians to facilitate the timely identification and preparation of care partners of older adult patients during their hospitalization. However, the CHAT has not yet been adapted or prospectively evaluated for use with care partners of hospitalized people living with dementia. Adapting and testing the CHAT via a pilot study will provide the necessary evidence to optimize feasibility and enable future efficacy trials. Objective: The purpose of this paper is to describe the study protocol for the adaptation and testing of the CHAT for use among care partners of hospitalized people living with dementia to better prepare them for their caregiving responsibilities after hospital discharge. Methods: Our protocol is based on the National Institutes of Health Stage Model and consists of 2 sequential phases, including formative research and the main trial. In phase 1, we will use a participatory human-centered design process that incorporates people living with dementia and their care partners, health care administrators, and clinicians to adapt the CHAT for dementia care (ie, the Dementia CHAT [D-CHAT]; stage IA). In phase 2, we will partner with a large academic medical system to complete a pilot randomized controlled trial to examine the feasibility and estimate the size of the effect of the D-CHAT on care partners? preparedness for caregiving (stage IB). We anticipate this study to take approximately 60 months to complete, from study start-up procedures to dissemination. The 2 phases will take place between December 1, 2022, and November 30, 2027. Results: The study protocol will yield (1) a converged-upon, ready-for-feasibility testing D-CHAT; (2) descriptive and feasibility characteristics of delivering the D-CHAT; and (3) effect size estimates of the D-CHAT on care partner preparedness. We anticipate that the resultant D-CHAT will provide clinicians with guidance on how to identify and better prepare care partners for hospitalized people living with dementia. In turn, care partners will feel equipped to fulfill caregiving roles for their family members or friends living with dementia. Conclusions: The expected results of this study are to favorably impact hospital-based care processes and outcomes for people living with dementia and their care partners and to elucidate the essential caregiving role that so many care partners of people living with dementia assume. Trial Registration: ClinicalTrials.gov NCT05592366; https://clinicaltrials.gov/ct2/show/NCT05592366 International Registered Report Identifier (IRRID): PRR1-10.2196/46808 UR - https://www.researchprotocols.org/2023/1/e46808 UR - http://dx.doi.org/10.2196/46808 UR - http://www.ncbi.nlm.nih.gov/pubmed/37347517 ID - info:doi/10.2196/46808 ER - TY - JOUR AU - Mahajan, Arnav AU - Hawkins, Austin PY - 2023/6/15 TI - Current Implementation Outcomes of Digital Surgical Simulation in Low- and Middle-Income Countries: Scoping Review JO - JMIR Med Educ SP - e23287 VL - 9 KW - adaptation KW - digital surgery KW - global surgery KW - simulation KW - surgery KW - systematic review KW - technology KW - video game N2 - Background: Digital surgical simulation and telecommunication provides an attractive option for improving surgical skills, widening access to training, and improving patient outcomes; however, it is unclear whether sufficient simulations and telecommunications are accessible, effective, or feasible in low- and middle-income countries (LMICs). Objective: This study aims to determine which types of surgical simulation tools have been most widely used in LMICs, how surgical simulation technology is being implemented, and what the outcomes of these efforts have been. We also offer recommendations for the future development of digital surgical simulation implementation in LMICs. Methods: We searched PubMed, MEDLINE, Embase, Web of Science, Cochrane Database of Systematic Reviews, and the Central Register of Controlled Trials to look for qualitative studies in published literature discussing implementation and outcomes of surgical simulation training in LMICs. Eligible papers involved surgical trainees or practitioners who were based in LMICs. Papers that include allied health care professionals involved in task sharing were excluded. We focused specifically on digital surgical innovations and excluded flipped classroom models and 3D models. Implementation outcome had to be reported according to Proctor?s taxonomy. Results: This scoping review examined the outcomes of digital surgical simulation implementation in LMICs for 7 papers. The majority of participants were medical students and residents who were identified as male. Participants rated surgical simulators and telecommunications devices highly for acceptability and usefulness, and they believed that the simulators increased their anatomical and procedural knowledge. However, limitations such as image distortion, excessive light exposure, and video stream latency were frequently reported. Depending on the product, the implementation cost varied between US $25 and US $6990. Penetration and sustainability are understudied implementation outcomes, as all papers lacked long-term monitoring of the digital surgical simulations. Most authors are from high-income countries, suggesting that innovations are being proposed without a clear understanding of how they can be incorporated into surgeons? practical training. Overall, the study indicates that digital surgical simulation is a promising tool for medical education in LMICs; however, additional research is required to address some of the limitations in order to achieve successful implementation, unless scaling efforts prove futile. Conclusions: This study indicates that digital surgical simulation is a promising tool for medical education in LMICs, but further research is necessary to address some of the limitations and ensure successful implementation. We urge more consistent reporting and understanding of implementation of science approaches in the development of digital surgical tools, as this is the critical factor that will determine whether we are able to meet the 2030 goals for surgical training in LMICs. Sustainability of implemented digital surgical tools is a pain point that must be focused on if we are to deliver digital surgical simulation tools to the populations that demand them the most. UR - https://mededu.jmir.org/2023/1/e23287 UR - http://dx.doi.org/10.2196/23287 UR - http://www.ncbi.nlm.nih.gov/pubmed/37318901 ID - info:doi/10.2196/23287 ER - TY - JOUR AU - Mao, Lingchao AU - Chu, Emily AU - Gu, Jinghong AU - Hu, Tao AU - Weiner, J. Bryan AU - Su, Yanfang PY - 2023/6/13 TI - A 4D Theoretical Framework for Measuring Topic-Specific Influence on Twitter: Development and Usability Study on Dietary Sodium Tweets JO - J Med Internet Res SP - e45897 VL - 25 KW - social media KW - health education KW - health promotion KW - dissemination strategy KW - influence KW - Twitter KW - activity KW - priority KW - originality KW - popularity N2 - Background: Social media has emerged as a prominent approach for health education and promotion. However, it is challenging to understand how to best promote health-related information on social media platforms such as Twitter. Despite commercial tools and prior studies attempting to analyze influence, there is a gap to fill in developing a publicly accessible and consolidated framework to measure influence and analyze dissemination strategies. Objective: We aimed to develop a theoretical framework to measure topic-specific user influence on Twitter and to examine its usability by analyzing dietary sodium tweets to support public health agencies in improving their dissemination strategies. Methods: We designed a consolidated framework for measuring influence that can capture topic-specific tweeting behaviors. The core of the framework is a summary indicator of influence decomposable into 4 dimensions: activity, priority, originality, and popularity. These measures can be easily visualized and efficiently computed for any Twitter account without the need for private access. We demonstrated the proposed methods by using a case study on dietary sodium tweets with sampled stakeholders and then compared the framework with a traditional measure of influence. Results: More than half a million dietary sodium tweets from 2006 to 2022 were retrieved for 16 US domestic and international stakeholders in 4 categories, that is, public agencies, academic institutions, professional associations, and experts. We discovered that World Health Organization, American Heart Association, Food and Agriculture Organization of the United Nations (UN-FAO), and World Action on Salt (WASH) were the top 4 sodium influencers in the sample. Each had different strengths and weaknesses in their dissemination strategies, and 2 stakeholders with similar overall influence, that is, UN-FAO and WASH, could have significantly different tweeting patterns. In addition, we identified exemplars in each dimension of influence. Regarding tweeting activity, a dedicated expert published more sodium tweets than any organization in the sample in the past 16 years. In terms of priority, WASH had more than half of its tweets dedicated to sodium. UN-FAO had both the highest proportion of original sodium tweets and posted the most popular sodium tweets among all sampled stakeholders. Regardless of excellence in 1 dimension, the 4 most influential stakeholders excelled in at least 2 out of 4 dimensions of influence. Conclusions: Our findings demonstrate that our method not only aligned with a traditional measure of influence but also advanced influence analysis by analyzing the 4 dimensions that contribute to topic-specific influence. This consolidated framework provides quantifiable measures for public health entities to understand their bottleneck of influence and refine their social media campaign strategies. Our framework can be applied to improve the dissemination of other health topics as well as assist policy makers and public campaign experts to maximize population impact. UR - https://www.jmir.org/2023/1/e45897 UR - http://dx.doi.org/10.2196/45897 UR - http://www.ncbi.nlm.nih.gov/pubmed/37310774 ID - info:doi/10.2196/45897 ER - TY - JOUR AU - Beames, R. Joanne AU - Werner-Seidler, Aliza AU - Hodgins, Michael AU - Brown, Lyndsay AU - Fujimoto, Hiroko AU - Bartholomew, Alexandra AU - Maston, Kate AU - Huckvale, Kit AU - Zbukvic, Isabel AU - Torok, Michelle AU - Christensen, Helen AU - Batterham, J. Philip AU - Calear, L. Alison AU - Lingam, Raghu AU - Boydell, M. Katherine PY - 2023/6/12 TI - Implementing a Digital Depression Prevention Program in Australian Secondary Schools: Cross-Sectional Qualitative Study JO - JMIR Pediatr Parent SP - e42349 VL - 6 KW - implementation KW - youth KW - digital KW - depression KW - secondary school KW - qualitative KW - consolidated framework for implementation research KW - teacher KW - educator KW - perspective KW - mental health KW - student KW - child KW - adolescent KW - adolescence KW - school KW - social work N2 - Background: Depression is common during adolescence and is associated with adverse educational, employment, and health outcomes in later life. Digital programs are increasingly being implemented in schools to improve and protect adolescent mental health. Although digital depression prevention programs can be effective, there is limited knowledge about how contextual factors influence real-world delivery at scale in schools. Objective: The purpose of this study was to examine the contextual factors that influence the implementation of the Future Proofing Program (FPP) from the perspectives of school staff. The FPP is a 2-arm hybrid type 1 effectiveness-implementation trial evaluating whether depression can be prevented at scale in schools, using an evidence-based smartphone app delivered universally to year 8 students (13-14 years of age). Methods: Qualitative interviews were conducted with 23 staff from 20 schools in New South Wales, Australia, who assisted with the implementation of the FPP. The interviews were guided by our theory-driven logic model. Reflexive thematic analysis, using both deductive and inductive coding, was used to analyze responses. Results: Staff perceived the FPP as a novel (?innovative approach?) and appropriate way to address an unmet need within schools (?right place at the right time?). Active leadership and counselor involvement were critical for planning and engaging; teamwork, communication, and staff capacity were critical for execution (?ways of working within schools?). Low student engagement and staffing availability were identified as barriers for future adoption and implementation by schools (?reflecting on past experiences?). Conclusions: Four superordinate themes pertaining to the program, implementation processes, and implementation barriers were identified from qualitative responses by school staff. On the basis of our findings, we proposed a select set of recommendations for future implementation of digital prevention programs delivered at scale in schools. These recommendations were designed to facilitate an organizational change and help staff to implement digital mental health programs within their schools. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-042133 UR - https://pediatrics.jmir.org/2023/1/e42349 UR - http://dx.doi.org/10.2196/42349 UR - http://www.ncbi.nlm.nih.gov/pubmed/37307051 ID - info:doi/10.2196/42349 ER - TY - JOUR AU - Hartling, Lisa AU - Elliott, A. Sarah AU - Munan, Matthew AU - Scott, D. Shannon PY - 2023/5/25 TI - Web-Based Knowledge Translation Tool About Pediatric Acute Gastroenteritis for Parents: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e45276 VL - 7 KW - knowledge translation KW - pediatric acute gastroenteritis KW - emergency department KW - health care decision-making KW - multiple methods KW - randomized controlled trial KW - qualitative interviews KW - web-based tool N2 - Background: Acute gastroenteritis (AGE) in children is a leading cause of emergency department (ED) visits, resulting in substantial health care costs and stress for families and caregivers. The majority of pediatric AGE cases are caused by viral infections and can be managed at home using strategies to prevent dehydration. To increase knowledge of, and support health decision-making for, pediatric AGE, we developed a knowledge translation (KT) tool (fully automated web-based whiteboard animation video). Objective: The aim of this study was to assess the potential effectiveness of the web-based KT tool in terms of knowledge, health care decision-making, use of resources, and perceived benefit and value. Methods: A convenience sample of parents was recruited between December 18, 2020, and August 10, 2021. Parents were recruited in the ED of a pediatric tertiary care hospital and followed for up to 14 days after the ED visit. The eligibility criteria included parent or legal guardian of a child aged <16 years presenting to the ED with an acute episode of diarrhea or vomiting, ability to communicate in English, and agreeable to follow-up via email. Parents were randomized to receive the web-based KT tool (intervention) about AGE or a sham video (control) during their ED visit. The primary outcome was knowledge assessed before the intervention (baseline), immediately after the intervention, and at follow-up 4 to 14 days after ED discharge. Other outcomes included decision regret, health care use, and KT tool usability and satisfaction. The intervention group participants were invited to participate in a semistructured interview to gather additional feedback about the KT tool. Results: A total of 103 parents (intervention: n=51, 49.5%, and control: n=52, 50.5%) completed the baseline and postintervention assessments. Of these 103 parents, 78 (75.7%; intervention: n=36, 46%, and control: n=42, 54%) completed the follow-up questionnaire. Knowledge scores after the intervention (mean 8.5, SD 2.6 vs mean 6.3, SD 1.7; P<.001) and at follow-up (mean 9.1, SD 2.7 vs mean 6.8, SD 1.6; P<.001) were significantly higher in the intervention group. After the intervention, parents in the intervention group reported greater confidence in knowledge than those in the control group. No significant difference in decision regret was found at any time point. Parents rated the KT tool higher than the sham video across 5 items assessing usability and satisfaction. Conclusions: The web-based KT tool improved parental knowledge about AGE and confidence in their knowledge, which are important precursors to behavior change. Further research is needed into understanding what information and delivery format as well as other factors influence parents? decision-making regarding their child?s health. Trial Registration: ClinicalTrials.gov NCT03234777; https://clinicaltrials.gov/ct2/show/NCT03234777 International Registered Report Identifier (IRRID): RR2-10.1186/s40814-018-0318-0 UR - https://formative.jmir.org/2023/1/e45276 UR - http://dx.doi.org/10.2196/45276 UR - http://www.ncbi.nlm.nih.gov/pubmed/37227758 ID - info:doi/10.2196/45276 ER - TY - JOUR AU - Moy, J. Amanda AU - Withall, Jennifer AU - Hobensack, Mollie AU - Yeji Lee, Rachel AU - Levy, R. Deborah AU - Rossetti, C. Sarah AU - Rosenbloom, Trent S. AU - Johnson, Kevin AU - Cato, Kenrick PY - 2023/5/17 TI - Eliciting Insights From Chat Logs of the 25X5 Symposium to Reduce Documentation Burden: Novel Application of Topic Modeling JO - J Med Internet Res SP - e45645 VL - 25 KW - topic modeling KW - content analysis KW - online chat KW - virtual conference KW - documentation burden KW - burnout KW - physicians KW - nurses KW - policy KW - symposium KW - chat bot N2 - Background: Addressing clinician documentation burden through ?targeted solutions? is a growing priority for many organizations ranging from government and academia to industry. Between January and February 2021, the 25 by 5: Symposium to Reduce Documentation Burden on US Clinicians by 75% (25X5 Symposium) convened across 2 weekly 2-hour sessions among experts and stakeholders to generate actionable goals for reducing clinician documentation over the next 5 years. Throughout this web-based symposium, we passively collected attendees? contributions to a chat functionality?with their knowledge that the content would be deidentified and made publicly available. This presented a novel opportunity to synthesize and understand participants? perceptions and interests from chat messages. We performed a content analysis of 25X5 Symposium chat logs to identify themes about reducing clinician documentation burden. Objective: The objective of this study was to explore unstructured chat log content from the web-based 25X5 Symposium to elicit latent insights on clinician documentation burden among clinicians, health care leaders, and other stakeholders using topic modeling. Methods: Across the 6 sessions, we captured 1787 messages among 167 unique chat participants cumulatively; 14 were private messages not included in the analysis. We implemented a latent Dirichlet allocation (LDA) topic model on the aggregated dataset to identify clinician documentation burden topics mentioned in the chat logs. Coherence scores and manual examination informed optimal model selection. Next, 5 domain experts independently and qualitatively assigned descriptive labels to model-identified topics and classified them into higher-level categories, which were finalized through a panel consensus. Results: We uncovered ten topics using the LDA model: (1) determining data and documentation needs (422/1773, 23.8%); (2) collectively reassessing documentation requirements in electronic health records (EHRs) (252/1773, 14.2%); (3) focusing documentation on patient narrative (162/1773, 9.1%); (4) documentation that adds value (147/1773, 8.3%); (5) regulatory impact on clinician burden (142/1773, 8%); (6) improved EHR user interface and design (128/1773, 7.2%); (7) addressing poor usability (122/1773, 6.9%); (8) sharing 25X5 Symposium resources (122/1773, 6.9%); (9) capturing data related to clinician practice (113/1773, 6.4%); and (10) the role of quality measures and technology in burnout (110/1773, 6.2%). Among these 10 topics, 5 high-level categories emerged: consensus building (821/1773, 46.3%), burden sources (365/1773, 20.6%), EHR design (250/1773, 14.1%), patient-centered care (162/1773, 9.1%), and symposium comments (122/1773, 6.9%). Conclusions: We conducted a topic modeling analysis on 25X5 Symposium multiparticipant chat logs to explore the feasibility of this novel application and elicit additional insights on clinician documentation burden among attendees. Based on the results of our LDA analysis, consensus building, burden sources, EHR design, and patient-centered care may be important themes to consider when addressing clinician documentation burden. Our findings demonstrate the value of topic modeling in discovering topics associated with clinician documentation burden using unstructured textual content. Topic modeling may be a suitable approach to examine latent themes presented in web-based symposium chat logs. UR - https://www.jmir.org/2023/1/e45645 UR - http://dx.doi.org/10.2196/45645 UR - http://www.ncbi.nlm.nih.gov/pubmed/37195741 ID - info:doi/10.2196/45645 ER - TY - JOUR AU - Sbaffi, Laura AU - Zamani, Efpraxia AU - Kalua, Khumbo PY - 2023/5/11 TI - Promoting Well-being Among Informal Caregivers of People With HIV/AIDS in Rural Malawi: Community-Based Participatory Research Approach JO - J Med Internet Res SP - e45440 VL - 25 KW - informal caregivers KW - HIV/AIDS KW - rural Malawi KW - health advisory messages KW - mobile phone N2 - Background: People living with HIV/AIDS and their informal caregivers (usually family members) in Malawi do not have adequate access to patient-centered care, particularly in remote rural areas of the country because of the high burden of HIV/AIDS, coupled with a fragmented and patchy health care system. Chronic conditions require self-care strategies, which are now promoted in both developed and developing contexts but are still only emerging in sub-Saharan African countries. Objective: This study aims to explore the effects of the implementation of a short-term intervention aimed at supporting informal caregivers of people living with HIV/AIDS in Malawi in their caring role and improving their well-being. The intervention includes the dissemination of 6 health advisory messages on topics related to the management of HIV/AIDS over a period of 6 months, via the WhatsApp audio function to 94 caregivers attending peer support groups in the rural area of Namwera. Methods: We adopted a community-based participatory research approach, whereby the health advisory messages were designed and formulated in collaboration with informal caregivers, local medical physicians, social care workers, and community chiefs and informed by prior discussions with informal caregivers. Feedback on the quality, relevance, and applicability of the messages was gathered via individual interviews with the caregivers. Results: The results showed that the messages were widely disseminated beyond the support groups via word of mouth and highlighted a very high level of adoption of the advice contained in the messages by caregivers, who reported immediate (short-term) and long-term self-assessed benefits for themselves, their families, and their local communities. Conclusions: This study offers a novel perspective on how to combine community-based participatory research with a cost-effective, health-oriented informational intervention that can be implemented to support effective HIV/AIDS self-care and facilitate informal caregivers? role. UR - https://www.jmir.org/2023/1/e45440 UR - http://dx.doi.org/10.2196/45440 UR - http://www.ncbi.nlm.nih.gov/pubmed/37166971 ID - info:doi/10.2196/45440 ER - TY - JOUR AU - Perrin Franck, Caroline AU - Babington-Ashaye, Awa AU - Dietrich, Damien AU - Bediang, Georges AU - Veltsos, Philippe AU - Gupta, Prasad Pramendra AU - Juech, Claudia AU - Kadam, Rigveda AU - Collin, Maxime AU - Setian, Lucy AU - Serrano Pons, Jordi AU - Kwankam, Yunkap S. AU - Garrette, Béatrice AU - Barbe, Solenne AU - Bagayoko, Oumar Cheick AU - Mehl, Garrett AU - Lovis, Christian AU - Geissbuhler, Antoine PY - 2023/5/10 TI - iCHECK-DH: Guidelines and Checklist for the Reporting on Digital Health Implementations JO - J Med Internet Res SP - e46694 VL - 25 KW - implementation science KW - knowledge management KW - reporting standards KW - publishing standards KW - guideline KW - Digital Health Hub KW - reporting guideline KW - digital health implementation KW - health outcome N2 - Background: Implementation of digital health technologies has grown rapidly, but many remain limited to pilot studies due to challenges, such as a lack of evidence or barriers to implementation. Overcoming these challenges requires learning from previous implementations and systematically documenting implementation processes to better understand the real-world impact of a technology and identify effective strategies for future implementation. Objective: A group of global experts, facilitated by the Geneva Digital Health Hub, developed the Guidelines and Checklist for the Reporting on Digital Health Implementations (iCHECK-DH, pronounced ?I checked?) to improve the completeness of reporting on digital health implementations. Methods: A guideline development group was convened to define key considerations and criteria for reporting on digital health implementations. To ensure the practicality and effectiveness of the checklist, it was pilot-tested by applying it to several real-world digital health implementations, and adjustments were made based on the feedback received. The guiding principle for the development of iCHECK-DH was to identify the minimum set of information needed to comprehensively define a digital health implementation, to support the identification of key factors for success and failure, and to enable others to replicate it in different settings. Results: The result was a 20-item checklist with detailed explanations and examples in this paper. The authors anticipate that widespread adoption will standardize the quality of reporting and, indirectly, improve implementation standards and best practices. Conclusions: Guidelines for reporting on digital health implementations are important to ensure the accuracy, completeness, and consistency of reported information. This allows for meaningful comparison and evaluation of results, transparency, and accountability and informs stakeholder decision-making. i-CHECK-DH facilitates standardization of the way information is collected and reported, improving systematic documentation and knowledge transfer that can lead to the development of more effective digital health interventions and better health outcomes. UR - https://www.jmir.org/2023/1/e46694 UR - http://dx.doi.org/10.2196/46694 UR - http://www.ncbi.nlm.nih.gov/pubmed/37163336 ID - info:doi/10.2196/46694 ER - TY - JOUR AU - Rochette, Annie AU - Thomas, Aliki AU - Salbach, M. Nancy AU - Vachon, Brigitte AU - Menon, Anita AU - Poissant, Lise AU - Boutin, Maurane AU - Grad, Roland AU - Pluye, Pierre PY - 2023/5/8 TI - Expected Health Benefits as the Ultimate Outcome of Information Available on Stroke Engine, a Knowledge Translation Stroke Rehabilitation Website: Web-Based Survey JO - JMIR Rehabil Assist Technol SP - e44715 VL - 10 KW - crowdsourcing KW - health-related information KW - internet KW - knowledge translation KW - rehabilitation KW - stroke N2 - Background: Electronic knowledge resources are readily available and typically target different audiences, including health professionals and the public, that is, those with lived experience and their relatives. The knowledge-to-action framework, in combination with the information assessment method (IAM), considering both the value-of-information construct and the conceptual model of acquisition-cognition-application, can be used to support the evaluation process of such resources. As an example, Stroke Engine is an evidence-based knowledge translation resource in stroke rehabilitation (assessments and interventions) for health professionals and students as well as individuals who have sustained a stroke and their relatives. According to Google Analytics, the website is perused >10,000 times per week. Objective: With the overall aim to improve the content available on Stroke Engine, we documented Stroke Engine users? perceptions of situational relevance, cognitive impact, intention to use, and expected patient and health benefits regarding the information consulted. Methods: A web-based survey anchored in the IAM was made available via an invitation tab. The IAM is a validated questionnaire that is designed to assess the value of information. Sociodemographic characteristics were also collected, and a space for free-text comments was provided. Descriptive statistics were used, and thematic analysis was used for the free-text comments. Results: The sample consisted of 6634 respondents. Health professionals (3663/6634, 55.22%) and students (2784/6634, 41.97%) represented 97.18% (6447/6634) of the total responses. The remaining 2.82% (187/6634) of the responses were from individuals who had sustained a stroke (87/6634, 1.31%) and their relatives (100/6634, 1.51%). Regarding situational relevance, assessments (including selecting, obtaining, and interpreting results from a test) was the main topic searched by health professionals (1838/3364, 54.64%) and students (1228/2437, 50.39%), whereas general information on stroke rehabilitation was the top-ranked topic for nearly two-thirds of the individuals with stroke (45/76, 59%) and their relatives (57/91, 63%). Cognitive impact was characterized by learning something new. Intention to use was high (4572/6379, 71.67%) among the respondents and varied in context (eg, refine a topic, research, class assignments, teaching, and education). Respondents commented on ways to improve content. Expected patient and health benefits such as improvement in health and well-being was the top-ranked category for all 4 subgroups, followed by the avoidance of unnecessary or inappropriate treatment for health professionals (183/623, 29.4%) and a feeling of being reassured for individuals with stroke (26/75, 35%) and their relatives (28/97, 29%). Conclusions: Valuable feedback on Stroke Engine was obtained in terms of its accessibility, relevance for informational needs and retrieval, accuracy, and applicability; however, of utmost importance is the potential implementation of its evidence-based content in clinical practice and the perceived expected impact on patients, their relatives, and their health professionals. The feedback received allowed for corrections and the identification of key topics for further development. UR - https://rehab.jmir.org/2023/1/e44715 UR - http://dx.doi.org/10.2196/44715 UR - http://www.ncbi.nlm.nih.gov/pubmed/37155228 ID - info:doi/10.2196/44715 ER - TY - JOUR AU - Olaye, M. Iredia AU - Seixas, A. Azizi PY - 2023/5/2 TI - The Gap Between AI and Bedside: Participatory Workshop on the Barriers to the Integration, Translation, and Adoption of Digital Health Care and AI Startup Technology Into Clinical Practice JO - J Med Internet Res SP - e32962 VL - 25 KW - digital health KW - startups KW - venture capital KW - artificial intelligence KW - AI translation KW - clinical practice KW - early-stage KW - funding KW - bedside KW - machine learning KW - technology KW - tech KW - qualitative KW - workshop KW - entrepreneurs N2 - Background: Artificial intelligence (AI) and digital health technological innovations from startup companies used in clinical practice can yield better health outcomes, reduce health care costs, and improve patients' experience. However, the integration, translation, and adoption of these technologies into clinical practice are plagued with many challenges and are lagging. Furthermore, explanations of the impediments to clinical translation are largely unknown and have not been systematically studied from the perspective of AI and digital health care startup founders and executives. Objective: The aim of this paper is to describe the barriers to integrating early-stage technologies in clinical practice and health care systems from the perspectives of digital health and health care AI founders and executives. Methods: A stakeholder focus group workshop was conducted with a sample of 10 early-stage digital health and health care AI founders and executives. Digital health, health care AI, digital health?focused venture capitalists, and physician executives were represented. Using an inductive thematic analysis approach, transcripts were organized, queried, and analyzed for thematic convergence. Results: We identified the following four categories of barriers in the integration of early-stage digital health innovations into clinical practice and health care systems: (1) lack of knowledge of health system technology procurement protocols and best practices, (2) demanding regulatory and validation requirements, (3) challenges within the health system technology procurement process, and (4) disadvantages of early-stage digital health companies compared to large technology conglomerates. Recommendations from the study participants were also synthesized to create a road map to mitigate the barriers to integrating early-stage or novel digital health technologies in clinical practice. Conclusions: Early-stage digital health and health care AI entrepreneurs identified numerous barriers to integrating digital health solutions into clinical practice. Mitigation initiatives should create opportunities for early-stage digital health technology companies and health care providers to interact, develop relationships, and use evidence-based research and best practices during health care technology procurement and evaluation processes. UR - https://www.jmir.org/2023/1/e32962 UR - http://dx.doi.org/10.2196/32962 UR - http://www.ncbi.nlm.nih.gov/pubmed/37129947 ID - info:doi/10.2196/32962 ER - TY - JOUR AU - Perrin Franck, Caroline AU - Geissbuhler, Antoine AU - Lovis, Christian PY - 2023/4/4 TI - ?To Err Is Evolution?: We Need the Implementation Report to Learn JO - JMIR Med Inform SP - e47695 VL - 11 KW - implementation science KW - knowledge management KW - knowledge sharing KW - digital health KW - implementation report UR - https://medinform.jmir.org/2023/1/e47695 UR - http://dx.doi.org/10.2196/47695 UR - http://www.ncbi.nlm.nih.gov/pubmed/37014675 ID - info:doi/10.2196/47695 ER - TY - JOUR AU - Dadich, Ann AU - Wells, Rebecca AU - Williams, J. Sharon AU - Taskin, Nazim AU - Coskun, Mustafa AU - Grenier, Corinne AU - Ponsignon, Frederic AU - Scahill, Shane AU - Best, Stephanie PY - 2023/3/15 TI - Cues Disseminated by Professional Associations That Represent 5 Health Care Professions Across 5 Nations: Lexical Analysis of Tweets JO - J Med Internet Res SP - e42927 VL - 25 KW - professional associations KW - social media KW - professional identity KW - collaboration KW - knowledge translation N2 - Background: Collaboration across health care professions is critical in efficiently and effectively managing complex and chronic health conditions, yet interprofessional care does not happen automatically. Professional associations have a key role in setting a profession?s agenda, maintaining professional identity, and establishing priorities. The associations? external communication is commonly undertaken through social media platforms, such as Twitter. Despite the valuable insights potentially available into professional associations through such communication, to date, their messaging has not been examined. Objective: This study aimed to identify the cues disseminated by professional associations that represent 5 health care professions spanning 5 nations. Methods: Using a back-iterative application programming interface methodology, public tweets were sourced from professional associations that represent 5 health care professions that have key roles in community-based health care: general practice, nursing, pharmacy, physiotherapy, and social work. Furthermore, the professional associations spanned Australia, Canada, New Zealand, the United Kingdom, and the United States. A lexical analysis was conducted of the tweets using Leximancer (Leximancer Pty Ltd) to clarify relationships within the discourse. Results: After completing a lexical analysis of 50,638 tweets, 7 key findings were identified. First, the discourse was largely devoid of references to interprofessional care. Second, there was no explicit discourse pertaining to physiotherapists. Third, although all the professions represented in this study support patients, discourse pertaining to general practitioners was most likely to be connected with that pertaining to patients. Fourth, tweets pertaining to pharmacists were most likely to be connected with discourse pertaining to latest and research. Fifth, tweets about social workers were unlikely to be connected with discourse pertaining to health or care. Sixth, notwithstanding a few exceptions, the findings across the different nations were generally similar, suggesting their generality. Seventh and last, tweets pertaining to physiotherapists were most likely to refer to discourse pertaining to profession. Conclusions: The findings indicate that health care professional associations do not use Twitter to disseminate cues that reinforce the importance of interprofessional care. Instead, they largely use this platform to emphasize what they individually deem to be important and advance the interests of their respective professions. Therefore, there is considerable opportunity for professional associations to assert how the profession they represent complements other health care professions and how the professionals they represent can enact interprofessional care for the benefit of patients and carers. UR - https://www.jmir.org/2023/1/e42927 UR - http://dx.doi.org/10.2196/42927 UR - http://www.ncbi.nlm.nih.gov/pubmed/36920443 ID - info:doi/10.2196/42927 ER - TY - JOUR AU - Howard, Fuchsia A. AU - Noga, Heather AU - Parmar, Gurkiran AU - Kennedy, Lan AU - Aragones, Sarah AU - Bassra, Roop AU - Gelfer, Lauren AU - Lopez de Arbina, Edurne AU - Sutherland, Jessica AU - Allaire, Catherine AU - Oliffe, L. John AU - Currie, M. Leanne AU - Yager, Holly AU - Yong, J. Paul PY - 2023/3/14 TI - Web-Based Digital Storytelling for Endometriosis and Pain: Qualitative Pilot Study JO - JMIR Form Res SP - e37549 VL - 7 KW - digital storytelling KW - endometriosis KW - pain KW - chronic pain KW - painful sex KW - dyspareunia KW - integrated knowledge translation KW - patient-oriented research KW - community-based participatory research KW - qualitative research KW - arts-based research KW - group therapy KW - sex therapy N2 - Background: Endometriosis is a complex chronic disease characterized by pain, including painful sex, that can contribute to considerable sexual function, self-esteem, and relationship challenges. Digital storytelling is an arts-based, participatory methodology wherein individuals create and share their illness experiences in detailing their lived experiences. Objective: The study objective was to pilot-test a web-based digital storytelling workshop focused on endometriosis to understand storytellers? experiences of workshop participation. We assessed the feasibility of story cocreation and sharing, including the emotional impact of workshop participation, the acceptability of the workshop for the subject matter, and the storytellers? willingness to share their stories with broader audiences as a method for knowledge translation. Methods: This study used a community-based participatory methodology supplemented with patient-oriented research and integrated knowledge translation. Study participants, referred to as storytellers, cocreated 3- to 5-minute individual digital stories about their lived experiences of endometriosis during a web-based workshop (comprising five 2-hour sessions over 6 weeks) facilitated by The Center for Digital Storytelling. Data were collected through participant observations at the workshop, storyteller weekly reflective journals, and an end-of-workshop focus group interview with storytellers. These data were analyzed using a qualitative interpretive description approach. Results: A total of 5 women and 1 nonbinary storyteller aged 19 to 39 years who had experienced endometriosis for 4 to 22 years participated in the study. We characterized storytelling workshop participation and the acceptability of story cocreation by describing participants? experiences of opportunity, commitment, and connection; complex emotions that were healing; and a desire to share. Feasibility was demonstrated through 100% engagement in the workshops. All 6 storytellers reported feeling empowered by publicly sharing their cocreated digital stories through social media and the Sex, Pain & Endometriosis website. Conclusions: Despite the complexities of the story-building process, the workshop and the cocreation and sharing of digital stories were feasible. The storytellers found that this process allowed for emotional healing and personal empowerment by offering a unique way to talk about painful sex, which also facilitated a connection among those in the workshop. The use of digital storytelling as a knowledge translation tool shows promise, and this approach also has potential as a therapeutic intervention. UR - https://formative.jmir.org/2023/1/e37549 UR - http://dx.doi.org/10.2196/37549 UR - http://www.ncbi.nlm.nih.gov/pubmed/36917164 ID - info:doi/10.2196/37549 ER - TY - JOUR AU - Besterman-Dahan, Karen AU - Hahm, Bridget AU - Chavez, Margeaux AU - Heuer, Jacquelyn AU - Melillo, Christine AU - Lind, Jason AU - Dillahunt-Aspillaga, Christina AU - Ottomanelli, Lisa PY - 2023/3/14 TI - Enhancing Veteran Community Reintegration Research (ENCORE): Protocol for a Mixed Methods and Stakeholder Engagement Project JO - JMIR Res Protoc SP - e42029 VL - 12 KW - veteran KW - community KW - community reintegration KW - stakeholder engagement KW - veterans community integration KW - veteran health administration KW - knowledge translation KW - research promotion KW - veterans association policy KW - policy N2 - Background: Veteran community reintegration (CR) has been defined as participation in community life, including employment or other productive activities, independent living, and social relationships. Veteran CR is a Veterans Health Administration priority, as a substantial proportion of veterans report difficulties with veteran CR following discharge from military service. Objective: Enhancing Veteran Community Reintegration Research (ENCORE) is a project funded by Veterans Health Administration?s Health Service Research and Development Service. The goal of ENCORE is to maximize veteran and family reintegration by promoting innovative research and knowledge translation (KT) that informs and improves equitable Department of Veterans Affairs (VA) policies, programs, and services. Overall, 2 strategic objectives guide ENCORE activities: mobilize veteran CR research and promote innovation, relevance, and acceleration of veteran CR research and KT. Methods: ENCORE uses a mixed methods and stakeholder-engaged approach to achieve objectives and to ensure that the KT products generated are inclusive, innovative, and meaningful to stakeholders. Project activities will occur over 5 years (2019-2024) in 5 phases: plan, engage, mobilize, promote, and evaluate. All activities will be conducted remotely owing to the ongoing COVID-19 pandemic. Methods used will include reviewing research funding and literature examining the gaps in veteran CR research, conducting expert informant interviews with VA program office representatives, and assembling and working with a Multistakeholder Partnership (MSP). MSP meetings will use external facilitation services, group facilitation techniques adapted for virtual settings, and a 6-step group facilitation process to ensure successful execution of meetings and accomplishment of goals. Results: As of December 2022, data collection for ENCORE is ongoing, with the team completing interviews with 20 stakeholders from 16 VA program offices providing veteran CR?related services. ENCORE developed and assembled the MSP, reviewed the VA funding portfolio and veteran CR research literature, and conducted a scientific gap analysis. The MSP developed a veteran CR research agenda in 2021 and continues to work with the ENCORE team to prepare materials for dissemination. Conclusions: The goal of this program is to improve the impact of veteran CR research on policies and programs. Using a stakeholder-engaged process, insights from key stakeholder groups are being incorporated to set a research agenda that is more likely to result in a relevant and responsive veteran CR research program. Future products will include the development of an effective and relevant dissemination plan and the generation of innovative and relevant dissemination products designed for rapid KT. International Registered Report Identifier (IRRID): DERR1-10.2196/42029 UR - https://www.researchprotocols.org/2023/1/e42029 UR - http://dx.doi.org/10.2196/42029 UR - http://www.ncbi.nlm.nih.gov/pubmed/36917162 ID - info:doi/10.2196/42029 ER - TY - JOUR AU - Tolppa, Timo AU - Pari, Vrindha AU - Pell, Christopher AU - Aryal, Diptesh AU - Hashmi, Madiha AU - Shamal Ghalib, Maryam AU - Jawad, Issrah AU - Tripathy, Swagata AU - Tirupakuzhi Vijayaraghavan, Kumar Bharath AU - Beane, Abi AU - Dondorp, M. Arjen AU - Haniffa, Rashan AU - PY - 2023/3/6 TI - Determinants of Implementation of a Critical Care Registry in Asia: Lessons From a Qualitative Study JO - J Med Internet Res SP - e41028 VL - 25 KW - CCU KW - critical care KW - registry KW - implementation KW - qualitative research KW - stakeholders KW - South Asia KW - health care N2 - Background: The Collaboration for Research, Implementation, and Training in Critical Care in Asia (CCA) is implementing a critical care registry to capture real-time data to facilitate service evaluation, quality improvement, and clinical studies. Objective: The purpose of this study is to examine stakeholder perspectives on the determinants of implementation of the registry by examining the processes of diffusion, dissemination, and sustainability. Methods: This study is a qualitative phenomenological inquiry using semistructured interviews with stakeholders involved in registry design, implementation, and use in 4 South Asian countries. The conceptual model of diffusion, dissemination, and sustainability of innovations in health service delivery guided interviews and analysis. Interviews were coded using the Rapid Identification of Themes from Audio recordings procedure and were analyzed based on the constant comparison approach. Results: A total of 32 stakeholders were interviewed. Analysis of stakeholder accounts identified 3 key themes: innovation-system fit; influence of champions; and access to resources and expertise. Determinants of implementation included data sharing, research experience, system resilience, communication and networks, and relative advantage and adaptability. Conclusions: The implementation of the registry has been possible due to efforts to increase the innovation-system fit, influence of motivated champions, and the support offered by access to resources and expertise. The reliance on individuals and the priorities of other health care actors pose a risk to sustainability. UR - https://www.jmir.org/2023/1/e41028 UR - http://dx.doi.org/10.2196/41028 UR - http://www.ncbi.nlm.nih.gov/pubmed/36877557 ID - info:doi/10.2196/41028 ER - TY - JOUR AU - Bucalon, Bernard AU - Whitelock-Wainwright, Emma AU - Williams, Chris AU - Conley, Jeanette AU - Veysey, Martin AU - Kay, Judy AU - Shaw, Tim PY - 2023/2/16 TI - Thought Leader Perspectives on the Benefits, Barriers, and Enablers for Routinely Collected Electronic Health Data to Support Professional Development: Qualitative Study JO - J Med Internet Res SP - e40685 VL - 25 KW - practice analytics KW - data visualization KW - continuing professional development KW - professional practice KW - reflective practice KW - lifelong learning KW - electronic health records KW - EHR N2 - Background: Hospitals routinely collect large amounts of administrative data such as length of stay, 28-day readmissions, and hospital-acquired complications; yet, these data are underused for continuing professional development (CPD). First, these clinical indicators are rarely reviewed outside of existing quality and safety reporting. Second, many medical specialists view their CPD requirements as time-consuming, having minimal impact on practice change and improving patient outcomes. There is an opportunity to build new user interfaces based on these data, designed to support individual and group reflection. Data-informed reflective practice has the potential to generate new insights about performance, bridging the gap between CPD and clinical practice. Objective: This study aims to understand why routinely collected administrative data have not yet become widely used to support reflective practice and lifelong learning. Methods: We conducted semistructured interviews (N=19) with thought leaders from a range of backgrounds, including clinicians, surgeons, chief medical officers, information and communications technology professionals, informaticians, researchers, and leaders from related industries. Interviews were thematically analyzed by 2 independent coders. Results: Respondents identified visibility of outcomes, peer comparison, group reflective discussions, and practice change as potential benefits. The key barriers included legacy technology, distrust with data quality, privacy, data misinterpretation, and team culture. Respondents suggested recruiting local champions for co-design, presenting data for understanding rather than information, coaching by specialty group leaders, and timely reflection linked to CPD as enablers to successful implementation. Conclusions: Overall, there was consensus among thought leaders, bringing together insights from diverse backgrounds and medical jurisdictions. We found that clinicians are interested in repurposing administrative data for professional development despite concerns with underlying data quality, privacy, legacy technology, and visual presentation. They prefer group reflection led by supportive specialty group leaders, rather than individual reflection. Our findings provide novel insights into the specific benefits, barriers, and benefits of potential reflective practice interfaces based on these data sets. They can inform the design of new models of in-hospital reflection linked to the annual CPD planning-recording-reflection cycle. UR - https://www.jmir.org/2023/1/e40685 UR - http://dx.doi.org/10.2196/40685 UR - http://www.ncbi.nlm.nih.gov/pubmed/36795463 ID - info:doi/10.2196/40685 ER - TY - JOUR AU - Kinast, Benjamin AU - Ulrich, Hannes AU - Bergh, Björn AU - Schreiweis, Björn PY - 2023/2/9 TI - Functional Requirements for Medical Data Integration into Knowledge Management Environments: Requirements Elicitation Approach Based on Systematic Literature Analysis JO - J Med Internet Res SP - e41344 VL - 25 KW - data integration KW - requirements engineering KW - requirements KW - knowledge management KW - software engineering N2 - Background: In patient care, data are historically generated and stored in heterogeneous databases that are domain specific and often noninteroperable or isolated. As the amount of health data increases, the number of isolated data silos is also expected to grow, limiting the accessibility of the collected data. Medical informatics is developing ways to move from siloed data to a more harmonized arrangement in information architectures. This paradigm shift will allow future research to integrate medical data at various levels and from various sources. Currently, comprehensive requirements engineering is working on data integration projects in both patient care? and research-oriented contexts, and it is significantly contributing to the success of such projects. In addition to various stakeholder-based methods, document-based requirement elicitation is a valid method for improving the scope and quality of requirements. Objective: Our main objective was to provide a general catalog of functional requirements for integrating medical data into knowledge management environments. We aimed to identify where integration projects intersect to derive consistent and representative functional requirements from the literature. On the basis of these findings, we identified which functional requirements for data integration exist in the literature and thus provide a general catalog of requirements. Methods: This work began by conducting a literature-based requirement elicitation based on a broad requirement engineering approach. Thus, in the first step, we performed a web-based systematic literature review to identify published articles that dealt with the requirements for medical data integration. We identified and analyzed the available literature by applying the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In the second step, we screened the results for functional requirements using the requirements engineering method of document analysis and derived the requirements into a uniform requirement syntax. Finally, we classified the elicited requirements into a category scheme that represents the data life cycle. Results: Our 2-step requirements elicitation approach yielded 821 articles, of which 61 (7.4%) were included in the requirement elicitation process. There, we identified 220 requirements, which were covered by 314 references. We assigned the requirements to different data life cycle categories as follows: 25% (55/220) to data acquisition, 35.9% (79/220) to data processing, 12.7% (28/220) to data storage, 9.1% (20/220) to data analysis, 6.4% (14/220) to metadata management, 2.3% (5/220) to data lineage, 3.2% (7/220) to data traceability, and 5.5% (12/220) to data security. Conclusions: The aim of this study was to present a cross-section of functional data integration?related requirements defined in the literature by other researchers. The aim was achieved with 220 distinct requirements from 61 publications. We concluded that scientific publications are, in principle, a reliable source of information for functional requirements with respect to medical data integration. Finally, we provide a broad catalog to support other scientists in the requirement elicitation phase. UR - https://www.jmir.org/2023/1/e41344 UR - http://dx.doi.org/10.2196/41344 UR - http://www.ncbi.nlm.nih.gov/pubmed/36757764 ID - info:doi/10.2196/41344 ER - TY - JOUR AU - Vis, Christiaan AU - Schuurmans, Josien AU - Aouizerate, Bruno AU - Atipei Craggs, Mette AU - Batterham, Philip AU - Bührmann, Leah AU - Calear, Alison AU - Cerga Pashoja, Arlinda AU - Christensen, Helen AU - Dozeman, Els AU - Duedal Pedersen, Claus AU - Ebert, Daniel David AU - Etzelmueller, Anne AU - Fanaj, Naim AU - Finch, L. Tracy AU - Hanssen, Denise AU - Hegerl, Ulrich AU - Hoogendoorn, Adriaan AU - Mathiasen, Kim AU - May, Carl AU - Meksi, Andia AU - Mustafa, Sevim AU - O'Dea, Bridianne AU - Oehler, Caroline AU - Piera-Jiménez, Jordi AU - Potthoff, Sebastian AU - Qirjako, Gentiana AU - Rapley, Tim AU - Rosmalen, Judith AU - Sacco, Ylenia AU - Samalin, Ludovic AU - Skjoth, Maria Mette AU - Tarp, Kristine AU - Titzler, Ingrid AU - Van der Eycken, Erik AU - van Genugten, Rosalie Claire AU - Whitton, Alexis AU - Zanalda, Enrico AU - Smit, H. Jan AU - Riper, Heleen PY - 2023/2/3 TI - Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial JO - J Med Internet Res SP - e41532 VL - 25 KW - common mental health disorders KW - internet-based cognitive behavioral therapy KW - iCBT KW - implementation strategies KW - tailored implementation KW - mobile phone N2 - Background: Internet-based cognitive behavioral therapy (iCBT) services for common mental health disorders have been found to be effective. There is a need for strategies that improve implementation in routine practice. One-size-fits-all strategies are likely to be ineffective. Tailored implementation is considered as a promising approach. The self-guided integrated theory-based Framework for intervention tailoring strategies toolkit (ItFits-toolkit) supports local implementers in developing tailored implementation strategies. Tailoring involves identifying local barriers; matching selected barriers to implementation strategies; developing an actionable work plan; and applying, monitoring, and adapting where necessary. Objective: This study aimed to compare the effectiveness of the ItFits-toolkit with implementation-as-usual (IAU) in implementing iCBT services in 12 routine mental health care organizations in 9 countries in Europe and Australia. Methods: A stepped-wedge cluster randomized trial design with repeated measures was applied. The trial period lasted 30 months. The primary outcome was the normalization of iCBT delivery by service providers (therapists, referrers, IT developers, and administrators), which was measured with the Normalization Measure Development as a proxy for implementation success. A 3-level linear mixed-effects modeling was applied to estimate the effects. iCBT service uptake (referral and treatment completion rates) and implementation effort (hours) were used as secondary outcomes. The perceived satisfaction (Client Satisfaction Questionnaire), usability (System Usability Scale), and impact of the ItFits-toolkit by implementers were used to assess the acceptability of the ItFits-toolkit. Results: In total, 456 mental health service providers were included in this study. Compared with IAU, the ItFits-toolkit had a small positive statistically significant effect on normalization levels in service providers (mean 0.09, SD 0.04; P=.02; Cohen d=0.12). The uptake of iCBT by patients was similar to that of IAU. Implementers did not spend more time on implementation work when using the ItFits-toolkit and generally regarded the ItFits-toolkit as usable and were satisfied with it. Conclusions: The ItFits-toolkit performed better than the usual implementation activities in implementing iCBT services in routine practice. There is practical utility in the ItFits-toolkit for supporting implementers in developing and applying effective tailored implementation strategies. However, the effect on normalization levels among mental health service providers was small. These findings warrant modesty regarding the effectiveness of self-guided tailored implementation of iCBT services in routine practice. Trial Registration: ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04686-4 UR - https://www.jmir.org/2023/1/e41532 UR - http://dx.doi.org/10.2196/41532 UR - http://www.ncbi.nlm.nih.gov/pubmed/36735287 ID - info:doi/10.2196/41532 ER - TY - JOUR AU - Batterham, Philip AU - Gulliver, Amelia AU - Sunderland, Matthew AU - Farrer, Louise AU - Kay-Lambkin, Frances AU - Trias, Angelica AU - Calear, Alison PY - 2023/2/2 TI - Factors Influencing Community Participation in Internet Interventions Compared With Research Trials: Observational Study in a Nationally Representative Adult Cohort JO - J Med Internet Res SP - e41663 VL - 25 KW - mental health KW - uptake KW - engagement KW - internet KW - research participation KW - implementation N2 - Background: Digital mental health (DMH) programs can be effective in treating and preventing mental health problems. However, community engagement with these programs can be poor. Understanding the barriers and enablers of DMH program use may assist in identifying ways to increase the uptake of these programs, which have the potential to provide broad-scale prevention and treatment in the community. Objective: In this study, we aimed to identify and compare factors that may influence participation in DMH programs in practice and research trials, identify any respondent characteristics that are associated with these factors, and assess the relationship between intentions to use DMH programs and actual uptake. Methods: Australian adults aged ?18 years were recruited from market research panels to participate in the study. The sample was representative of the Australian adult population based on age, gender, and location. Participants completed a cross-sectional web-based survey assessing demographic characteristics, mental health symptom measures, attitudes and use of DMH programs in practice and in research studies, and the factors influencing their use in both settings. Results: Across both research and practice, trust in the organization delivering the service or trial was the top-ranked factor influencing participation, followed by anonymity or privacy and adequate information. There was little variation in rankings across demographic groups, including intentions to use DMH programs or mental health status. Intentions to use DMH programs were a strong predictor of both current (odds ratio 2.50, 99% CI 1.41-4.43; P<.001) and past (odds ratio 2.98, 99% CI 1.71-5.19; P<.001) use behaviors. Conclusions: Efforts to increase the uptake of DMH programs or participation in research trials should focus on clearly communicating the following to users: the legitimacy of the organization delivering the program, security and use of participant data, and effectiveness of DMH programs. UR - https://www.jmir.org/2023/1/e41663 UR - http://dx.doi.org/10.2196/41663 UR - http://www.ncbi.nlm.nih.gov/pubmed/36729613 ID - info:doi/10.2196/41663 ER - TY - JOUR AU - Scott, F. Andrew AU - Ayers, Stephanie AU - Pluye, Pierre AU - Grad, Roland AU - Sztramko, Richard AU - Marr, Sharon AU - Papaioannou, Alexandra AU - Clark, Sandra AU - Gerantonis, Patricia AU - Levinson, J. Anthony PY - 2022/12/22 TI - Impact and Perceived Value of iGeriCare e-Learning Among Dementia Care Partners and Others: Pilot Evaluation Using the IAM4all Questionnaire JO - JMIR Aging SP - e40357 VL - 5 IS - 4 KW - dementia KW - caregiver KW - web-based education KW - internet KW - consumer health information KW - feedback KW - perception KW - survey KW - questionnaire KW - patient education KW - health education KW - care partner KW - caregiving KW - spousal care KW - informal care KW - Alzheimer KW - cognitive impairment KW - cognitively impaired KW - Lewy body KW - gerontology KW - geriatric N2 - Background: Care partners of people living with dementia may benefit from web-based education. We developed iGeriCare, an award-winning internet-based platform with 12 multimedia e-learning lessons about dementia. Objective: Our objective was to evaluate users? perceptions of impact. Methods: From March 17, 2021 to May 16, 2022, data were collected upon lesson completion. We used the content-validated Information Assessment Method for all (IAM4all) for patients and the public adapted for dementia care partners. The IAM4all questionnaire assesses outcomes of web-based consumer health information. Responses were collected using SurveyMonkey, and data were analyzed using IBM SPSS Statistics (version 28). Results: A total of 409 responses were collected, with 389 (95.1%) survey respondents completing the survey. Of 409 respondents, 179 (43.8%) identified as a family or friend care partner, 84 (20.5%) identified as an individual concerned they may have mild cognitive impairment or dementia, 380 (92.9%) identified the lesson as relevant or very relevant, and 403 (98.5%) understood the lesson well or very well. Over half of respondents felt they were motivated to learn more, they were taught something new, or they felt validated in what they do, while some felt reassured or felt that the lesson refreshed their memory. Of 409 respondents, 401 (98%) said they would use the information, in particular, to better understand something, discuss the information with someone else, do things differently, or do something. Conclusions: Users identified iGeriCare as relevant and beneficial and said that they would use the information. To our knowledge, this is the first time the IAM4all questionnaire has been used to assess patient and caregiver feedback on internet-based dementia education resources. A randomized controlled trial to study feasibility and impact on caregiver knowledge, self-efficacy, and burden is in progress. UR - https://aging.jmir.org/2022/4/e40357 UR - http://dx.doi.org/10.2196/40357 UR - http://www.ncbi.nlm.nih.gov/pubmed/36150051 ID - info:doi/10.2196/40357 ER - TY - JOUR AU - Hagg, J. Lauryn AU - Merkouris, S. Stephanie AU - O?Dea, A. Gypsy AU - Francis, M. Lauren AU - Greenwood, J. Christopher AU - Fuller-Tyszkiewicz, Matthew AU - Westrupp, M. Elizabeth AU - Macdonald, A. Jacqui AU - Youssef, J. George PY - 2022/11/8 TI - Examining Analytic Practices in Latent Dirichlet Allocation Within Psychological Science: Scoping Review JO - J Med Internet Res SP - e33166 VL - 24 IS - 11 KW - latent Dirichlet allocation KW - LDA KW - review KW - analysis KW - methodology N2 - Background: Topic modeling approaches allow researchers to analyze and represent written texts. One of the commonly used approaches in psychology is latent Dirichlet allocation (LDA), which is used for rapidly synthesizing patterns of text within ?big data,? but outputs can be sensitive to decisions made during the analytic pipeline and may not be suitable for certain scenarios such as short texts, and we highlight resources for alternative approaches. This review focuses on the complex analytical practices specific to LDA, which existing practical guides for training LDA models have not addressed. Objective: This scoping review used key analytical steps (data selection, data preprocessing, and data analysis) as a framework to understand the methodological approaches being used in psychology research using LDA. Methods: A total of 4 psychology and health databases were searched. Studies were included if they used LDA to analyze written words and focused on a psychological construct or issue. The data charting processes were constructed and employed based on common data selection, preprocessing, and data analysis steps. Results: A total of 68 studies were included. These studies explored a range of research areas and mostly sourced their data from social media platforms. Although some studies reported on preprocessing and data analysis steps taken, most studies did not provide sufficient detail for reproducibility. Furthermore, the debate surrounding the necessity of certain preprocessing and data analysis steps is revealed. Conclusions: Our findings highlight the growing use of LDA in psychological science. However, there is a need to improve analytical reporting standards and identify comprehensive and evidence-based best practice recommendations. To work toward this, we developed an LDA Preferred Reporting Checklist that will allow for consistent documentation of LDA analytic decisions and reproducible research outcomes. UR - https://www.jmir.org/2022/11/e33166 UR - http://dx.doi.org/10.2196/33166 UR - http://www.ncbi.nlm.nih.gov/pubmed/36346659 ID - info:doi/10.2196/33166 ER - TY - JOUR AU - Shibasaki, Sanchia AU - Watkin Lui, Felecia AU - Ah Mat, Lynda PY - 2022/11/1 TI - Knowledge Translation and Implementation Planning to Promote Research Governance in Nongovernment Organizations in the Torres Strait: Descriptive Study JO - Interact J Med Res SP - e39213 VL - 11 IS - 2 KW - knowledge translation KW - implementation planning KW - research governance KW - nongovernment organizations KW - nongovernment organisations KW - Aboriginal and Torres Strait Islander N2 - Background: Aboriginal and Torres Strait Islander people in Australia have participated in Western research for decades. When done well, research has resulted in significant benefits and positive impacts on society. However, the primary benefactor of this research has and continues to be researchers, with limited or no research knowledge mobilized for uptake and beneficial use by end users, such as individuals and communities. In 2021, the Torres Strait Islanders Research to Policy and Practice Hub (the Hub) at James Cook University designed and implemented several strategies, including a games-based interactive workshop with representatives from nongovernment organizations (NGOs). Feedback suggests the workshop and associated activities were a success. Objective: We describe knowledge translation (KT) and implementation planning to design and implement strategies to increase awareness and understanding of NGOs in research governance. Methods: This descriptive study involved representatives from NGOs on Thursday Island in the Torres Strait. We collected data from a literature review and informal discussions. We used several models and frameworks to guide our approach and underpin data collection and analysis. Results: Designing and implementing strategies to increase awareness and understanding of NGOs in the Torres Strait to govern research involved several key steps: (1) identifying and defining what needed to change and who needed to change, (2) identifying and mapping barriers and facilitators, (3) selecting the most appropriate strategies to support change, (4) implementing activities, and (5) monitoring and evaluating our approach. We developed a program logic to understand and communicate to others how we would implement activities and what resources would be required to support this process. We drew on several evidence-based KT and implementation models and frameworks to do this. First, a KT planning template was used to inform what evidence we wanted to mobilize, to whom, and for what purpose. Based on this step, we recognized we wanted to bring about change with the target audience, and as such, we drew on the previously mentioned implementation planning models and frameworks. We collated the outcomes from these initial steps. Conclusions: Our KT and implementation practice experience were successful. Encouraging researchers and end users to adopt similar practices requires investment in training and development of KT and implementation practice. This also entails modifying research standards and guidelines to include KT and implementation practice when working with Aboriginal and Torres Strait Islander people and other vulnerable groups, creating incentives for researchers and end users to embed KT and implementation practice in research, and recognizing and rewarding the benefits and impact beyond publication and presentation. UR - https://www.i-jmr.org/2022/2/e39213 UR - http://dx.doi.org/10.2196/39213 UR - http://www.ncbi.nlm.nih.gov/pubmed/36318255 ID - info:doi/10.2196/39213 ER - TY - JOUR AU - Painter, Annabelle AU - Hayhoe, Benedict AU - Riboli-Sasco, Eva AU - El-Osta, Austen PY - 2022/10/26 TI - Online Symptom Checkers: Recommendations for a Vignette-Based Clinical Evaluation Standard JO - J Med Internet Res SP - e37408 VL - 24 IS - 10 KW - online symptom checkers KW - clinical evaluation KW - validation KW - assessment KW - standards KW - third-party assessment KW - quality assurance UR - https://www.jmir.org/2022/10/e37408 UR - http://dx.doi.org/10.2196/37408 UR - http://www.ncbi.nlm.nih.gov/pubmed/36287594 ID - info:doi/10.2196/37408 ER - TY - JOUR AU - Kenjrawi, Yazan AU - Dashash, Mayssoon PY - 2022/10/25 TI - The First Asynchronous Online Evidence-Based Medicine Course for Syrian Health Workforce: Effectiveness and Feasibility Pilot Study JO - JMIR Form Res SP - e36782 VL - 6 IS - 10 KW - evidence-based medicine KW - continuous medical education KW - web-based learning KW - Syria KW - medical graduates KW - medical education KW - web-based course N2 - Background: Evidence-based medicine (EBM) is critical for providing the best scientifically proven patient health care, and it is implemented worldwide in order to improve the quality of the delivered health care. However, not all Syrian health professionals are knowledgeable about the importance, methodology, and implementation of EBM. Providing web-based learning courses on EBM might be effective in improving the EBM knowledge of health care professionals. Objective: This study was performed to test the effectiveness and the feasibility of an asynchronous web-based course on EBM in improving the competencies of Syrian health care professionals in terms of EBM. Methods: A web-based course on EBM was developed in Arabic and uploaded onto the Syrian Virtual University platform. An electronic registration form was designed and distributed to medical groups on social media for registration to this web-based course. Both the pretest and posttest had the same 3 sections to measure the impact of this web-based EBM program on the knowledge, skills, and attitudes of the Syrian health care professionals. The posttest had an additional section for measuring the efficacy and ease of use of this program. Student paired 1-tailed t test was used to analyze the differences in the different assessment sections among the participants. Results: Nineteen participants filled the electronic registration form, but 8 participants did not meet the inclusion criteria. Therefore, the pretest was sent to the remaining 11 participants (7 men and 4 women) who graduated from Syrian universities. Ten of them completed the pretest, while 7 of them completed the posttest. The web-based course was found to be effective in improving the participants? EBM knowledge, skills, and attitudes at P>.05. Further, the web-based EBM course was feasible and easy-to-use. Conclusions: In order for EBM to be implemented in Syria, continuous medical education training programs should be designed for clinical practitioners. Our study shows that asynchronous web-based medical education is an effective and a feasible means for introducing the concept of EBM, improving practitioners? skills, and promoting the positive attitudes of Syrian clinical practitioners toward EBM. UR - https://formative.jmir.org/2022/10/e36782 UR - http://dx.doi.org/10.2196/36782 UR - http://www.ncbi.nlm.nih.gov/pubmed/36282556 ID - info:doi/10.2196/36782 ER - TY - JOUR AU - Elliott, A. Sarah AU - Kreutz, Jason AU - Wright, S. Kelsey AU - Di Lallo, Sherri AU - Scott, D. Shannon AU - Hartling, Lisa PY - 2022/10/5 TI - Adapting Child Health Knowledge Translation Tools for Use by Indigenous Communities: Qualitative Study Exploring Health Care Providers? Perspectives JO - JMIR Form Res SP - e36353 VL - 6 IS - 10 KW - knowledge translation KW - culture KW - Indigenous culture KW - child health KW - adaptation N2 - Background: Our research groups have developed a number of parental knowledge translation (KT) tools to help families understand common childhood illnesses and make informed decisions regarding when to seek urgent care. We have developed a series of videos to help parents understand how to manage common acute childhood illnesses at home and when to contact emergency health care services. It is unclear whether the videos in their current form and language are useful for a wider range of populations, including Indigenous groups. Objective: The purpose of this study was to explore whether and understand how our KT tools could be adapted for use with Indigenous communities. Methods: Health care providers (HCPs) serving Indigenous families in Alberta, Canada, were asked to review 2 of our KT tools (one on croup and one on acute otitis media), complete a demographic survey, and participate in a one-on-one semistructured interview. HCPs were asked to reflect on the usability of the KT tools within their practice and what cultural adaptation considerations they felt would be needed to develop KT tools that meet the needs of Indigenous clients. Audio recordings from the interviews were transcribed verbatim and analyzed for relevant themes using thematic analysis. Results: A total of 18 HCPs (n=15, 83% women and n=3, 17% men) from various health professions (eg, physician, registered nurse, and licensed practical nurse) were interviewed. Of these 18 HCPs, 7 (39%) self-identified as Indigenous. Four overarching themes were identified as important when considering how to adapt KT tools for use by Indigenous communities: accessibility, relatability, KT design, and relationship building. Access to tangible resources and personal and professional connections were considered important. Accessibility affects the types of KT tools that can be obtained or used by various individuals and communities and the extent to which they can implement recommendations given in those KT tools. In addition, the extent to which users relate to the depictions and content within KT tools must be considered. The environments, portrayals of characters, and cultural norms and values presented within KT tools should be relevant to users to increase the relatability and uptake of recommendations. Most importantly, fostering genuine and sustainable relationships with users and communities is a vital consideration for KT tool developers. Conclusions: These findings serve to cultivate a greater understanding of the various components that HCPs consider important when developing or culturally adapting KT tools for use by Indigenous families. This information will help support the effective adaptation and distribution of KT tools for use by a broad audience. Careful consideration of the themes identified in this study highlights the importance of working together with the knowledge users (health care consumers) when developing KT tools. UR - https://formative.jmir.org/2022/10/e36353 UR - http://dx.doi.org/10.2196/36353 UR - http://www.ncbi.nlm.nih.gov/pubmed/36197711 ID - info:doi/10.2196/36353 ER - TY - JOUR AU - Estabrooks, Carole AU - Song, Yuting AU - Anderson, Ruth AU - Beeber, Anna AU - Berta, Whitney AU - Chamberlain, Stephanie AU - Cummings, Greta AU - Duan, Yinfei AU - Hayduk, Leslie AU - Hoben, Matthias AU - Iaconi, Alba AU - Lanham, Holly AU - Perez, Janelle AU - Wang, Jing AU - Norton, Peter PY - 2022/9/15 TI - The Influence of Context on Implementation and Improvement: Protocol for a Mixed Methods, Secondary Analyses Study JO - JMIR Res Protoc SP - e40611 VL - 11 IS - 9 KW - organizational context KW - facilitation KW - PARIHS framework KW - Promoting Action on Research Implementation in Health Services KW - implementation science N2 - Background: Caring for the well-being of older adults is one of the greatest challenges in modern societies. Improving the quality of care and life for older adults and the work lives of their care providers calls for effective knowledge translation of evidence-based best practices. Objective: This study?s purpose is to contribute to knowledge translation by better understanding the roles of organizational context (workplace environment) and facilitation (process or role) in implementation and improvement success. Our study has 2 goals: (1) to advance knowledge translation science by further developing and testing the Promoting Action on Research Implementation in Health Services framework (which outlines how implementation relies on the interplay of context, facilitation, and evidence) and (2) to advance research by optimizing implementation success via tailoring of modifiable elements of organizational context and facilitation. Methods: This is secondary analyses of 15 years of longitudinal data from the Translating Research in Elder Care (TREC) program?s multiple data sources. This research is ongoing in long-term care (LTC) homes in western Canada. TREC data include the following: 5 waves of survey collection, 2 clinical trials, and regular ongoing outcome data for LTC residents. We will use a sequential exploratory and confirmatory mixed methods design. We will analyze qualitative and quantitative data holdings in an iterative process: (1) comprehensive reanalysis of qualitative data to derive hypotheses, (2) quantitative modeling to test hypotheses, and (3) action cycles to further refine and integrate qualitative and quantitative analyses. The research team includes 4 stakeholder panels: (1) system decision- and policy makers, (2) care home managers, (3) direct care staff, and (4) a citizen engagement group of people living with dementia and family members of LTC residents. A fifth group is our panel of external scientific advisors. Each panel will engage periodically, providing their perspectives on project direction and findings. Results: This study is funded by the Canadian Institutes of Health Research. Ethics approval was obtained from the University of Alberta (Pro00096541). The results of the secondary analyses are expected by the end of 2023. Conclusions: The project will advance knowledge translation science by deepening our understanding of the roles of context, the interactions between context and facilitation, and their influence on resident and staff quality outcomes. Importantly, findings will inform understanding of the mechanisms by which context and facilitation affect the success of implementation and offer insights into factors that influence the implementation success of interventions in nursing homes. International Registered Report Identifier (IRRID): DERR1-10.2196/40611 UR - https://www.researchprotocols.org/2022/9/e40611 UR - http://dx.doi.org/10.2196/40611 UR - http://www.ncbi.nlm.nih.gov/pubmed/36107475 ID - info:doi/10.2196/40611 ER - TY - JOUR AU - Nguyen, Hoang Long AU - Nguyen, Khanh Lien Thi AU - Nguyen, Thi Tham AU - Trong Dam, Anh Vu AU - Vu, Thi Thuc Minh AU - Nguyen, Si Hao Anh AU - Vu, Thu Giang AU - Latkin, A. Carl AU - Ho, M. Roger C. AU - Ho, H. Cyrus S. PY - 2022/9/13 TI - Practices, Perceived Benefits, and Barriers Among Medical Students and Health Care Professionals Regarding the Adoption of eHealth in Clinical Settings: Cross-sectional Survey Study JO - JMIR Med Educ SP - e34905 VL - 8 IS - 3 KW - eHealth KW - literacy KW - perception KW - practices KW - health care professional N2 - Background: eHealth is increasingly becoming an indispensable part of health practice and policy-making strategies. However, the use of eHealth tools in clinical practice and the perceptions of eHealth among medical students and health care professionals in Vietnam are not well understood. Objective: This study aims to investigate perceptions and practices regarding eHealth and their associated factors among medical students and health care professionals. Methods: A web-based cross-sectional study was conducted on 523 medical students and health care professionals. Information about the practices for, perceived barriers to, and benefits of eHealth application in clinical practices was collected. Multivariate Tobit and logistic regression models were used to determine factors associated with perceptions and practices. Results: In total, 61.6% (322/523) of participants used eHealth tools in clinical practices, with moderate levels of eHealth literacy. The score for the perceived benefits of eHealth tools was low. The most common barrier for eHealth utilization was human resources for IT (240/523, 45.9%), followed by security and risk control capacity (226/523, 43.2%) and no training in eHealth application (223/523, 42.6%). Age, eHealth literacy, and the use of the internet for updating medical knowledge were positively associated with using eHealth tools in clinical practices. Conclusions: eHealth tools were moderately used in clinical practices, and the benefits of eHealth were underestimated among health care professionals and medical students in Vietnam. Renovating the current medical education curriculum to integrate eHealth principles should be required to equip health care professionals and medical students with essential skills for rapid digital transformation. UR - https://mededu.jmir.org/2022/3/e34905 UR - http://dx.doi.org/10.2196/34905 UR - http://www.ncbi.nlm.nih.gov/pubmed/36098992 ID - info:doi/10.2196/34905 ER - TY - JOUR AU - Shuldiner, Jennifer AU - Srinivasan, Diya AU - Hall, N. Justin AU - May, R. Carl AU - Desveaux, Laura PY - 2022/9/12 TI - Implementing a Virtual Emergency Department: Qualitative Study Using the Normalization Process Theory JO - JMIR Hum Factors SP - e39430 VL - 9 IS - 3 KW - virtual care KW - emergency department KW - Normalization Process Theory N2 - Background: COVID-19 necessitated the rapid implementation and uptake of virtual health care; however, virtual care?s potential role remains unclear in the urgent care setting. In December 2020, the first virtual emergency department (ED) in the Greater Toronto Area was piloted at Sunnybrook Health Sciences Centre by connecting patients to emergency physicians through an online portal. Objective: This study aims to understand whether and how ED physicians were able to integrate a virtual ED alongside in-person operations. Methods: We conducted semistructured interviews with ED physicians guided by the Normalization Process Theory (NPT). The NPT provides a framework to understand how individuals and teams navigate the process of embedding new models of care as part of normal practice. All physicians who had worked within the virtual ED model were invited to participate. Data were analyzed using a combination of inductive and deductive techniques informed by the NPT. Results: A total of 14 physicians were interviewed. Participant experiences were categorized into 1 of 2 groups: 1 group moved to normalize the virtual ED in practice, while the other described barriers to routine adoption. These groups differed in their perception of the patient benefits as well as the perceived role in the virtual ED. The group that normalized the virtual ED model saw value for patients (coherence) and was motivated by patient satisfaction witnessed (reflexive monitoring) at the end of the virtual appointment. By contrast, the other group did not find virtual ED work reflective of the perceived role of urgent care (cognitive participation) and felt their skills as ED physicians were underutilized. The limited ability to examine patients and a sense that patient issues were not fully resolved at the end of the virtual appointment caused frustration among the second group. Conclusions: As further digital integration within the health care system occurs, it will be essential to support the evolution of staff skill sets to ensure physicians are satisfied with the care they are providing to their patients, while also ensuring the technology and process are efficient. UR - https://humanfactors.jmir.org/2022/3/e39430 UR - http://dx.doi.org/10.2196/39430 UR - http://www.ncbi.nlm.nih.gov/pubmed/36094801 ID - info:doi/10.2196/39430 ER - TY - JOUR AU - Weng, Heng AU - Chen, Jielong AU - Ou, Aihua AU - Lao, Yingrong PY - 2022/9/2 TI - Leveraging Representation Learning for the Construction and Application of a Knowledge Graph for Traditional Chinese Medicine: Framework Development Study JO - JMIR Med Inform SP - e38414 VL - 10 IS - 9 KW - knowledge graph KW - knowledge embedding KW - traditional Chinese medicine KW - knowledge discovery KW - medicine KW - clinical KW - framework N2 - Background: Knowledge discovery from treatment data records from Chinese physicians is a dramatic challenge in the application of artificial intelligence (AI) models to the research of traditional Chinese medicine (TCM). Objective: This paper aims to construct a TCM knowledge graph (KG) from Chinese physicians and apply it to the decision-making related to diagnosis and treatment in TCM. Methods: A new framework leveraging a representation learning method for TCM KG construction and application was designed. A transformer-based Contextualized Knowledge Graph Embedding (CoKE) model was applied to KG representation learning and knowledge distillation. Automatic identification and expansion of multihop relations were integrated with the CoKE model as a pipeline. Based on the framework, a TCM KG containing 59,882 entities (eg, diseases, symptoms, examinations, drugs), 17 relations, and 604,700 triples was constructed. The framework was validated through a link predication task. Results: Experiments showed that the framework outperforms a set of baseline models in the link prediction task using the standard metrics mean reciprocal rank (MRR) and Hits@N. The knowledge graph embedding (KGE) multitagged TCM discriminative diagnosis metrics also indicated the improvement of our framework compared with the baseline models. Conclusions: Experiments showed that the clinical KG representation learning and application framework is effective for knowledge discovery and decision-making assistance in diagnosis and treatment. Our framework shows superiority of application prospects in tasks such as KG-fused multimodal information diagnosis, KGE-based text classification, and knowledge inference?based medical question answering. UR - https://medinform.jmir.org/2022/9/e38414 UR - http://dx.doi.org/10.2196/38414 UR - http://www.ncbi.nlm.nih.gov/pubmed/36053574 ID - info:doi/10.2196/38414 ER - TY - JOUR AU - Jewer, Jennifer PY - 2022/8/25 TI - Investigating a Work System Approach to Implement an Emergency Department Surge Management System: Case Study JO - J Med Internet Res SP - e37472 VL - 24 IS - 8 KW - emergency department KW - surge management KW - work system KW - system implementation KW - emergency department information system KW - mobile phone N2 - Background: Emergency department (ED) crowding is a global health care issue. eHealth systems have the potential to reduce crowding; however, the true benefits are seldom realized because the systems are not integrated into clinicians? work. We sought a deep understanding of how an eHealth system implementation can be structured to truly integrate the system into the workflow. Objective: The specific objectives of this study were to examine whether work system theory (WST) is a good approach to structure the implementation of an eHealth system by incorporating the entire work system, and not just the eHealth system, in the implementation framework; identify the role that specific elements of WST?s static framework and dynamic work system life cycle model play in the implementation; and demonstrate how WST can be applied in the health care setting to guide the implementation of an eHealth system. Methods: Through a case study of an ED in a rural hospital, we used a mixed methods approach to examine the implementation of a surge management system through the lens of WST. We conducted 14 hours of observation in the ED; 20 interviews with clinicians, management, and members of the implementation team; and a survey of 23 clinicians; reviewed related documentation; and analyzed ED data to measure wait times. We used template analysis based on WST to structure our analysis of qualitative data and descriptive statistics for quantitative data. Results: The surge management system helped to reduce crowding in the ED, staff was satisfied with the implementation, and wait time improvements have been maintained for several years. Although study participants indicated changes to their workflow, 72% (13/18) of survey participants were satisfied with their use of the system, and 82% (14/17) indicated that it was integrated with their workflow. Examining the implementation through the lens of WST enabled us to identify the aspects of the implementation that made it so successful. By applying the WST static framework, we saw how the implementation team incorporated the elements of the ED work system, assessed their alignment, and designed interventions to address areas of misalignment. The dynamic work system life cycle model captured how planned and unplanned changes were managed throughout the iterative implementation cycle?83% (15/18) of participants indicated that there was sufficient management support for the changes and 80% (16/20) indicated the change served an important purpose. Conclusions: The broad scope and holistic approach of WST is well suited to guide eHealth system implementations as it focuses efforts on the entire work system and not just the IT artifact. We broaden the focus of WST by applying it to the implementation of an ED surge management system. These findings will guide further studies and implementations of eHealth systems using WST. UR - https://www.jmir.org/2022/8/e37472 UR - http://dx.doi.org/10.2196/37472 UR - http://www.ncbi.nlm.nih.gov/pubmed/36006684 ID - info:doi/10.2196/37472 ER - TY - JOUR AU - Krnic Martinic, Marina AU - ?ivljak, Marta AU - Maru?i?, Ana AU - Sapunar, Damir AU - Poklepovi? Peri?i?, Tina AU - Buljan, Ivan AU - Tokali?, Ru?ica AU - Mali?a, Snje?ana AU - Neuberg, Marijana AU - Ivani?evi?, Kata AU - Aranza, Diana AU - Skitareli?, Nata?a AU - Zorani?, Sanja AU - Mik?i?, ?tefica AU - ?avi?, Dalibor AU - Puljak, Livia PY - 2022/8/25 TI - Web-Based Educational Intervention to Improve Knowledge of Systematic Reviews Among Health Science Professionals: Randomized Controlled Trial JO - J Med Internet Res SP - e37000 VL - 24 IS - 8 KW - educational intervention KW - systematic review KW - health science professionals KW - knowledge KW - randomized controlled trial N2 - Background: Lack of knowledge of systematic reviews (SRs) could prevent individual health care professionals from using SRs as a source of information in their clinical practice or discourage them from participating in such research. Objective: In this randomized controlled trial, we evaluated the effect of a short web-based educational intervention on short-term knowledge of SRs. Methods: Eligible participants were 871 Master?s students of university health sciences studies in Croatia; 589 (67.6%) students who agreed to participate in the trial were randomized using a computer program into 2 groups. Intervention group A (294/589, 49.9%) received a short web-based educational intervention about SR methodology, and intervention group B (295/589, 50.1%) was presented with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. The participants? knowledge of SRs was assessed before and after the intervention. The participants could not be blinded because of the nature of the intervention. The primary outcome was the difference in the percentage of correct answers about SR methodology per participant between the groups after the intervention, expressed as relative risk and 95% CI. Results: Results from 162 and 165 participants in the educational intervention and PRISMA checklist groups, respectively, were available for analysis. Most of them (educational intervention group: 130/162, 80.2%; PRISMA checklist group: 131/165, 79.4%) were employed as health care professionals in addition to being health sciences students. After the intervention, the educational intervention group had 23% (relative risk percentage) more correct answers in the postintervention questionnaire than the PRISMA checklist group (relative risk=1.23, 95% CI 1.17-1.29). Conclusions: A short web-based educational intervention about SRs is an effective tool for short-term improvement of knowledge of SRs among health care studies students, most of whom were also employed as health care professionals. Further studies are needed to explore the long-term effects of the tested education. Trial Registration: OSF Registries 10.17605/OSF.IO/RYMVC; https://osf.io/rymvc UR - https://www.jmir.org/2022/8/e37000 UR - http://dx.doi.org/10.2196/37000 UR - http://www.ncbi.nlm.nih.gov/pubmed/36006686 ID - info:doi/10.2196/37000 ER - TY - JOUR AU - Massougbodji, José AU - Zomahoun, Vignon Hervé Tchala AU - Adisso, Lionel Evehouenou AU - Sawadogo, Jasmine AU - Borde, Valérie AU - Cameron, Cynthia AU - Moisan, Hélčne AU - Paquette, Jean-Sébastien AU - Akbaraly, Zamzam AU - Châteauneuf, Lëa-Kim AU - David, Genevičve AU - AU - Légaré, France PY - 2022/8/19 TI - Scaling Up Citizen Workshops in Public Libraries to Disseminate and Discuss Primary Care Research Results: Quasi-Experimental Study JO - JMIR Aging SP - e39016 VL - 5 IS - 3 KW - scaling up KW - knowledge translation KW - dissemination strategies KW - integrated knowledge translation KW - public libraries KW - citizen workshops KW - potentially inappropriate medicines N2 - Background: Little is known about engaging patients and stakeholders in the process of scaling up effective knowledge translation interventions targeting the public. Objective: Using an integrated knowledge translation approach, we aimed to scale up and evaluate an effective pilot program to disseminate research results in public libraries. Methods: We conducted a scaling-up study targeting the public. On the basis of our successful pilot project, we codeveloped and implemented a large-scale program of free citizen workshops in public libraries, in a close research partnership with stakeholders and patient representatives. Citizen workshops, each facilitated by 1 participating physician and 1 science communicator, consisted of a 45-minute computer-assisted presentation and a 45-minute open exchange. The intervention outcome was knowledge gained. The scale-up outcomes were satisfaction, appropriateness, coverage, and costs. An evaluation questionnaire was used to collect data of interest. Both quantitative and qualitative analyses were performed. Results: The workshop theme chosen by the patient and stakeholder representatives was the high prevalence of medication overuse among people aged ?65 years. From April to May 2019, 26 workshops were conducted in 25 public libraries reaching 362 people. The mean age of participants was 64.8 (SD 12.5) years. In total, 18 participating physicians and 6 science communicators facilitated the workshops. Participants reported significant knowledge gain (mean difference 2.1, 95% CI 2.0-2.2; P<.001). The median score for overall public satisfaction was 9 out of 10 (IQR 8-10). The public participants globally rated the workshops as having a high level of appropriateness. Coverage was 92% (25/27) of the total number of public libraries targeted. Costs were CAD $6051.84 (US $4519.69) for workshop design and CAD $22,935.41 (US $17,128.85) for scaling them up. Conclusions: This project successfully established a large-scale and successful implementation science or knowledge translation bridge among researchers, clinicians, and citizens via public libraries. This study provides a model for a dissemination practice that benefits the public by both engaging them in the dissemination process and targeting them directly. UR - https://aging.jmir.org/2022/3/e39016 UR - http://dx.doi.org/10.2196/39016 UR - http://www.ncbi.nlm.nih.gov/pubmed/35690963 ID - info:doi/10.2196/39016 ER - TY - JOUR AU - Strid, Nilsing Emma AU - Wallin, Lars AU - Nilsagĺrd, Ylva PY - 2022/8/19 TI - Implementation of a Health Promotion Practice Using Individually Targeted Lifestyle Interventions in Primary Health Care: Protocol for the ?Act in Time? Mixed Methods Process Evaluation Study JO - JMIR Res Protoc SP - e37634 VL - 11 IS - 8 KW - implementation science KW - facilitation KW - practice guideline KW - lifestyle KW - health promotion KW - primary health care KW - health personnel KW - qualitative research KW - quality improvement N2 - Background: There is growing evidence that noncommunicable diseases (NCDs) can be attributable to unhealthy lifestyle habits. However, there has been little application of this knowledge in primary health care (PHC). Objective: This study aims to evaluate the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a PHC setting. This practice is based on national guidelines targeting unhealthy lifestyle habits with a potential risk for NCDs. Methods: A pre-post implementation study design with a control group is used in a PHC setting in central Sweden. The Medical Research Council guidelines for process evaluation of complex interventions will be applied. The implementation process and outcomes will be assessed using a mix of qualitative and quantitative methods. A strategic sample of up to 6 PHC centers will be included as intervention centers, which will receive a 12-month multifaceted implementation strategy. Up to 6 matched PHC centers will serve as controls. Core components in the implementation strategy are external and internal facilitators in line with the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and the Astrakan change leadership model. Data will be collected at baseline, during the implementation phase, and 4-6 months after the implementation strategy. Questionnaires will be sent to roughly 500 patients in every PHC center and 200 health care professionals (HCPs) before and after implementation. In addition, purposeful sampling will be used for interviews and focus group discussions with managers, HCPs, patient representatives, and internal and external facilitators. Use of data from medical records and activity logs will be an additional data source. Results: Recruitment of PHC centers began in March 2021 and ended in Spring 2022. Based on the planned timeline with the 12-month implementation strategy and 4-6-month follow-up, we expect to collect the final data in Summer 2023. Conclusions: This study will explain implementation process and outcomes using a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a real-world PHC context. The study is expected to provide new knowledge about the role of facilitators and their contribution to implementation outcomes. These findings can guide policy makers, managers, and PHC staff to integrate health promotion and disease prevention in PHC and provide methodological support to facilitators. Trial Registration: ClinicalTrials.gov NCT04799860; https://clinicaltrials.gov/ct2/show/NCT04799860 International Registered Report Identifier (IRRID): DERR1-10.2196/37634 UR - https://www.researchprotocols.org/2022/8/e37634 UR - http://dx.doi.org/10.2196/37634 UR - http://www.ncbi.nlm.nih.gov/pubmed/35984700 ID - info:doi/10.2196/37634 ER - TY - JOUR AU - Matthews, Stacey AU - Atkins, Brooke AU - Walton, Natalie AU - Mitchell, Julie-Anne AU - Jennings, Garry AU - Buttery, K. Amanda PY - 2022/8/5 TI - Development and Use of a Cardiac Clinical Guideline Mobile App in Australia: Acceptability and Multi-Methods Study JO - JMIR Form Res SP - e35599 VL - 6 IS - 8 KW - mHealth KW - mobile heath KW - apps KW - app KW - guideline KW - cardiovascular disease KW - atrial fibrillation KW - heart failure KW - heart KW - cardiac KW - cardiovascular KW - acute coronary syndrome KW - smartphone KW - implementation KW - digital health KW - develop KW - evaluate KW - evaluation KW - Australia N2 - Background: Implementation of clinical guidelines into routine practice remains highly variable. Strategies to increase guideline uptake include developing digital tools and mobile apps for use in clinical practice. The National Heart Foundation of Australia in collaboration with the Cardiac Society of Australia and New Zealand published 3 key cardiac clinical guidelines, including the Australian clinical guidelines for the (1) prevention and detection of atrial fibrillation, (2) detection and management of heart failure, and (3) management of acute coronary syndromes. To improve access and uptake for health care providers, we developed the Smart Heart Guideline App. Objective: This study aims to evaluate the acceptability, implementation, and usability of an Australian-specific cardiac guidelines mobile app. Methods: We used an iterative multiple methods development and implementation approach. First, we conducted a cross-sectional web-based survey with end users (n=504 health professionals) in 2017 to determine the acceptability of an Australian-specific cardiac clinical guidelines mobile app. Second, the Smart Heart Guidelines app was created using a design, user testing, and revision process. The app includes interactive algorithms and flowcharts to inform diagnosis and management at the point of care. The freely available app was launched in October 2019 on iOS and Android operating systems and promoted and implemented using multiple methods. Third, data from 2 annual national cross-sectional general practitioner (GP) surveys in 2019 and 2020 were evaluated to understand the awareness and use of the clinical guidelines and the app. Fourth, data from the app stores were analyzed between October 1, 2019, and June 30, 2021, to evaluate usage. Results: Most health professionals surveyed (447/504, 89%) reported accessing resources electronically, and most (318/504, 63%) reported that they would use an Australian-specific cardiac guidelines app. GPs surveyed in 2019 were aware of the heart failure (159/312, 51%) and atrial fibrillation (140/312, 45%) guidelines, and in 2020, a total of 34 of 189 (18%) reported that they were aware of the app. The app was downloaded 11,313 times (7483, 66% from the Apple App Store; 3830, 34% from Google Play) during the first 20-month period. Most downloads (6300/7483, 84%) were a result of searching for the app in the stores. Monthly download rates varied. App Store data showed that people used the app twice (on average 2.06 times) during the 20 months. Many (3256/3830, 85%) Android users deleted the app. Conclusions: Health professionals supported the development of the Smart Heart Guidelines app. Although initial downloads were promising, the frequency of using the app was low and deletion rates were high. Further evaluation of users? experience of the most and least useful components of the app is needed. UR - https://formative.jmir.org/2022/8/e35599 UR - http://dx.doi.org/10.2196/35599 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930350 ID - info:doi/10.2196/35599 ER - TY - JOUR AU - Kaur, Manpreet AU - Costello, Jeremy AU - Willis, Elyse AU - Kelm, Karen AU - Reformat, Z. Marek AU - Bolduc, V. Francois PY - 2022/8/5 TI - Deciphering the Diversity of Mental Models in Neurodevelopmental Disorders: Knowledge Graph Representation of Public Data Using Natural Language Processing JO - J Med Internet Res SP - e39888 VL - 24 IS - 8 KW - concept map KW - neurodevelopmental disorder KW - knowledge graph KW - text analysis KW - semantic relatedness KW - PubMed KW - forums KW - mental model N2 - Background: Understanding how individuals think about a topic, known as the mental model, can significantly improve communication, especially in the medical domain where emotions and implications are high. Neurodevelopmental disorders (NDDs) represent a group of diagnoses, affecting up to 18% of the global population, involving differences in the development of cognitive or social functions. In this study, we focus on 2 NDDs, attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), which involve multiple symptoms and interventions requiring interactions between 2 important stakeholders: parents and health professionals. There is a gap in our understanding of differences between mental models for each stakeholder, making communication between stakeholders more difficult than it could be. Objective: We aim to build knowledge graphs (KGs) from web-based information relevant to each stakeholder as proxies of mental models. These KGs will accelerate the identification of shared and divergent concerns between stakeholders. The developed KGs can help improve knowledge mobilization, communication, and care for individuals with ADHD and ASD. Methods: We created 2 data sets by collecting the posts from web-based forums and PubMed abstracts related to ADHD and ASD. We utilized the Unified Medical Language System (UMLS) to detect biomedical concepts and applied Positive Pointwise Mutual Information followed by truncated Singular Value Decomposition to obtain corpus-based concept embeddings for each data set. Each data set is represented as a KG using a property graph model. Semantic relatedness between concepts is calculated to rank the relation strength of concepts and stored in the KG as relation weights. UMLS disorder-relevant semantic types are used to provide additional categorical information about each concept?s domain. Results: The developed KGs contain concepts from both data sets, with node sizes representing the co-occurrence frequency of concepts and edge sizes representing relevance between concepts. ADHD- and ASD-related concepts from different semantic types shows diverse areas of concerns and complex needs of the conditions. KG identifies converging and diverging concepts between health professionals literature (PubMed) and parental concerns (web-based forums), which may correspond to the differences between mental models for each stakeholder. Conclusions: We show for the first time that generating KGs from web-based data can capture the complex needs of families dealing with ADHD or ASD. Moreover, we showed points of convergence between families and health professionals? KGs. Natural language processing?based KG provides access to a large sample size, which is often a limiting factor for traditional in-person mental model mapping. Our work offers a high throughput access to mental model maps, which could be used for further in-person validation, knowledge mobilization projects, and basis for communication about potential blind spots from stakeholders in interactions about NDDs. Future research will be needed to identify how concepts could interact together differently for each stakeholder. UR - https://www.jmir.org/2022/8/e39888 UR - http://dx.doi.org/10.2196/39888 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930346 ID - info:doi/10.2196/39888 ER - TY - JOUR AU - Reszel, Jessica AU - van den Hoek, Joan AU - Nguyen, Tram AU - Aravind, Gayatri AU - Bayley, T. Mark AU - Bird, Marie-Louise AU - Edwards, Kate AU - Eng, J. Janice AU - Moore, L. Jennifer AU - Nelson, A. Michelle L. AU - Ploughman, Michelle AU - Richardson, Julie AU - Salbach, M. Nancy AU - Tang, Ada AU - Graham, D. Ian PY - 2022/7/29 TI - How Community-Based Teams Use the Stroke Recovery in Motion Implementation Planner: Longitudinal Qualitative Field Test Study JO - JMIR Form Res SP - e37243 VL - 6 IS - 7 KW - knowledge translation KW - knowledge mobilization KW - implementation science KW - implementation planning KW - stroke KW - rehabilitation KW - capacity building KW - community-based exercise programs N2 - Background: The Stroke Recovery in Motion Implementation Planner guides teams through the process of planning for the implementation of community-based exercise programs for people with stroke, in alignment with implementation science frameworks. Objective: The purpose of this study was to conduct a field test with end users to describe how teams used the Planner in real-world conditions; describe the effects of Planner use on participants? implementation-planning knowledge, attitudes, and activities; and identify factors influencing the use of the Planner. Methods: This field test study used a longitudinal qualitative design. We recruited teams across Canada who intended to implement a community-based exercise program for people with stroke in the next 6 to 12 months and were willing to use the Planner to guide their work. We completed semistructured interviews at the time of enrollment, monitoring calls every 1 to 2 months, and at the end of the study to learn about implementation-planning work completed and Planner use. The interviews were analyzed using conventional content analysis. Completed Planner steps were plotted onto a timeline for comparison across teams. Results: We enrolled 12 participants (program managers and coordinators, rehabilitation professionals, and fitness professionals) from 5 planning teams. The teams were enrolled in the study between 4 and 14 months, and we conducted 25 interviews. We observed that the teams worked through the planning process in diverse and nonlinear ways, adapted to their context. All teams provided examples of how using the Planner changed their implementation-planning knowledge (eg, knowing the steps), attitudes (eg, valuing community engagement), and activities (eg, hosting stakeholder meetings). We identified team, organizational, and broader contextual factors that hindered and facilitated uptake of the Planner. Participants shared valuable tips from the field to help future teams optimize use of the Planner. Conclusions: The Stroke Recovery in Motion Implementation Planner is an adaptable resource that may be used in diverse settings to plan community-based exercise programs for people with stroke. These findings may be informative to others who are developing resources to build the capacity of those working in community-based settings to implement new programs and practices. Future work is needed to monitor the use and understand the effect of using the Planner on exercise program implementation and sustainability.  UR - https://formative.jmir.org/2022/7/e37243 UR - http://dx.doi.org/10.2196/37243 UR - http://www.ncbi.nlm.nih.gov/pubmed/35904855 ID - info:doi/10.2196/37243 ER - TY - JOUR AU - Reszel, Jessica AU - van den Hoek, Joan AU - Nguyen, Tram AU - Aravind, Gayatri AU - Bayley, T. Mark AU - Bird, Marie-Louise AU - Edwards, Kate AU - Eng, J. Janice AU - Moore, L. Jennifer AU - Nelson, A. Michelle L. AU - Ploughman, Michelle AU - Richardson, Julie AU - Salbach, M. Nancy AU - Tang, Ada AU - Graham, D. Ian PY - 2022/7/29 TI - The Stroke Recovery in Motion Implementation Planner: Mixed Methods User Evaluation JO - JMIR Form Res SP - e37189 VL - 6 IS - 7 KW - stroke KW - rehabilitation KW - community-based exercise programs KW - knowledge translation KW - knowledge mobilization KW - implementation science N2 - Background: As more people are surviving stroke, there is a growing need for services and programs that support the long-term needs of people living with the effects of stroke. Exercise has many benefits; however, most people with stroke do not have access to specialized exercise programs that meet their needs in their communities. To catalyze the implementation of these programs, our team developed the Stroke Recovery in Motion Implementation Planner, an evidence-informed implementation guide for teams planning a community-based exercise program for people with stroke. Objective: This study aimed to conduct a user evaluation to elicit user perceptions of the usefulness and acceptability of the Planner to inform revisions. Methods: This mixed methods study used a concurrent triangulation design. We used purposive sampling to enroll a diverse sample of end users (program managers and coordinators, rehabilitation health partners, and fitness professionals) from three main groups: those who are currently planning a program, those who intend to plan a program in the future, and those who had previously planned a program. Participants reviewed the Planner and completed a questionnaire and interviews to identify positive features, areas of improvement, value, and feasibility. We used descriptive statistics for quantitative data and content analysis for qualitative data. We triangulated the data sources to identify Planner modifications. Results: A total of 39 people participated in this study. Overall, the feedback was positive, highlighting the value of the Planner?s comprehensiveness, tools and templates, and real-world examples. The identified areas for improvement included clarifying the need for specific steps, refining navigation, and creating more action-oriented content. Most participants reported an increase in knowledge and confidence after reading the Planner and reported that using the resource would improve their planning approach. Conclusions: We used a rigorous and user-centered process to develop and evaluate the Planner. End users indicated that it is a valuable resource and identified specific changes for improvement. The Planner was subsequently updated and is now publicly available for community planning teams to use in the planning and delivery of evidence-informed, sustainable, community-based exercise programs for people with stroke. UR - https://formative.jmir.org/2022/7/e37189 UR - http://dx.doi.org/10.2196/37189 UR - http://www.ncbi.nlm.nih.gov/pubmed/35904870 ID - info:doi/10.2196/37189 ER - TY - JOUR AU - Uwizeye, Bernard Claude AU - Zomahoun, Vignon Hervé Tchala AU - Bussičres, André AU - Thomas, Aliki AU - Kairy, Dahlia AU - Massougbodji, José AU - Rheault, Nathalie AU - Tchoubi, Sébastien AU - Philibert, Leonel AU - Abib Gaye, Serigne AU - Khadraoui, Lobna AU - Ben Charif, Ali AU - Diendéré, Ella AU - Langlois, Léa AU - Dugas, Michčle AU - Légaré, France PY - 2022/7/11 TI - Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews JO - Interact J Med Res SP - e38419 VL - 11 IS - 2 KW - knowledge translation KW - knowledge product KW - implementation strategies KW - review KW - health care professionals KW - primary care N2 - Background: The underuse or overuse of knowledge products leads to waste in health care, and primary care is no exception. Objective: This study aimed to characterize which knowledge products are frequently implemented, the implementation strategies used in primary care, and the implementation outcomes that are measured. Methods: We performed a systematic review (SR) of SRs using the Cochrane systematic approach to include eligible SRs. The inclusion criteria were any primary care contexts, health care professionals and patients, any Effective Practice and Organization of Care implementation strategies of specified knowledge products, any comparators, and any implementation outcomes based on the Proctor framework. We searched the MEDLINE, EMBASE, CINAHL, Ovid PsycINFO, Web of Science, and Cochrane Library databases from their inception to October 2019 without any restrictions. We searched the references of the included SRs. Pairs of reviewers independently performed selection, data extraction, and methodological quality assessment by using A Measurement Tool to Assess Systematic Reviews 2. Data extraction was informed by the Effective Practice and Organization of Care taxonomy for implementation strategies and the Proctor framework for implementation outcomes. We performed a descriptive analysis and summarized the results by using a narrative synthesis. Results: Of the 11,101 records identified, 81 (0.73%) SRs were included. Of these 81, a total of 47 (58%) SRs involved health care professionals alone. Moreover, 15 SRs had a high or moderate methodological quality. Most of them addressed 1 type of knowledge product (56/81, 69%), common clinical practice guidelines (26/56, 46%) or management, and behavioral or pharmacological health interventions (24/56, 43%). Mixed strategies were used for implementation (67/81, 83%), predominantly education-based (meetings in 60/81, 74%; materials distribution in 59/81, 73%; and academic detailing in 45/81, 56%), reminder (53/81, 36%), and audit and feedback (40/81, 49%) strategies. Education meetings (P=.13) and academic detailing (P=.11) seemed to be used more when the population was composed of health care professionals alone. Improvements in the adoption of knowledge products were the most commonly measured outcome (72/81, 89%). The evidence level was reported in 12% (10/81) of SRs on 62 outcomes (including 48 improvements in adoption), of which 16 (26%) outcomes were of moderate or high level. Conclusions: Clinical practice guidelines and management and behavioral or pharmacological health interventions are the most commonly implemented knowledge products and are implemented through the mixed use of educational, reminder, and audit and feedback strategies. There is a need for a strong methodology for the SR of randomized controlled trials to explore their effectiveness and the entire cascade of implementation outcomes. UR - https://www.i-jmr.org/2022/2/e38419 UR - http://dx.doi.org/10.2196/38419 UR - http://www.ncbi.nlm.nih.gov/pubmed/35635786 ID - info:doi/10.2196/38419 ER - TY - JOUR AU - Fortmann, Jonas AU - Lutz, Marlene AU - Spreckelsen, Cord PY - 2022/6/22 TI - System for Context-Specific Visualization of Clinical Practice Guidelines (GuLiNav): Concept and Software Implementation JO - JMIR Form Res SP - e28013 VL - 6 IS - 6 KW - clinical practice guideline KW - clinical decision support system KW - decision support techniques KW - computer-assisted decision making KW - guideline representation KW - workflow control patterns KW - workflow KW - clinical KW - decision making KW - support systems KW - software KW - eHealth KW - electronic health N2 - Background: Clinical decision support systems often adopt and operationalize existing clinical practice guidelines leading to higher guideline availability, increased guideline adherence, and data integration. Most of these systems use an internal state-based model of a clinical practice guideline to derive recommendations but do not provide the user with comprehensive insight into the model. Objective: Here we present a novel approach based on dynamic guideline visualization that incorporates the individual patient?s current treatment context. Methods: We derived multiple requirements to be fulfilled by such an enhanced guideline visualization. Using business process and model notation as the representation format for computer-interpretable guidelines, a combination of graph-based representation and logical inferences is adopted for guideline processing. A context-specific guideline visualization is inferred using a business rules engine. Results: We implemented and piloted an algorithmic approach for guideline interpretation and processing. As a result of this interpretation, a context-specific guideline is derived and visualized. Our implementation can be used as a software library but also provides a representational state transfer interface. Spring, Camunda, and Drools served as the main frameworks for implementation. A formative usability evaluation of a demonstrator tool that uses the visualization yielded high acceptance among clinicians. Conclusions: The novel guideline processing and visualization concept proved to be technically feasible. The approach addresses known problems of guideline-based clinical decision support systems. Further research is necessary to evaluate the applicability of the approach in specific medical use cases. UR - https://formative.jmir.org/2022/6/e28013 UR - http://dx.doi.org/10.2196/28013 UR - http://www.ncbi.nlm.nih.gov/pubmed/35731571 ID - info:doi/10.2196/28013 ER - TY - JOUR AU - Chute, Chaloner AU - French, Tara AU - Raman, Sneha AU - Bradley, Jay PY - 2022/6/10 TI - User Requirements for Comanaged Digital Health and Care: Review JO - J Med Internet Res SP - e35337 VL - 24 IS - 6 KW - delivery of health care KW - integrated KW - patient-centered care KW - digital technology KW - decision-making KW - health services accessibility KW - trust KW - mHealth KW - eHealth KW - telehealth N2 - Background: The sustainability of health and social care has led to an imperative to shift the balance of care to communities and support person-centered, integrated, preventive, comanaged, and sustainable care. The digital tool set can support this shift; however, it must extend beyond a clinical focus to include broader personal, social, and environmental needs, experiences, and outcomes. The existing digital health and care design and user requirements literature focuses mainly on specific digital products or design methods. There is little whole-system or whole-of-life consideration, which is crucial to enacting more significant transformations that span different groups and domains. Objective: This study aimed to present a set of recurring user requirements and themes for comanaged digital health and care services derived from the body of co-design projects within a digital health and care program. This study aimed to enable people and organizations looking to reorient their approach to health and care research and delivery from a system-led and condition-specific approach to a more person-centric, whole-of-life model. Methods: Participatory design formed the core methodological approach in underlying the design research, from which user requirements were derived. The process of surfacing requirements involved a selection framework for the identification of eligible projects and a structured review process to consolidate user requirements. Results: This paper presents a set of 14 common user requirements that resulted from a review of co-design projects. The findings demonstrate overlapping and reinforcing sets of needs from citizens and care professionals related to how data are comanaged to improve care and outcomes. This paper discusses the alignment, contrasts, and gaps with broader, comparable literature. It highlights consensus around requirements for personal health storytelling, sharing data on care experiences and how this can support personalized guidance, visualize trends to support decision-making, and generally improve dialog between a citizen and care professionals. These findings identify gaps around how groups and networks of people engage, posing difficult questions for people designing support services as some of the user requirements are not easily met by organizations operating in silos. Conclusions: This study proposes future recommendations for citizens as active, informed, and consenting partners using new forms of privacy-preserving digital infrastructure that puts the citizen in firm control. It is also recommended that these findings be used by people developing new digital services to ensure that they can start with knowledge of the broader user requirement context. This should inform domain-specific research and development questions and processes. Further work is needed to extend these common requirements to more explicitly consider the trust framework required when citizens comanage their data and care across a broad range of formal and informal actors. Consideration of how authority, delegation, and trust function between members of the public will be critical. UR - https://www.jmir.org/2022/6/e35337 UR - http://dx.doi.org/10.2196/35337 UR - http://www.ncbi.nlm.nih.gov/pubmed/35687379 ID - info:doi/10.2196/35337 ER - TY - JOUR AU - Bernard, M. Renaldo AU - Toppo, Claudia AU - Raggi, Alberto AU - de Mul, Marleen AU - de Miquel, Carlota AU - Pugliese, Teresa Maria AU - van der Feltz-Cornelis, M. Christina AU - Ortiz-Tallo, Ana AU - Salvador-Carulla, Luis AU - Lukersmith, Sue AU - Hakkaart-van Roijen, Leona AU - Merecz-Kot, Dorota AU - Staszewska, Kaja AU - Sabariego, Carla PY - 2022/6/1 TI - Strategies for Implementing Occupational eMental Health Interventions: Scoping Review JO - J Med Internet Res SP - e34479 VL - 24 IS - 6 KW - implementation KW - mobile health KW - mHealth KW - mental health KW - eMental health KW - occupational health KW - barriers KW - facilitators KW - scoping review KW - mobile phone N2 - Background: The implementation of eMental health interventions, especially in the workplace, is a complex process. Therefore, learning from existing implementation strategies is imperative to ensure improvements in the adoption, development, and scalability of occupational eMental health (OeMH) interventions. However, the implementation strategies used for these interventions are often undocumented or inadequately reported and have not been systematically gathered across implementations in a way that can serve as a much-needed guide for researchers. Objective: The objective of this scoping review was to identify implementation strategies relevant to the uptake of OeMH interventions that target employees and detail the associated barriers and facilitation measures. Methods: A scoping review was conducted. The descriptive synthesis was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and the Consolidated Framework for Implementation Research. Results: A total of 31 of 32,916 (0.09%) publications reporting the use of the web-, smartphone-, telephone-, and email-based OeMH interventions were included. In all, 98 implementation strategies, 114 barriers, and 131 facilitators were identified. The synthesis of barriers and facilitators produced 19 facilitation measures that provide initial recommendations for improving the implementation of OeMH interventions. Conclusions: This scoping review represents one of the first steps in a research agenda aimed at improving the implementation of OeMH interventions by systematically selecting, shaping, evaluating, and reporting implementation strategies. There is a dire need for improved reporting of implementation strategies and combining common implementation frameworks with more technology-centric implementation frameworks to fully capture the complexities of eHealth implementation. Future research should investigate a wider range of common implementation outcomes for OeMH interventions that also focus on a wider set of common mental health problems in the workplace. This scoping review?s findings can be critically leveraged by discerning decision-makers to improve the reach, effectiveness, adoption, implementation, and maintenance of OeMH interventions. UR - https://www.jmir.org/2022/6/e34479 UR - http://dx.doi.org/10.2196/34479 UR - http://www.ncbi.nlm.nih.gov/pubmed/35648457 ID - info:doi/10.2196/34479 ER - TY - JOUR AU - Garcia, Cristian AU - Rehman, Nadia AU - Lawson, O. Daeria AU - Djiadeu, Pascal AU - Mbuagbaw, Lawrence PY - 2022/5/13 TI - Developing Reporting Guidelines for Studies of HIV Drug Resistance Prevalence: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e35969 VL - 11 IS - 5 KW - HIV KW - drug resistance KW - reporting guideline KW - prevalence KW - surveillance KW - antiretroviral therapy KW - report KW - global health KW - problem N2 - Background: HIV drug resistance is a global health problem that limits the effectiveness of antiretroviral therapy. Adequate surveillance of HIV drug resistance is challenged by heterogenous and inadequate data reporting, which compromises the accuracy, interpretation, and usability of prevalence estimates. Previous research has found that the quality of reporting in studies of HIV drug resistance prevalence is low, and thus better guidance is needed to ensure complete and uniform reporting. Objective: This paper contributes to the process of developing reporting guidelines for prevalence studies of HIV drug resistance by reporting the methodology used in creating a reporting item checklist and generating key insights on items that are important to report. Methods: We will conduct a sequential explanatory mixed methods study among authors and users of studies of HIV drug resistance. The two-phase design will include a cross-sectional electronic survey (quantitative phase) followed by a focus group discussion (qualitative phase). Survey participants will rate the essentiality of various reporting items. This data will be analyzed using content validity ratios to determine the items that will be retained for focus group discussions. Participants in these discussions will revise the items and any additionally suggested items and settle on a complete reporting item checklist. We will also conduct a thematic analysis of the group discussions to identify emergent themes regarding the agreement process. Results: As of November 2021, data collection for both phases of the study is complete. In July 2021, 51 participants had provided informed consent and completed the electronic survey. In October 2021, focus group discussions were held. Nine participants in total participated in two virtual focus group discussions. As of May 2022, data are being analyzed. Conclusions: This study supports the development of a reporting checklist for studies of HIV drug resistance by achieving agreement among experts on what items should be reported in these studies. The results of this work will be refined and elaborated on by a writing committee of HIV drug resistance experts and external reviewers to develop finalized reporting guidelines. International Registered Report Identifier (IRRID): DERR1-10.2196/35969 UR - https://www.researchprotocols.org/2022/5/e35969 UR - http://dx.doi.org/10.2196/35969 UR - http://www.ncbi.nlm.nih.gov/pubmed/35559984 ID - info:doi/10.2196/35969 ER - TY - JOUR AU - Campbell, Alyson AU - Hartling, Lisa AU - Plourde, Vickie AU - Scott, D. Shannon PY - 2022/5/10 TI - Parental Knowledge, Self-confidence, and Usability Evaluation of a Web-Based Infographic for Pediatric Concussion: Multimethod Study JO - JMIR Pediatr Parent SP - e36317 VL - 5 IS - 2 KW - concussion KW - mTBI KW - usability evaluation KW - knowledge assessment KW - knowledge translation KW - parent knowledge KW - parent confidence KW - patient engagement KW - educational tool N2 - Background: Concussions, which are known as mild traumatic brain injuries, are complex injuries caused by direct or indirect blows to the head and are increasingly being recognized as a significant public health concern for children and their families. Previous research has identified few studies examining the efficacy of educational interventions on parental concussion knowledge. The aim of this research was to actively work together with children who have experienced a concussion and their parents to develop, refine, and evaluate the usability of a web-based infographic for pediatric concussion. Objective: The objective of this study was to report on the usability of the infographic, parental knowledge, and self-confidence in pediatric concussion knowledge before and after exposure to the infographic. Methods: A multiphase, multimethod research design using patient engagement techniques was used to develop a web-based infographic. For this phase of the research (usability, knowledge, and confidence evaluation), parents who could communicate in English were recruited via social media platforms and invited to complete web-based questionnaires. Electronic preintervention and postintervention questionnaires were administered to parents to assess changes to concussion knowledge and confidence after viewing the infographic. A usability questionnaire with 11 items was also completed. Results: A web-based, infographic was developed. The infographic is intended for parents and children and incorporates information that parents and children identified as both wants and needs about concussion alongside the best available research evidence on pediatric concussion. A total of 31 surveys were completed by parents. The mean scores for each item on the usability surveys ranged from 8.03 (SD 1.70) to 9.26 (SD 1.09) on a 10-point Likert scale, indicating that the usability components of the infographic were largely positive. There was no statistically significant difference between preintervention and postintervention knowledge scores (Z=?0.593; P=.55; both preintervention and postintervention knowledge scores had a median of 9 out of 10). In contrast, there was a statistically significant difference between preintervention (mean 3.9/5, SD 0.56) and postintervention (mean 4.4/5, SD 0.44) confidence in knowledge scores (t30=?5.083; P<.001). Conclusions: Our results demonstrate that parents positively rated a web-based, infographic for pediatric concussion. In addition, although there was no statistically significant difference overall in parents? knowledge scores before and after viewing the infographic, their confidence in their knowledge did significantly increase. These results suggest that using a web-based infographic as a knowledge translation intervention may be useful in increasing parents? confidence in managing their child?s concussion. UR - https://pediatrics.jmir.org/2022/2/e36317 UR - http://dx.doi.org/10.2196/36317 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536631 ID - info:doi/10.2196/36317 ER - TY - JOUR AU - Landis-Lewis, Zach AU - Flynn, Allen AU - Janda, Allison AU - Shah, Nirav PY - 2022/5/10 TI - A Scalable Service to Improve Health Care Quality Through Precision Audit and Feedback: Proposal for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e34990 VL - 11 IS - 5 KW - learning health system KW - audit and feedback KW - anesthesiology KW - knowledge-based system KW - human-centered design N2 - Background: Health care delivery organizations lack evidence-based strategies for using quality measurement data to improve performance. Audit and feedback (A&F), the delivery of clinical performance summaries to providers, demonstrates the potential for large effects on clinical practice but is currently implemented as a blunt one size fits most intervention. Each provider in a care setting typically receives a performance summary of identical metrics in a common format despite the growing recognition that precisionizing interventions hold significant promise in improving their impact. A precision approach to A&F prioritizes the display of information in a single metric that, for each recipient, carries the highest value for performance improvement, such as when the metric?s level drops below a peer benchmark or minimum standard for the first time, thereby revealing an actionable performance gap. Furthermore, precision A&F uses an optimal message format (including framing and visual displays) based on what is known about the recipient and the intended gist meaning being communicated to improve message interpretation while reducing the cognitive processing burden. Well-established psychological principles, frameworks, and theories form a feedback intervention knowledge base to achieve precision A&F. From an informatics perspective, precision A&F requires a knowledge-based system that enables mass customization by representing knowledge configurable at the group and individual levels. Objective: This study aims to implement and evaluate a demonstration system for precision A&F in anesthesia care and to assess the effect of precision feedback emails on care quality and outcomes in a national quality improvement consortium. Methods: We propose to achieve our aims by conducting 3 studies: a requirements analysis and preferences elicitation study using human-centered design and conjoint analysis methods, a software service development and implementation study, and a cluster randomized controlled trial of a precision A&F service with a concurrent process evaluation. This study will be conducted with the Multicenter Perioperative Outcomes Group, a national anesthesia quality improvement consortium with >60 member hospitals in >20 US states. This study will extend the Multicenter Perioperative Outcomes Group quality improvement infrastructure by using existing data and performance measurement processes. Results: The proposal was funded in September 2021 with a 4-year timeline. Data collection for Aim 1 began in March 2022. We plan for a 24-month trial timeline, with the intervention period of the trial beginning in March 2024. Conclusions: The proposed aims will collectively demonstrate a precision feedback service developed using an open-source technical infrastructure for computable knowledge management. By implementing and evaluating a demonstration system for precision feedback, we create the potential to observe the conditions under which feedback interventions are effective. International Registered Report Identifier (IRRID): PRR1-10.2196/34990 UR - https://www.researchprotocols.org/2022/5/e34990 UR - http://dx.doi.org/10.2196/34990 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536637 ID - info:doi/10.2196/34990 ER - TY - JOUR AU - Batterham, J. Philip AU - Gulliver, Amelia AU - Kurz, Ella AU - Farrer, M. Louise AU - Vis, Christiaan AU - Schuurmans, Josien AU - Calear, L. Alison PY - 2022/5/6 TI - 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 JO - J Med Internet Res SP - e34769 VL - 24 IS - 5 KW - implementation KW - mental health KW - adherence KW - uptake KW - internet N2 - 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 UR - https://www.jmir.org/2022/5/e34769 UR - http://dx.doi.org/10.2196/34769 UR - http://www.ncbi.nlm.nih.gov/pubmed/35522458 ID - info:doi/10.2196/34769 ER - TY - JOUR AU - Herter, Ernst Willem AU - Khuc, Janine AU - Cinŕ, Giovanni AU - Knottnerus, J. Bart AU - Numans, E. Mattijs AU - Wiewel, A. Maryse AU - Bonten, N. Tobias AU - de Bruin, P. Daan AU - van Esch, Thamar AU - Chavannes, H. Niels AU - Verheij, A. Robert PY - 2022/5/4 TI - Impact of a Machine Learning?Based Decision Support System for Urinary Tract Infections: Prospective Observational Study in 36 Primary Care Practices JO - JMIR Med Inform SP - e27795 VL - 10 IS - 5 KW - machine learning KW - ML KW - artificial intelligence KW - clinical decision support system KW - implementation study KW - information technology KW - urinary tract infections N2 - Background: There is increasing attention on machine learning (ML)-based clinical decision support systems (CDSS), but their added value and pitfalls are very rarely evaluated in clinical practice. We implemented a CDSS to aid general practitioners (GPs) in treating patients with urinary tract infections (UTIs), which are a significant health burden worldwide. Objective: This study aims to prospectively assess the impact of this CDSS on treatment success and change in antibiotic prescription behavior of the physician. In doing so, we hope to identify drivers and obstacles that positively impact the quality of health care practice with ML. Methods: The CDSS was developed by Pacmed, Nivel, and Leiden University Medical Center (LUMC). The CDSS presents the expected outcomes of treatments, using interpretable decision trees as ML classifiers. Treatment success was defined as a subsequent period of 28 days during which no new antibiotic treatment for UTI was needed. In this prospective observational study, 36 primary care practices used the software for 4 months. Furthermore, 29 control practices were identified using propensity score-matching. All analyses were performed using electronic health records from the Nivel Primary Care Database. Patients for whom the software was used were identified in the Nivel database by sequential matching using CDSS use data. We compared the proportion of successful treatments before and during the study within the treatment arm. The same analysis was performed for the control practices and the patient subgroup the software was definitely used for. All analyses, including that of physicians? prescription behavior, were statistically tested using 2-sided z tests with an ? level of .05. Results: In the treatment practices, 4998 observations were included before and 3422 observations (of 2423 unique patients) were included during the implementation period. In the control practices, 5044 observations were included before and 3360 observations were included during the implementation period. The proportion of successful treatments increased significantly from 75% to 80% in treatment practices (z=5.47, P<.001). No significant difference was detected in control practices (76% before and 76% during the pilot, z=0.02; P=.98). Of the 2423 patients, we identified 734 (30.29%) in the CDSS use database in the Nivel database. For these patients, the proportion of successful treatments during the study was 83%?a statistically significant difference, with 75% of successful treatments before the study in the treatment practices (z=4.95; P<.001). Conclusions: The introduction of the CDSS as an intervention in the 36 treatment practices was associated with a statistically significant improvement in treatment success. We excluded temporal effects and validated the results with the subgroup analysis in patients for whom we were certain that the software was used. This study shows important strengths and points of attention for the development and implementation of an ML-based CDSS in clinical practice. Trial Registration: ClinicalTrials.gov NCT04408976; https://clinicaltrials.gov/ct2/show/NCT04408976 UR - https://medinform.jmir.org/2022/5/e27795 UR - http://dx.doi.org/10.2196/27795 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507396 ID - info:doi/10.2196/27795 ER - TY - JOUR AU - Linkewich, Elizabeth AU - Quant, Sylvia AU - Bechard, Lauren AU - Donald, Michelle PY - 2022/4/27 TI - Using a Virtual Community of Practice to Support Stroke Best Practice Implementation: Mixed Methods Evaluation JO - JMIR Form Res SP - e31827 VL - 6 IS - 4 KW - stroke KW - rehabilitation KW - knowledge translation KW - implementation KW - quality improvement KW - evidence-based practice KW - evaluation KW - continuing education KW - social media KW - internet KW - web-based learning KW - allied health N2 - Background: Successful best practice implementation is influenced by access to peer support and knowledge exchange. The Toronto Stroke Networks Virtual Community of Practice, a secure social media platform, is a knowledge translation tool supporting dissemination and adoption of stroke best practices for interprofessional stroke stakeholders. Objective: The aim of this study is to evaluate the use of a virtual community of practice (VCoP) in supporting regional stroke care best practice implementation in an urban context. Methods: A mixed methods approach was used. Qualitative data were collected through focus groups and interviews with stroke care provider members of the VCoP working in acute and rehabilitation settings. Thematic analysis was completed, and the Wenger Value Creation Model and developmental evaluation were used to reflect practice change. Quantitative data were collected and analyzed using website analytics on VCoP use. Results: A year after implementation, the VCoP had 379 members. Analysis of web analytics data and transcripts from focus groups and interviews conducted with 26 VCoP members indicated that the VCoP provided immediate value in supporting user networking, community activities, and interactions. Skill acquisition and changes in perspective acquired through discussion and project work on the VCoP were valued by members, with potential value for supporting practice change. Learning about new stroke best practices through the VCoP was a starting point for individuals and teams to contemplate change. Conclusions: These findings suggest that the VCoP supports the early stages of practice change and stroke best practice implementation. Future research should examine how VCoPs can support higher levels of value creation for implementing stroke best practices. UR - https://formative.jmir.org/2022/4/e31827 UR - http://dx.doi.org/10.2196/31827 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475730 ID - info:doi/10.2196/31827 ER - TY - JOUR AU - Nam, Seojin AU - Kim, Donghun AU - Jung, Woojin AU - Zhu, Yongjun PY - 2022/4/22 TI - Understanding the Research Landscape of Deep Learning in Biomedical Science: Scientometric Analysis JO - J Med Internet Res SP - e28114 VL - 24 IS - 4 KW - deep learning KW - scientometric analysis KW - research publications KW - research landscape KW - research collaboration KW - knowledge diffusion N2 - Background: Advances in biomedical research using deep learning techniques have generated a large volume of related literature. However, there is a lack of scientometric studies that provide a bird?s-eye view of them. This absence has led to a partial and fragmented understanding of the field and its progress. Objective: This study aimed to gain a quantitative and qualitative understanding of the scientific domain by analyzing diverse bibliographic entities that represent the research landscape from multiple perspectives and levels of granularity. Methods: We searched and retrieved 978 deep learning studies in biomedicine from the PubMed database. A scientometric analysis was performed by analyzing the metadata, content of influential works, and cited references. Results: In the process, we identified the current leading fields, major research topics and techniques, knowledge diffusion, and research collaboration. There was a predominant focus on applying deep learning, especially convolutional neural networks, to radiology and medical imaging, whereas a few studies focused on protein or genome analysis. Radiology and medical imaging also appeared to be the most significant knowledge sources and an important field in knowledge diffusion, followed by computer science and electrical engineering. A coauthorship analysis revealed various collaborations among engineering-oriented and biomedicine-oriented clusters of disciplines. Conclusions: This study investigated the landscape of deep learning research in biomedicine and confirmed its interdisciplinary nature. Although it has been successful, we believe that there is a need for diverse applications in certain areas to further boost the contributions of deep learning in addressing biomedical research problems. We expect the results of this study to help researchers and communities better align their present and future work. UR - https://www.jmir.org/2022/4/e28114 UR - http://dx.doi.org/10.2196/28114 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451980 ID - info:doi/10.2196/28114 ER - TY - JOUR AU - Hodges, Jacqueline AU - Caldwell, Sylvia AU - Cohn, Wendy AU - Flickinger, Tabor AU - Waldman, Lena Ava AU - Dillingham, Rebecca AU - Castel, Amanda AU - Ingersoll, Karen PY - 2022/4/22 TI - Evaluation of the Implementation and Effectiveness of a Mobile Health Intervention to Improve Outcomes for People With HIV in the Washington, DC Cohort: Study Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e37748 VL - 11 IS - 4 KW - human immunodeficiency virus KW - HIV KW - mobile health KW - mHealth KW - implementation science KW - cluster randomized controlled trial KW - smartphone N2 - Background: Gaps remain in achieving retention in care and durable HIV viral load suppression for people with HIV in Washington, DC (hereafter DC). Although people with HIV seeking care in DC have access to a range of supportive services, innovative strategies are needed to enhance patient engagement in this setting. Mobile health (mHealth) interventions have shown promise in reaching previously underengaged groups and improving HIV-related outcomes in various settings. Objective: This study will evaluate the implementation and effectiveness of a clinic-deployed, multifeature mHealth intervention called PositiveLinks (PL) among people with HIV enrolled in the DC Cohort, a longitudinal cohort of people with HIV receiving care in DC. A cluster randomized controlled trial will be conducted using a hybrid effectiveness-implementation design and will compare HIV-related outcomes between clinics randomized to PL versus usual care. Methods: The study aims are threefold: (1) We will perform a formative evaluation of PL in the context of DC Cohort clinics to test the feasibility, acceptability, and usability of PL and tailor the platform for use in this context. (2) We will conduct a cluster randomized controlled trial with 12 DC Cohort clinics randomized to PL or usual care (n=6 [50%] per arm) and measure the effectiveness of PL by the primary outcomes of patient visit constancy, retention in care, and HIV viral load suppression. We aim to enroll a total of 482 participants from DC Cohort clinic sites, specifically including people with HIV who show evidence of inconsistent retention in care or lack of viral suppression. (3) We will use the Consolidated Framework for Implementation Research (CFIR) and the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to measure implementation success and identify site, patient, provider, and system factors associated with successful implementation. Evaluation activities will occur pre-, mid-, and postimplementation. Results: Formative data collection was completed between April 2021 and January 2022. Preliminary mHealth platform modifications have been performed, and the first round of user testing has been completed. A preimplementation evaluation was performed to identify relevant implementation outcomes and design a suite of instruments to guide data collection for evaluation of PL implementation throughout the trial period. Instruments include those already developed to support DC Cohort Study activities and PL implementation in other cohorts, which required modification for use in the study, as well as novel instruments designed to complete data collection, as guided by the CFIR and RE-AIM frameworks. Conclusions: Formative and preimplementation evaluations will be completed in spring 2022 when the trial is planned to launch. Specifically, comprehensive formative data analysis will be completed following data collection, coding, preliminary review, and synthesis. Corresponding platform modifications are ready for beta testing within the DC Cohort. Finalization of the platform for use in the trial will follow beta testing. Trial Registration: ClinicalTrials.gov NCT04998019; https://clinicaltrials.gov/ct2/show/NCT04998019 International Registered Report Identifier (IRRID): PRR1-10.2196/37748 UR - https://www.researchprotocols.org/2022/4/e37748 UR - http://dx.doi.org/10.2196/37748 UR - http://www.ncbi.nlm.nih.gov/pubmed/35349466 ID - info:doi/10.2196/37748 ER - TY - JOUR AU - Valenzuela, Waldo AU - Balsiger, Fabian AU - Wiest, Roland AU - Scheidegger, Olivier PY - 2022/4/11 TI - Medical-Blocks?A Platform for Exploration, Management, Analysis, and Sharing of Data in Biomedical Research: System Development and Integration Results JO - JMIR Form Res SP - e32287 VL - 6 IS - 4 KW - biomedical research KW - data sharing KW - data handling KW - data science KW - platform KW - software KW - translational medical research KW - medical informatics KW - PACS KW - DICOM N2 - Background: Biomedical research requires health care institutions to provide sensitive clinical data to leverage data science and artificial intelligence technologies. However, providing researchers access to health care data in a simple and secure manner proves to be challenging for health care institutions. Objective: This study aims to introduce and describe Medical-Blocks, a platform for exploration, management, analysis, and sharing of data in biomedical research. Methods: The specification requirements for Medical-Blocks included connection to data sources of health care institutions with an interface for data exploration, management of data in an internal file storage system, data analysis through visualization and classification of data, and data sharing via a file hosting service for collaboration. Medical-Blocks should be simple to use via a web-based user interface and extensible with new functionalities by a modular design via microservices (blocks). The scalability of the platform should be ensured through containerization. Security and legal regulations were considered during development. Results: Medical-Blocks is a web application that runs in the cloud or as a local instance at a health care institution. Local instances of Medical-Blocks access data sources such as electronic health records and picture archiving and communication system at health care institutions. Researchers and clinicians can explore, manage, and analyze the available data through Medical-Blocks. Data analysis involves the classification of data for metadata extraction and the formation of cohorts. In collaborations, metadata (eg, the number of patients per cohort) or the data alone can be shared through Medical-Blocks locally or via a cloud instance with other researchers and clinicians. Conclusions: Medical-Blocks facilitates biomedical research by providing a centralized platform to interact with medical data in collaborative research projects. Access to and management of medical data are simplified. Data can be swiftly analyzed to form cohorts for research and be shared among researchers. The modularity of Medical-Blocks makes the platform feasible for biomedical research where heterogeneous medical data are required. UR - https://formative.jmir.org/2022/4/e32287 UR - http://dx.doi.org/10.2196/32287 UR - http://www.ncbi.nlm.nih.gov/pubmed/35232718 ID - info:doi/10.2196/32287 ER - TY - JOUR AU - Mosch, Katharina Lina AU - Poncette, Akira-Sebastian AU - Spies, Claudia AU - Weber-Carstens, Steffen AU - Schieler, Monique AU - Krampe, Henning AU - Balzer, Felix PY - 2022/4/8 TI - Creation of an Evidence-Based Implementation Framework for Digital Health Technology in the Intensive Care Unit: Qualitative Study JO - JMIR Form Res SP - e22866 VL - 6 IS - 4 KW - digital health KW - patient monitoring KW - intensive care medicine KW - intensive care unit KW - technological innovation KW - user-centered KW - usability KW - implementation KW - implementation science KW - qualitative research KW - interview N2 - Background: Digital health technologies such as continuous remote monitoring and artificial intelligence?driven clinical decision support systems could improve clinical outcomes in intensive care medicine. However, comprehensive evidence and guidelines for the successful implementation of digital health technologies into specific clinical settings such as the intensive care unit (ICU) are scarce. We evaluated the implementation of a remote patient monitoring platform and derived a framework proposal for the implementation of digital health technology in an ICU. Objective: This study aims to investigate barriers and facilitators to the implementation of a remote patient monitoring technology and to develop a proposal for an implementation framework for digital health technology in the ICU. Methods: This study was conducted from May 2018 to March 2020 during the implementation of a tablet computer?based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of 7 semistructured interviews with clinical ICU stakeholders and descriptive questionnaire data. The results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework. Results: This study revealed an insufficient implementation process due to lack of staff engagement and few perceived benefits from the novel solution. Further implementation barriers were the high staff presence and monitoring coverage in the ICU. The implementation framework includes strategies to be applied before and during implementation, targeting the implementation setting by involving all ICU stakeholders, assessing the intervention?s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, considering the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects in the ICU. Conclusions: Implementation of digital health in the ICU should involve a thorough preimplementation assessment of the ICU?s need for innovation and its readiness to change, as well as an ongoing evaluation of the implementation conditions. Involvement of all stakeholders, transparent communication, and continuous feedback in an equal atmosphere are essential, but leadership roles must be clearly defined and competently filled. Our proposed framework may guide health care providers with concrete, evidence-based, and step-by-step recommendations for implementation practice, facilitating the introduction of digital health in intensive care. Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 UR - https://formative.jmir.org/2022/4/e22866 UR - http://dx.doi.org/10.2196/22866 UR - http://www.ncbi.nlm.nih.gov/pubmed/35394445 ID - info:doi/10.2196/22866 ER - TY - JOUR AU - Elliott, A. Sarah AU - Wright, S. Kelsey AU - Scott, D. Shannon AU - Mohamed, Muna AU - Farah, Asha AU - Hartling, Lisa PY - 2022/4/4 TI - Adapting Child Health Knowledge Translation Tools for Somali Parents: Qualitative Study Exploring Process Considerations and Stakeholder Engagement JO - JMIR Form Res SP - e36354 VL - 6 IS - 4 KW - knowledge translation KW - cultural adaptation KW - trust KW - linguistics KW - parents KW - child health N2 - Background: We have developed a series of knowledge translation (KT) tools that integrate parental experiences to communicate evidence-based information about acute childhood health conditions to parents and caregivers. While we created these tools with parent input, it is unclear if they are useful for diverse parent groups, including specific immigrant and refugee groups in Canada. Objective: This study aims to explore the usefulness of our preexisting KT tools within our local Somali community, and understand what cultural and linguistic adaptations could improve their usability. Methods: After viewing 4 KT tools (differing in design and format) about various acute child health conditions, health care providers (HCPs) and knowledge brokers (KBs) who work with Somali families were interviewed about the usability of these tools and discussed considerations for adapting KT tools for use within the Somali community. Results: A total of 13 HCPs and KBs participated and indicated that the Somali community values accessibility, representation, and the role of trusted others in delivering effective KT products. Understanding accessibility barriers, the power of adequate representation, and engaging meaningfully with prominent community leaders were key suggestions for ensuring relevance of KT products and uptake by community members. Conclusions: This study represents an essential piece of understanding processes for adapting or developing KT products for culturally and linguistically diverse communities. UR - https://formative.jmir.org/2022/4/e36354 UR - http://dx.doi.org/10.2196/36354 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377330 ID - info:doi/10.2196/36354 ER - TY - JOUR AU - Lowery, Julie AU - Fagerlin, Angela AU - Larkin, R. Angela AU - Wiener, S. Renda AU - Skurla, E. Sarah AU - Caverly, J. Tanner PY - 2022/4/1 TI - Implementation of a Web-Based Tool for Shared Decision-making in Lung Cancer Screening: Mixed Methods Quality Improvement Evaluation JO - JMIR Hum Factors SP - e32399 VL - 9 IS - 2 KW - shared decision-making KW - lung cancer KW - screening KW - clinical decision support KW - academic detailing KW - quality improvement KW - implementation N2 - Background: Lung cancer risk and life expectancy vary substantially across patients eligible for low-dose computed tomography lung cancer screening (LCS), which has important consequences for optimizing LCS decisions for different patients. To account for this heterogeneity during decision-making, web-based decision support tools are needed to enable quick calculations and streamline the process of obtaining individualized information that more accurately informs patient-clinician LCS discussions. We created DecisionPrecision, a clinician-facing web-based decision support tool, to help tailor the LCS discussion to a patient?s individualized lung cancer risk and estimated net benefit. Objective: The objective of our study is to test two strategies for implementing DecisionPrecision in primary care at eight Veterans Affairs medical centers: a quality improvement (QI) training approach and academic detailing (AD). Methods: Phase 1 comprised a multisite, cluster randomized trial comparing the effectiveness of standard implementation (adding a link to DecisionPrecision in the electronic health record vs standard implementation plus the Learn, Engage, Act, and Process [LEAP] QI training program). The primary outcome measure was the use of DecisionPrecision at each site before versus after LEAP QI training. The second phase of the study examined the potential effectiveness of AD as an implementation strategy for DecisionPrecision at all 8 medical centers. Outcomes were assessed by comparing absolute tool use before and after AD visits and conducting semistructured interviews with a subset of primary care physicians (PCPs) following the AD visits. Results: Phase 1 findings showed that sites that participated in the LEAP QI training program used DecisionPrecision significantly more often than the standard implementation sites (tool used 190.3, SD 174.8 times on average over 6 months at LEAP sites vs 3.5 SD 3.7 at standard sites; P<.001). However, this finding was confounded by the lack of screening coordinators at standard implementation sites. In phase 2, there was no difference in the 6-month tool use between before and after AD (95% CI ?5.06 to 6.40; P=.82). Follow-up interviews with PCPs indicated that the AD strategy increased provider awareness and appreciation for the benefits of the tool. However, other priorities and limited time prevented PCPs from using them during routine clinical visits. Conclusions: The phase 1 findings did not provide conclusive evidence of the benefit of a QI training approach for implementing a decision support tool for LCS among PCPs. In addition, phase 2 findings showed that our light-touch, single-visit AD strategy did not increase tool use. To enable tool use by PCPs, prediction-based tools must be fully automated and integrated into electronic health records, thereby helping providers personalize LCS discussions among their many competing demands. PCPs also need more time to engage in shared decision-making discussions with their patients. Trial Registration: ClinicalTrials.gov NCT02765412; https://clinicaltrials.gov/ct2/show/NCT02765412 UR - https://humanfactors.jmir.org/2022/2/e32399 UR - http://dx.doi.org/10.2196/32399 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363144 ID - info:doi/10.2196/32399 ER - TY - JOUR AU - Marcu, Gabriela AU - Ondersma, J. Steven AU - Spiller, N. Allison AU - Broderick, M. Brianna AU - Kadri, Reema AU - Buis, R. Lorraine PY - 2022/3/30 TI - Barriers and Considerations in the Design and Implementation of Digital Behavioral Interventions: Qualitative Analysis JO - J Med Internet Res SP - e34301 VL - 24 IS - 3 KW - computers KW - mobile apps KW - screening KW - brief interventions KW - diagnosis KW - computer-assisted/methods KW - surveys and questionnaires KW - motivational interviewing KW - therapy KW - implementation KW - qualitative KW - mobile phone N2 - Background: Digital behavioral interventions have become increasingly popular for their ability to support patient diagnosis and treatment, chronic disease self-management, behavior change, and adherence to recommended care. However, digital intervention development is impeded by challenges such as limited technical skills, limited access to developers, and cost. The purpose of this study is to elicit in-depth qualitative feedback from intervention developers who have interest in digital behavioral interventions but lack programming skills regarding the barriers they experience and key considerations in the design and implementation of digital interventions. Objective: This study aims to understand barriers in the design and implementation of digital behavioral interventions, as well as to identify key considerations for researchers who are developing these interventions. Methods: We conducted semistructured qualitative interviews with 18 researchers who had experience either designing (but not coding) digital behavioral interventions or running research studies with them. Participants were a convenience sample of users of the Computerized Intervention Authoring System platform, an existing no-code development platform for building digital intervention content, and were recruited through either direct email solicitation or snowball sampling. All interviews were conducted and recorded over videoconference between February and April 2020. Recordings from interviews were transcribed and thematically analyzed by multiple coders. Results: Interviews were completed with 18 participants and lasted between 24 and 65 (mean 46.9, SD 11.3) minutes. Interviewees were predominantly female (17/18, 94%) and represented different job roles, ranging from researcher to project/study staff. Three key barriers in the development of digital behavior interventions were identified during interviews: lack of cross-disciplinary understanding; variability in recipients? technology access, infrastructure, and literacy; and the idea that evidence-based in-person interactions do not translate directly to digital interactions. Interviewees identified several key considerations that interventionists learned to prioritize, which have the potential to overcome these barriers and lead to successful interventions. Conclusions: Barriers in the development of digital behavioral interventions are often created by a lack of cross-disciplinary understanding, which can lead to difficulties conceptualizing interventions, unrealistic expectations in terms of cost, and confusion about the development process. Moreover, concerns about research study participant characteristics and access to technology, as well as the translation of in-person interventions to digital, are apparent. Appropriate training in how to work with software development teams may help future digital behavior intervention creators overcome these barriers and may lead to new, exciting innovations in this space. UR - https://www.jmir.org/2022/3/e34301 UR - http://dx.doi.org/10.2196/34301 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353043 ID - info:doi/10.2196/34301 ER - TY - JOUR AU - Ramchandran, S. Rajeev AU - Yousefi-Nooraie, Reza AU - Dadgostar, Porooshat AU - Yilmaz, Sule AU - Basant, Jesica AU - Dozier, M. Ann PY - 2022/3/30 TI - Implementation of Teleophthalmology to Improve Diabetic Retinopathy Surveillance: Qualitative Interview Study of Clinical Staff Informed by Implementation Science Frameworks JO - JMIR Diabetes SP - e32162 VL - 7 IS - 1 KW - Consolidated Framework for Implementation Research KW - teleophthalmology KW - diabetic retinopathy KW - implementation KW - qualitative study KW - Practical, Robust Implementation and Sustainability Model N2 - Background: The store-and-forward camera-based evaluation of the eye, or teleophthalmology, is an effective way to identify diabetic retinopathy, the leading cause of blindness in the United States, but uptake has been slow. Understanding the barriers to and facilitators of implementing teleophthalmology programs from those actively adopting, running, and sustaining such programs is important for widespread adoption. Objective: This study aims to understand the factors that are important in introducing teleophthalmology to improve access to diagnostic eye care for patients with diabetes in primary care clinics by using implementation science. Methods: This qualitative study in 3 urban, low-income, largely racial and ethnic minority?serving safety-net primary care clinics in Rochester, New York, interviewed nurses and physicians on implementing a teleophthalmology program by using questions informed by the Practical, Robust Implementation and Sustainability Model and the Consolidated Framework for Implementation Research. Results: Primary care nurses operationalizing the program in their clinics saw increased work burden and a lack of self-efficacy as barriers. Continuous training on the teleophthalmology process for nurses, physicians, and administrative staff through in-service and peer training by champions and superusers were identified by interviewees as needs. Facilitators included the perceived convenience for the patient and a perceived educational advantage to the program, as it gave an opportunity for providers to discuss the importance of eye care with patients. Concerns in making and tracking referrals to ophthalmology because of challenges related to care coordination were highlighted. The financial aspects of the program (eg, patient coverage and care provider reimbursement) were unclear to many staff members, influencing adoption and sustainability. Conclusions: Streamlining processes and workflows, training and assigning adequate staff, effectively coordinating care between primary care and eye care to improve follow-ups, and ensuring financial viability can all help streamline the adoption of teleophthalmology. UR - https://diabetes.jmir.org/2022/1/e32162 UR - http://dx.doi.org/10.2196/32162 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353038 ID - info:doi/10.2196/32162 ER - TY - JOUR AU - Keizer, Julia AU - Bente, E. Britt AU - Al Naiemi, Nashwan AU - Van Gemert-Pijnen, JEWC Lisette AU - Beerlage-De Jong, Nienke PY - 2022/3/11 TI - Improving the Development and Implementation of Audit and Feedback Systems to Support Health Care Workers in Limiting Antimicrobial Resistance in the Hospital: Scoping Review JO - J Med Internet Res SP - e33531 VL - 24 IS - 3 KW - scoping review KW - audit and feedback KW - eHealth KW - development KW - implementation KW - antimicrobial resistance KW - antibiotic stewardship KW - infection control N2 - Background: For eHealth technologies in general and audit and feedback (AF) systems specifically, integrating interdisciplinary theoretical underpinnings is essential, as it increases the likelihood of achieving desired outcomes by ensuring a fit among eHealth technology, stakeholders, and their context. In addition, reporting on the development and implementation process of AF systems, including substantiations of choices, enables the identification of best practices and accumulation of knowledge across studies but is often not elaborated on in publications. Objective: This scoping review aims to provide insights into the development and implementation strategies for AF systems for a real-world problem that threatens modern health care?antimicrobial resistance?and provide an interdisciplinary conceptual framework that can serve as a checklist and guidance for making informed choices in the development and implementation of future AF systems. Methods: A scoping review was conducted by querying PubMed, Scopus, Web of Science, IEEE Xplore Digital Library, and Embase (?2010) for studies describing either the development or implementation process, or both, of an AF system for antimicrobial resistance or infections in hospitals. Studies reporting only on effectiveness or impact were excluded. A total of 3 independent reviewers performed the study selection, and 2 reviewers constructed the conceptual framework through the axial and selective coding of often-used theories, models, and frameworks (TMFs) from the literature on AF and eHealth development and implementation. Subsequently, the conceptual framework was used for the systematic extraction and interpretation of the studies? descriptions of AF systems and their development and implementation. Results: The search resulted in 2125 studies that were screened for eligibility, of which 12 (0.56%); 2012-2020) were included. These studies described the development and implementation processes heterogeneously in terms of study aims, study targets, target groups, methods, and theoretical underpinnings. Few studies have explicitly explained how choices for the development and implementation of AF systems were substantiated by the TMFs. The conceptual framework provided insights into what is reported on the development and implementation process and revealed underreported AF system constructs (eg, AF system design; engagement with the AF system; and comparison, goal setting, and action planning) and development and implementation (eg, champions) constructs. Conclusions: This scoping review showed the current heterogeneous reporting of AF systems and their development and implementation processes and exemplified how interdisciplinary TMFs can (and should) be balanced in a conceptual framework to capture relevant AF systems and development and implementation constructs. Thereby, it provides a concrete checklist and overall guidance that supports the professionalization and harmonization of AF system development and implementation. For the development and implementation of future AF systems and other eHealth technologies, researchers and health care workers should be supported in selecting and integrating TMFs into their development and implementation process and encouraged to explicitly report on theoretical underpinnings and the substantiation of choices. UR - https://www.jmir.org/2022/3/e33531 UR - http://dx.doi.org/10.2196/33531 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275082 ID - info:doi/10.2196/33531 ER - TY - JOUR AU - Rřislien, Jo AU - O'Hara, K. Jane AU - Smeets, Ionica AU - Brřnnick, Kolbjřrn AU - Berg, Hilde Siv AU - Shortt, Therese Marie AU - Lungu, Adrian Daniel AU - Thune, Henriette AU - Wiig, Siri PY - 2022/3/11 TI - Creating Effective, Evidence-Based Video Communication of Public Health Science (COVCOM Study): Protocol for a Sequential Mixed Methods Effect Study JO - JMIR Res Protoc SP - e34275 VL - 11 IS - 3 KW - pandemics KW - risk KW - public health KW - science communication KW - mixed methods KW - evidence-based medicine KW - COVID-19 N2 - Background: The nonlinear nature of contagious diseases and the potential for exponential growth can be difficult to grasp for the general public. This has strong implications for public health communication, which needs to be both easily accessible and efficient. A pandemic is an extreme situation, and the accompanying strict societal measures are generally easier to accept if one understands the underlying reasoning behind them. Bringing about informed attitude change and achieving compliance to strict restrictions requires explanations of scientific concepts and terminologies that laypersons can understand. Objective: The aim of the project is to develop effective, evidence-based modes of video communication for translating complex, but important, health messages about pandemics to both the general population and decision makers. The study uses COVID-19 as a case to learn and prepare society for handling the ongoing and future pandemics, as well as to provide evidence-based tools for the science communication toolbox. Methods: The project applies a mixed methods design, combining qualitative methods (eg, interviews, observational studies, literature reviews) and quantitative methods (eg, randomized controlled trials [RCTs]). The project brings together researchers from a wide range of academic fields, as well as communication industry professionals. Results: This study has received funding from the Trond Mohn Foundation through the Research Council of Norway?s ?COVID-19 Emergency Call for Proposals? March 2020. Recruitment and data collection for the exploratory first phase of the project ran from February 2021 to March 2021. Creative communication work started in May 2021, and the production of videos for use in the RCTs in the final phase of the project started in September 2021. Conclusions: The COVCOM project will take on several grand challenges within the field of communicating science and provide evidence-based tools to the science communication toolbox. A long-term goal of the project is to contribute to the creation of a more resilient health care system by developing communication responses tailormade for different audiences, preparing society for any future pandemic. International Registered Report Identifier (IRRID): DERR1-10.2196/34275 UR - https://www.researchprotocols.org/2022/3/e34275 UR - http://dx.doi.org/10.2196/34275 UR - http://www.ncbi.nlm.nih.gov/pubmed/35147500 ID - info:doi/10.2196/34275 ER - TY - JOUR AU - Zhao, Junqiang AU - Harvey, Gillian AU - Vandyk, Amanda AU - Gifford, Wendy PY - 2022/3/9 TI - Social Media for ImpLementing Evidence (SMILE): Conceptual Framework JO - JMIR Form Res SP - e29891 VL - 6 IS - 3 KW - social media KW - research use KW - knowledge translation KW - implementation science KW - conceptual framework N2 - Background: Social media has become widely used by individual researchers and professional organizations to translate research evidence into health care practice. Despite its increasing popularity, few social media initiatives consider the theoretical perspectives of how social media works as a knowledge translation strategy to affect research use. Objective: The purpose of this paper is to propose a conceptual framework to understand how social media works as a knowledge translation strategy for health care providers, policy makers, and patients to inform their health care decision-making. Methods: We developed this framework using an integrative approach that first involved reviewing 5 long-standing social media initiatives. We then drafted the initial framework using a deductive approach by referring to 5 theories on social media studies and knowledge translation. A total of 58 empirical studies on factors that influenced the use of social media and its messages and strategies for promoting the use of research evidence via social media were further integrated to substantiate and fine-tune our initial framework. Through an iterative process, we developed the Social Media for ImpLementing Evidence (SMILE) framework. Results: The SMILE framework has six key constructs: developers, messages and delivery strategies, recipients, context, triggers, and outcomes. For social media to effectively enable recipients to use research evidence in their decision-making, the framework proposes that social media content developers respond to target recipients? needs and context and develop relevant messages and appropriate delivery strategies. The recipients? use of social media messages is influenced by the virtual?technical, individual, organizational, and system contexts and can be activated by three types of triggers: sparks, facilitators, and signals. Conclusions: The SMILE framework maps the factors that are hypothesized to influence the use of social media messages by recipients and offers a heuristic device for social media content developers to create interventions for promoting the use of evidence in health care decision-making. Empirical studies are now needed to test the propositions of this framework. UR - https://formative.jmir.org/2022/3/e29891 UR - http://dx.doi.org/10.2196/29891 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262488 ID - info:doi/10.2196/29891 ER - TY - JOUR AU - Sivaratnam, Surabhi AU - Hwang, Kyobin AU - Chee-A-Tow, Alyssandra AU - Ren, Lily AU - Fang, Geoffrey AU - Jibb, Lindsay PY - 2022/2/21 TI - Using Social Media to Engage Knowledge Users in Health Research Priority Setting: Scoping Review JO - J Med Internet Res SP - e29821 VL - 24 IS - 2 KW - social media KW - research priority-setting KW - knowledge user KW - scoping review N2 - Background: The need to include individuals with lived experience (ie, patients, family members, caregivers, researchers, and clinicians) in health research priority setting is becoming increasingly recognized. Social media?based methods represent a means to elicit and prioritize the research interests of such individuals, but there remains sparse methodological guidance on how best to conduct these social media efforts and assess their effectiveness. Objective: This review aims to identify social media strategies that enhance participation in priority-setting research, collate metrics assessing the effectiveness of social media campaigns, and summarize the benefits and limitations of social media?based research approaches, as well as recommendations for prospective campaigns. Methods: We searched PubMed, Embase, Cochrane Library, Scopus, and Web of Science from database inception until September 2021. Two reviewers independently screened all titles and abstracts, as well as full texts for studies that implemented and evaluated social media strategies aimed at engaging knowledge users in research priority setting. We subsequently conducted a thematic analysis to aggregate study data by related codes and themes. Results: A total of 23 papers reporting on 22 unique studies were included. These studies used Facebook, Twitter, Reddit, websites, video-calling platforms, emails, blogs, e-newsletters, and web-based forums to engage with health research stakeholders. Priority-setting engagement strategies included paid platform?based advertisements, email-embedded survey links, and question-and-answer forums. Dissemination techniques for priority-setting surveys included snowball sampling and the circulation of participation opportunities via internal members? and external organizations? social media platforms. Social media campaign effectiveness was directly assessed as number of clicks and impressions on posts, frequency of viewed posts, volume of comments and replies, number of times individuals searched for a campaign page, and number of times a hashtag was used. Campaign effectiveness was indirectly assessed as numbers of priority-setting survey responses and visits to external survey administration sites. Recommendations to enhance engagement included the use of social media group moderators, opportunities for peer-to-peer interaction, and the establishment of a consistent tone and brand. Conclusions: Social media may increase the speed and reach of priority-setting participation opportunities leading to the development of research agendas informed by patients, family caregivers, clinicians, and researchers. Perceived limitations of the approach include underrepresentation of certain demographic groups and addressing such limitations will enhance the inclusion of diverse research priority opinions in future research agendas. UR - https://www.jmir.org/2022/2/e29821 UR - http://dx.doi.org/10.2196/29821 UR - http://www.ncbi.nlm.nih.gov/pubmed/35188476 ID - info:doi/10.2196/29821 ER - TY - JOUR AU - Bucalon, Bernard AU - Shaw, Tim AU - Brown, Kerri AU - Kay, Judy PY - 2022/2/14 TI - State-of-the-art Dashboards on Clinical Indicator Data to Support Reflection on Practice: Scoping Review JO - JMIR Med Inform SP - e32695 VL - 10 IS - 2 KW - practice analytics dashboards KW - data visualization KW - reflective practice KW - professional learning KW - mobile phone N2 - Background: There is an increasing interest in using routinely collected eHealth data to support reflective practice and long-term professional learning. Studies have evaluated the impact of dashboards on clinician decision-making, task completion time, user satisfaction, and adherence to clinical guidelines. Objective: This scoping review aims to summarize the literature on dashboards based on patient administrative, medical, and surgical data for clinicians to support reflective practice. Methods: A scoping review was conducted using the Arksey and O?Malley framework. A search was conducted in 5 electronic databases (MEDLINE, Embase, Scopus, ACM Digital Library, and Web of Science) to identify studies that met the inclusion criteria. Study selection and characterization were performed by 2 independent reviewers (BB and CP). One reviewer extracted the data that were analyzed descriptively to map the available evidence. Results: A total of 18 dashboards from 8 countries were assessed. Purposes for the dashboards were designed for performance improvement (10/18, 56%), to support quality and safety initiatives (6/18, 33%), and management and operations (4/18, 22%). Data visualizations were primarily designed for team use (12/18, 67%) rather than individual clinicians (4/18, 22%). Evaluation methods varied among asking the clinicians directly (11/18, 61%), observing user behavior through clinical indicators and use log data (14/18, 78%), and usability testing (4/18, 22%). The studies reported high scores on standard usability questionnaires, favorable surveys, and interview feedback. Improvements to underlying clinical indicators were observed in 78% (7/9) of the studies, whereas 22% (2/9) of the studies reported no significant changes in performance. Conclusions: This scoping review maps the current literature landscape on dashboards based on routinely collected clinical indicator data. Although there were common data visualization techniques and clinical indicators used across studies, there was diversity in the design of the dashboards and their evaluation. There was a lack of detail regarding the design processes documented for reproducibility. We identified a lack of interface features to support clinicians in making sense of and reflecting on their personal performance data. UR - https://medinform.jmir.org/2022/2/e32695 UR - http://dx.doi.org/10.2196/32695 UR - http://www.ncbi.nlm.nih.gov/pubmed/35156928 ID - info:doi/10.2196/32695 ER - TY - JOUR AU - Aggarwal, Ravi AU - Visram, Sheena AU - Martin, Guy AU - Sounderajah, Viknesh AU - Gautama, Sanjay AU - Jarrold, Kevin AU - Klaber, Robert AU - Maxwell, Shona AU - Neal, John AU - Pegg, Jack AU - Redhead, Julian AU - King, Dominic AU - Ashrafian, Hutan AU - Darzi, Ara PY - 2022/2/8 TI - Defining the Enablers and Barriers to the Implementation of Large-scale, Health Care?Related Mobile Technology: Qualitative Case Study in a Tertiary Hospital Setting JO - JMIR Mhealth Uhealth SP - e31497 VL - 10 IS - 2 KW - mHealth KW - implementation science KW - mobile technology KW - mobile apps KW - clinical applications KW - smartphone apps KW - health care industry KW - stakeholders KW - mobile phone N2 - Background: The successful implementation of clinical smartphone apps in hospital settings requires close collaboration with industry partners. A large-scale, hospital-wide implementation of a clinical mobile app for health care professionals developed in partnership with Google Health and academic partners was deployed on a bring-your-own-device basis using mobile device management at our UK academic hospital. As this was the first large-scale implementation of this type of innovation in the UK health system, important insights and lessons learned from the deployment may be useful to other organizations considering implementing similar technology in partnership with commercial companies. Objective: The aims of this study are to define the key enablers and barriers and to propose a road map for the implementation of a hospital-wide clinical mobile app developed in collaboration with an industry partner as a data processor and an academic partner for independent evaluation. Methods: Semistructured interviews were conducted with high-level stakeholders from industry, academia, and health care providers who had instrumental roles in the implementation of the app at our hospital. The interviews explored the participants? views on the enablers and barriers to the implementation process. The interviews were analyzed using a broadly deductive approach to thematic analysis. Results: In total, 14 participants were interviewed. Key enablers identified were the establishment of a steering committee with high-level clinical involvement, well-defined roles and responsibilities between partners, effective communication strategies with end users, safe information governance precautions, and increased patient engagement and transparency. Barriers identified were the lack of dedicated resources for mobile change at our hospital, risk aversion, unclear strategy and regulation, and the implications of bring-your-own-device and mobile device management policies. The key lessons learned from the deployment process were highlighted, and a road map for the implementation of large-scale clinical mobile apps in hospital settings was proposed. Conclusions: Despite partnering with one of the world?s biggest technology companies, the cultural and technological change required for mobile working and implementation in health care was found to be a significant challenge. With an increasing requirement for health care organizations to partner with industry for advanced mobile technologies, the lessons learned from our implementation can influence how other health care organizations undertake a similar mobile change and improve the chances of successful widespread mobile transformation. UR - https://mhealth.jmir.org/2022/2/e31497 UR - http://dx.doi.org/10.2196/31497 UR - http://www.ncbi.nlm.nih.gov/pubmed/35133287 ID - info:doi/10.2196/31497 ER - TY - JOUR AU - Freebairn, Louise AU - Occhipinti, Jo-An AU - Song, C. Yun Ju AU - Skinner, Adam AU - Lawson, Kenny AU - Lee, Yeeun Grace AU - Hockey, J. Samuel AU - Huntley, Samantha AU - Hickie, B. Ian PY - 2022/2/7 TI - Participatory Methods for Systems Modeling of Youth Mental Health: Implementation Protocol JO - JMIR Res Protoc SP - e32988 VL - 11 IS - 2 KW - participatory system modeling KW - youth mental health KW - co-design KW - public health systems research KW - mental health services N2 - Background: Despite significant investment, mental health issues remain a leading cause of death among young people globally. Sophisticated decision analysis methods are needed to better understand the dynamic and multisector drivers of youth mental health. System modeling can help explore complex issues such as youth mental health and inform strategies to effectively respond to local needs and achieve lasting improvements. The advantages of engaging stakeholders in model development processes have long been recognized; however, the methods for doing so are often not well-described. Objective: This paper aims to describe the participatory procedures that will be used to support systems modeling for national multisite implementation. The Right Care, First Time, Where You Live research program will focus on regional youth mental health applications of systems modeling in 8 different sites across Australia. Methods: The participatory model development approach involves an iterative process of engaging with a range of participants, including people with lived experience of mental health issues. Their knowledge of the local systems, pathways, and drivers is combined with the academic literature and data to populate the models and validate their structure. The process centers around 3 workshops where participants interact and actively engage in group model-building activities to define, refine, and validate the systems models. This paper provides a detailed blueprint for the implementation of this process for mental health applications. Results: The participatory modeling methods described in this paper will be implemented at 2 sites per year from 2022 to 2025. The 8 selected sites have been chosen to capture variations in important factors, including determinants of mental health issues and access to services. Site engagement commenced in August 2021, and the first modeling workshops are scheduled to commence in February 2022. Conclusions: Mental health system decision makers require tools to help navigate complex environments and leverage interdisciplinary problem-solving. Systems modeling can mobilize data from diverse sources to explore a range of scenarios, including the impact of interventions in different combinations and contexts. Involving stakeholders in the model development process ensures that the model findings are context-relevant and fit-for-purpose to inform decision-making. International Registered Report Identifier (IRRID): PRR1-10.2196/32988 UR - https://www.researchprotocols.org/2022/2/e32988 UR - http://dx.doi.org/10.2196/32988 UR - http://www.ncbi.nlm.nih.gov/pubmed/35129446 ID - info:doi/10.2196/32988 ER - TY - JOUR AU - Terlouw, Gijs AU - Kuipers, Derek AU - Veldmeijer, Lars AU - van 't Veer, Job AU - Prins, Jelle AU - Pierie, Jean-Pierre PY - 2022/2/3 TI - Boundary Objects as Dialogical Learning Accelerators for Social Change in Design for Health: Systematic Review JO - JMIR Hum Factors SP - e31167 VL - 9 IS - 1 KW - boundary objects KW - health KW - innovation KW - design KW - systematic review N2 - Background: Boundary objects can add value for innovative design and implementation research in health care through their organizational focus and the dynamic structure between ill-structured and tailored use. However, when innovation is approached as a boundary object, more attention will need to be paid to the preimplementation phase. Research and design thinking pay attention to the preimplementation stage but do not have a social or organizational focus per se. The integration of boundary objects in design methodologies can provide a more social and organizational focus in innovative design projects by mapping out the mechanisms that occur at boundaries during design. Four dialogical learning mechanisms that can be triggered at boundaries have been described in the literature: identification, coordination, reflection, and transformation. These mechanisms seem suitable for integration in innovative design research on health. Objective: Focusing on innovation in health, this study aims to find out whether the different learning mechanisms can be linked to studies on health innovation that mention boundary objects as a concept and assess whether the related mechanisms provide insight into the stage of the design and implementation or change process. Methods: The following 6 databases were searched for relevant abstracts: PubMed, Scopus, Education Resources Information Center, PsycINFO, Information Science and Technology Abstracts, and Embase. These databases cover a wide range of published studies in the field of health. Results: Our initial search yielded 3102 records; after removing the duplicates, 2186 (70.47%) records were screened on the title and abstract, and 25 (0.81%) papers were included; of the 13 papers where we identified 1 mechanism, 5 (38%) described an innovation or innovative project, and of the 12 papers where we identified more mechanisms, 9 (75%) described the development or implementation of an innovation. The reflective mechanism was not identified solely but was present in papers describing a more successful development or implementation project of innovation. In these papers, the predetermined goals were achieved, and the process of integration was relatively smoother. Conclusions: The concept of boundary objects has found its way into health care. Although the idea of a boundary object was introduced to describe how specific artifacts can fulfill a bridging function between different sociocultural sites and thus have a social focus, the focus in the included papers was often on the boundary object itself rather than the social effect. The reflection and transformation mechanisms were underrepresented in the included studies but based on the findings in this review, pursuing to trigger the reflective mechanism in design, development, and implementation projects can lead to a more fluid and smooth integration of innovation into practice. UR - https://humanfactors.jmir.org/2022/1/e31167 UR - http://dx.doi.org/10.2196/31167 UR - http://www.ncbi.nlm.nih.gov/pubmed/35113023 ID - info:doi/10.2196/31167 ER - TY - JOUR AU - Oberschmidt, Kira AU - Grünloh, Christiane AU - Nijboer, Femke AU - van Velsen, Lex PY - 2022/1/28 TI - Best Practices and Lessons Learned for Action Research in eHealth Design and Implementation: Literature Review JO - J Med Internet Res SP - e31795 VL - 24 IS - 1 KW - action research KW - eHealth KW - best practices KW - lessons learned N2 - Background: Action research (AR) is an established research framework to introduce change in a community following a cyclical approach and involving stakeholders as coresearchers in the process. In recent years, it has also been used for eHealth development. However, little is known about the best practices and lessons learned from using AR for eHealth development. Objective: This literature review aims to provide more knowledge on the best practices and lessons learned from eHealth AR studies. Additionally, an overview of the context in which AR eHealth studies take place is given. Methods: A semisystematic review of 44 papers reporting on 40 different AR projects was conducted to identify the best practices and lessons learned in the research studies while accounting for the particular contextual setting and used AR approach. Results: Recommendations include paying attention to the training of stakeholders? academic skills, as well as the various roles and tasks of action researchers. The studies also highlight the need for constant reflection and accessible dissemination suiting the target group. Conclusions: This literature review identified room for improvements regarding communicating and specifying the particular AR definition and applied approach. UR - https://www.jmir.org/2022/1/e31795 UR - http://dx.doi.org/10.2196/31795 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089158 ID - info:doi/10.2196/31795 ER - TY - JOUR AU - Woodcock, W. Elizabeth PY - 2022/1/11 TI - Barriers to and Facilitators of Automated Patient Self-scheduling for Health Care Organizations: Scoping Review JO - J Med Internet Res SP - e28323 VL - 24 IS - 1 KW - appointment KW - scheduling KW - outpatient KW - ambulatory KW - online KW - self-serve KW - e-book KW - web-based KW - automation KW - patient satisfaction KW - self-scheduling KW - eHealth KW - digital health KW - mobile phone N2 - Background: Appointment management in the outpatient setting is important for health care organizations, as waits and delays lead to poor outcomes. Automated patient self-scheduling of outpatient appointments has demonstrable advantages in the form of patients? arrival rates, labor savings, patient satisfaction, and more. Despite evidence of the potential benefits of self-scheduling, the organizational uptake of self-scheduling in health care has been limited. Objective: The objective of this scoping review is to identify and to catalog existing evidence of the barriers to and facilitators of self-scheduling for health care organizations. Methods: A scoping review was conducted by searching 4 databases (PubMed, CINAHL, Business Source Ultimate, and Scopus) and systematically reviewing peer-reviewed studies. The Consolidated Framework for Implementation Research was used to catalog the studies. Results: In total, 30 full-text articles were included in this review. The results demonstrated that self-scheduling initiatives have increased over time, indicating the broadening appeal of self-scheduling. The body of literature regarding intervention characteristics is appreciable. Outer setting factors, including national policy, competition, and the response to patients? needs and technology access, have played an increasing role in influencing implementation over time. Self-scheduling, compared with using the telephone to schedule an appointment, was most often cited as a relative advantage. Scholarly pursuit lacked recommendations related to the framework?s inner setting, characteristics of individuals, and processes as determinants of implementation. Future discoveries regarding these Consolidated Framework for Implementation Research domains may help detect, categorize, and appreciate organizational-level barriers to and facilitators of self-scheduling to advance knowledge regarding this solution. Conclusions: This scoping review cataloged evidence of the existence, advantages, and intervention characteristics of patient self-scheduling. Automated self-scheduling may offer a solution to health care organizations striving to positively affect access. Gaps in knowledge regarding the uptake of self-scheduling by health care organizations were identified to inform future research. UR - https://www.jmir.org/2022/1/e28323 UR - http://dx.doi.org/10.2196/28323 UR - http://www.ncbi.nlm.nih.gov/pubmed/35014968 ID - info:doi/10.2196/28323 ER - TY - JOUR AU - Ulrich, Hannes AU - Kock-Schoppenhauer, Ann-Kristin AU - Deppenwiese, Noemi AU - Gött, Robert AU - Kern, Jori AU - Lablans, Martin AU - Majeed, W. Raphael AU - Stöhr, R. Mark AU - Stausberg, Jürgen AU - Varghese, Julian AU - Dugas, Martin AU - Ingenerf, Josef PY - 2022/1/11 TI - Understanding the Nature of Metadata: Systematic Review JO - J Med Internet Res SP - e25440 VL - 24 IS - 1 KW - metadata KW - metadata definition KW - systematic review KW - data integration KW - data identification KW - data classification N2 - Background: Metadata are created to describe the corresponding data in a detailed and unambiguous way and is used for various applications in different research areas, for example, data identification and classification. However, a clear definition of metadata is crucial for further use. Unfortunately, extensive experience with the processing and management of metadata has shown that the term ?metadata? and its use is not always unambiguous. Objective: This study aimed to understand the definition of metadata and the challenges resulting from metadata reuse. Methods: A systematic literature search was performed in this study following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting on systematic reviews. Five research questions were identified to streamline the review process, addressing metadata characteristics, metadata standards, use cases, and problems encountered. This review was preceded by a harmonization process to achieve a general understanding of the terms used. Results: The harmonization process resulted in a clear set of definitions for metadata processing focusing on data integration. The following literature review was conducted by 10 reviewers with different backgrounds and using the harmonized definitions. This study included 81 peer-reviewed papers from the last decade after applying various filtering steps to identify the most relevant papers. The 5 research questions could be answered, resulting in a broad overview of the standards, use cases, problems, and corresponding solutions for the application of metadata in different research areas. Conclusions: Metadata can be a powerful tool for identifying, describing, and processing information, but its meaningful creation is costly and challenging. This review process uncovered many standards, use cases, problems, and solutions for dealing with metadata. The presented harmonized definitions and the new schema have the potential to improve the classification and generation of metadata by creating a shared understanding of metadata and its context. UR - https://www.jmir.org/2022/1/e25440 UR - http://dx.doi.org/10.2196/25440 UR - http://www.ncbi.nlm.nih.gov/pubmed/35014967 ID - info:doi/10.2196/25440 ER - TY - JOUR AU - Martínez Silvagnoli, Leia AU - Shepherd, Caroline AU - Pritchett, James AU - Gardner, Jason PY - 2022/1/11 TI - Optimizing Readability and Format of Plain Language Summaries for Medical Research Articles: Cross-sectional Survey Study JO - J Med Internet Res SP - e22122 VL - 24 IS - 1 KW - biomedical research KW - health literacy KW - multiple sclerosis KW - plain language summary KW - psoriasis KW - rheumatoid arthritis N2 - Background: Plain language summaries (PLSs) are intended to provide readers with a clear, nontechnical, and easily understandable overview of medical and scientific literature; however, audience preferences for specific PLS formats have yet to be fully explored. Objective: This study aims to evaluate the preferred readability level and format for PLSs of medical research articles of different disease states via a web-based survey of audiences of different age groups. Methods: Articles describing phase III clinical trials published in top-level, peer-reviewed journals between May 2016 and May 2018 were identified for 3 chronic disease states representing a range of adult patient age groups: (1) psoriasis, a skin disease representative of younger patients; (2) multiple sclerosis (MS), a neurological disease representative of middle-aged patients; and (3) rheumatoid arthritis (RA), a painful joint disease representative of older patients. Four PLSs were developed for each research article, of which 3 were text-only summaries (written with high, medium, and low complexity) and 1 was an infographic. To evaluate each of the 4 PLS formats, a 20-question open survey (specific to one of the 3 diseases) was sent to a representative sample selected via UK-based patient association websites, Twitter, and Facebook patient groups. A weighted-average calculation was applied to respondents? ranked preferences for each PLS format. Results: For all 3 articles, the weighted-average preference scores showed that infographic (psoriasis 2.91, MS 2.71, and RA 2.78) and medium-complexity text-based PLS (reading age 14-17 years, US Grade 9-11; psoriasis 2.90; MS 2.47; RA 2.77) were the two most preferred PLS formats. Conclusions: Audience preferences should be accounted for when preparing PLSs to accompany peer-reviewed original research articles. Oversimplified text can be viewed negatively, and graphical summaries or medium-complexity text-based summaries appear to be the most popular. Plain Language Summary: Patients and caregivers should have the chance to read about medical research in a format they can understand. However, we do not know much about the formats that people with different illnesses or ages prefer. Researchers wanted to find out more about this. They selected 3 medical articles about illnesses that affect different age groups: psoriasis (younger patients), multiple sclerosis (middle-aged patients), and rheumatoid arthritis (older patients). They created 4 summaries of each article. One was a graphical summary, and the other 3 were words-only summaries of high, medium, and low complexity. Then, the researchers posted surveys on UK patient group websites and Facebook patient groups to ask people what they thought of the summaries. The surveys were taken by 167 people. These people were patients with psoriasis, multiple sclerosis, or rheumatoid arthritis, or their caregivers. Most were women, and about half had a university degree. For each illness, most people preferred the graphical summary. Among the word-only summaries, most people preferred the medium-complexity wording written for a reading age of 14 to 17 years. People felt that the graphical and medium-complexity summaries were clear and concise, while the others used jargon or were too simple. Authors of medical articles should remember these results when writing summaries for patients. More research is needed about the preferences of other people, such as those with other illnesses. (See Multimedia Appendix 1 for the graphical summary of the plain language summary.) UR - https://www.jmir.org/2022/1/e22122 UR - http://dx.doi.org/10.2196/22122 UR - http://www.ncbi.nlm.nih.gov/pubmed/35014966 ID - info:doi/10.2196/22122 ER - TY - JOUR AU - Břnes, Erlend AU - Granja, Conceiçăo AU - Solvoll, Terje PY - 2022/1/10 TI - Implementation of the Flexible Assertive Community Treatment (FACT) Model in Norway: eHealth Assessment Study JO - J Med Internet Res SP - e32220 VL - 24 IS - 1 KW - mental health KW - FACT KW - electronic health records KW - eHealth KW - FACT implementation KW - EHR KW - implementation KW - assessment KW - model KW - community KW - treatment KW - policy KW - regulation KW - infrastructure KW - literature KW - challenge KW - intervention N2 - Background: Flexible Assertive Community Treatment (FACT) is a model for treatment of long-term severe mental disorders. This method has become more widespread in Norway. Objective: The objective of our study was to examine how the implementation of FACT teams in Norway has been affected by eHealth policy, infrastructure, and regulations. Another objective was to examine existing literature on eHealth interventions and challenges within FACT teams. Methods: We have examined Norwegian policy regulating mental health services, laws and regulations, eHealth infrastructure, relevant literature on FACT teams, and current implementation of FACT in Norway. Results: FACT teams are a wanted part of the Norwegian service system, but the current eHealth infrastructure makes sharing of data within teams and levels of health care challenging, even if eHealth regulations allow such sharing. This has been shown to be an issue in the current implementation of FACT teams in Norway. There is little or no existing research on the eHealth challenges facing FACT teams. Conclusions: Weaknesses in the Norwegian eHealth infrastructure have been a barrier for an easy implementation of FACT teams in Norway. It is difficult to share information between the different levels of health care. We need systems that allow for easy, secure sharing of health information to and between the FACT team members and other involved health care workers. UR - https://www.jmir.org/2022/1/e32220 UR - http://dx.doi.org/10.2196/32220 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006087 ID - info:doi/10.2196/32220 ER - TY - JOUR AU - Miao, Melissa AU - Power, Emma AU - Rietdijk, Rachael AU - Debono, Deborah AU - Brunner, Melissa AU - Salomon, Alexander AU - Mcculloch, Ben AU - Wright, Rebecca Meg AU - Welsh, Monica AU - Tremblay, Bastian AU - Rixon, Caleb AU - Williams, Liz AU - Morrow, Rosemary AU - Evain, Jean-Christophe AU - Togher, Leanne PY - 2022/1/10 TI - Coproducing Knowledge of the Implementation of Complex Digital Health Interventions for Adults with Acquired Brain Injury and their Communication Partners: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e35080 VL - 11 IS - 1 KW - priority setting KW - public involvement KW - implementation science KW - internet interventions KW - acquired brain injury KW - delivery of health care KW - caregivers KW - speech-language pathology KW - brain injury KW - mobile phone N2 - Background: The Social Brain Toolkit, conceived and developed in partnership with stakeholders, is a novel suite of web-based communication interventions for people with brain injury and their communication partners. To support effective implementation, the developers of the Social Brain Toolkit have collaborated with people with brain injury, communication partners, clinicians, and individuals with digital health implementation experience to coproduce new implementation knowledge. In recognition of the equal value of experiential and academic knowledge, both types of knowledge are included in this study protocol, with input from stakeholder coauthors. Objective: This study aims to collaborate with stakeholders to prioritize theoretically based implementation targets for the Social Brain Toolkit, understand the nature of these priorities, and develop targeted implementation strategies to address these priorities, in order to support the Social Brain Toolkit?s implementation. Methods: Theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation, a maximum variation sample (N=35) of stakeholders coproduced knowledge of the implementation of the Social Brain Toolkit. People with brain injury (n=10), communication partners (n=11), and clinicians (n=5) participated in an initial web-based prioritization survey based on the NASSS framework. Survey completion was facilitated by plain English explanations and accessible captioned videos developed through 3 rounds of piloting. A speech-language pathologist also assisted stakeholders with brain injury to participate in the survey via video teleconference. Participants subsequently elaborated on their identified priorities via 7 web-based focus groups, in which researchers and stakeholders exchanged stakeholder perspectives and research evidence from a concurrent systematic review. Stakeholders were supported to engage in focus groups through the use of visual supports and plain English explanations. Additionally, individuals with experience in digital health implementation (n=9) responded to the prioritization survey questions via individual interview. The results will be deductively analyzed in relation to the NASSS framework in a coauthorship process with people with brain injury, communication partners, and clinicians. Results: Ethical approval was received from the University of Technology Sydney Health and Medical Research Ethics Committee (ETH20-5466) on December 15, 2020. Data were collected from April 13 to November 18, 2021. Data analysis is currently underway, with results expected for publication in mid-2022. Conclusions: In this study, researchers supported individuals with living experience of acquired brain injury, of communicating with or clinically supporting someone post injury, and of digital health implementation, to directly access and leverage the latest implementation research evidence and theory. With this support, stakeholders were able to prioritize implementation research targets, develop targeted implementation solutions, and coauthor and publish new implementation findings. The results will be used to optimize the implementation of 3 real-world, evidence-based interventions and thus improve the outcomes of people with brain injury and their communication partners. International Registered Report Identifier (IRRID): DERR1-10.2196/35080 UR - https://www.researchprotocols.org/2022/1/e35080 UR - http://dx.doi.org/10.2196/35080 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006082 ID - info:doi/10.2196/35080 ER - TY - JOUR AU - Ariff, Shabina AU - Maznani, Ikram AU - Bhura, Maria AU - Memon, Zahid AU - Arshad, Tayyaba AU - Samejo, Ahmed Tariq AU - Zaidi, Shujaat AU - Umer, Muhammad AU - Ahmed, Imran AU - Habib, Atif Muhammad AU - Soofi, Bashir Sajid AU - Bhutta, A. Zulfiqar PY - 2022/1/7 TI - Understanding Perceptions and Practices for Designing an Appropriate Community-Based Kangaroo Mother Care Implementation Package: Qualitative Exploratory Study JO - JMIR Form Res SP - e30663 VL - 6 IS - 1 KW - kangaroo mother care KW - low birth weight KW - neonatal mortality formative research KW - Pakistan KW - newborn care N2 - Background: Low birth weight (LBW) is a common outcome of preterm birth, which increases the risk of an infant?s morbidity and mortality. Approximately 20 million infants are born with LBW globally per year. Since a significant number of births in Pakistan take place at home, it is important to focus on the use of kangaroo mother care (KMC), the practice of skin-to-skin contact, in communities to prevent neonatal mortality and morbidity. Objective: We employed a formative research approach to understand the context of communities and facilities with regard to neonatal care and KMC practice. The broader aims were to inform the design and delivery of culturally appropriate platforms to introduce KMC in communities, and develop effective recruitment and retention strategies of KMC in rural areas of the Dadu district in the Sindh province of Pakistan. Methods: We conducted focus group discussions, in-depth interviews, and key informant interviews with families of LBW babies, community members, health care providers, and hospital administrators to identify barriers, enablers, and a knowledge base for KMC interventions. Results: Newborn care practices in communities were found to be suboptimal. The community was generally unaware of the KMC intervention for the care of LBW babies. However, facility health care providers, the community, and family members were willing to provide KMC to improve outcomes. We found significant support from the community members and health care providers for KMC practices. Mothers were also ready to provide intermittent KMC. The administrative staff at the hospitals accepted the introduction of KMC practices for LBW babies. Conclusions: KMC as a method of treating LBW babies is widely accepted in the community. This formative research provides strategically valuable information that will be helpful for developing effective implementation strategies by identifying common community practices for LBW babies, along with identifying the barriers and enablers to KMC practice. UR - https://formative.jmir.org/2022/1/e30663 UR - http://dx.doi.org/10.2196/30663 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994692 ID - info:doi/10.2196/30663 ER - TY - JOUR AU - Edwards, J. Katie AU - Jones, B. Ray AU - Shenton, Deborah AU - Page, Toni AU - Maramba, Inocencio AU - Warren, Alison AU - Fraser, Fiona AU - Kri?aj, Tanja AU - Coombe, Tristan AU - Cowls, Hazel AU - Chatterjee, Arunangsu PY - 2021/12/20 TI - The Use of Smart Speakers in Care Home Residents: Implementation Study JO - J Med Internet Res SP - e26767 VL - 23 IS - 12 KW - voice-activated technology KW - smart speaker KW - care home KW - technology-enabled care KW - older people KW - learning disability KW - digital technology KW - consumer device KW - smart device N2 - Background: The use of smart speakers to improve well-being had been trialed in social care by others; however, we were not aware of their implementation in most care homes across a region in the Southwest of the United Kingdom. For the widespread adoption of new technology, it must be locally demonstrable and become normalized. Objective: The aim of this study was to install smart speakers in care homes in a rural and coastal region and to explore if and how the devices were being used, the barriers to their implementation, and their potential benefits. Methods: Email, workshops, drop-in sessions, phone, and cold calling was used to contact all 230 care homes, offering a free smart speaker and some advisory support. Care homes accepting the devices were asked to complete a feedback diary. Nonresponse rate for diary completion was high and was thus supplemented with a telephone survey. Results: Over the course of 7 months, we installed 156 devices in 92 care homes for older people, 50 devices for people with physical or mental health needs, and 8 for others. The devices were used mainly for music but also for poetry, recipes, light controls, jokes, and video calls. Care home managers reported the benefits for the residents, including enhanced engagement with home activities, enjoyment, calming effects, and the acquisition of new skills. Implementation problems included internet connectivity, staff capacity, and skills. Conclusions: Affordable consumer devices such as smart speakers should be installed in all care homes to benefit residents. Voice-activated technologies are easy to use and promote interaction. This study indicates that implementation in care homes was possible and that smart speakers had multifaceted benefits for residents and staff. Most care homes in this region now use smart speakers for their residents, thereby normalizing this practice. UR - https://www.jmir.org/2021/12/e26767 UR - http://dx.doi.org/10.2196/26767 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932010 ID - info:doi/10.2196/26767 ER - TY - JOUR AU - Darnell, Doyanne AU - Areán, A. Patricia AU - Dorsey, Shannon AU - Atkins, C. David AU - Tanana, J. Michael AU - Hirsch, Tad AU - Mooney, D. Sean AU - Boudreaux, D. Edwin AU - Comtois, Anne Katherine PY - 2021/12/15 TI - Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospitalized Patients: Protocol for Formative and Pilot Feasibility Research JO - JMIR Res Protoc SP - e33695 VL - 10 IS - 12 KW - suicide prevention KW - hospital KW - training KW - e-learning KW - artificial intelligence KW - implementation science KW - user-centered design KW - task-shifting KW - quality assessment KW - fidelity N2 - Background: Suicide is the 10th leading cause of death in the United States, with >47,000 deaths in 2019. Most people who died by suicide had contact with the health care system in the year before their death. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill-building are resource intensive and difficult to implement. Advances in artificial intelligence technology hold promise for improving the scalability and sustainability of training methods, as it is now possible for computers to assess the intervention delivery skills of trainees and provide feedback to guide skill improvements. Much remains to be known about how best to integrate these novel technologies into continuing education for health care providers. Objective: In Project WISE (Workplace Integrated Support and Education), we aim to develop e-learning training in suicide safety planning, enhanced with novel skill-building technologies that can be integrated into the routine workflow of nurses serving patients hospitalized for medical or surgical reasons or traumatic injury. The research aims include identifying strategies for the implementation and workflow integration of both the training and safety planning with patients, adapting 2 existing technologies to enhance general counseling skills for use in suicide safety planning (a conversational agent and an artificial intelligence?based feedback system), observing training acceptability and nurse engagement with the training components, and assessing the feasibility of recruitment, retention, and collection of longitudinal self-report and electronic health record data for patients identified as at risk of suicide. Methods: Our developmental research includes qualitative and observational methods to explore the implementation context and technology usability, formative evaluation of the training paradigm, and pilot research to assess the feasibility of conducting a future cluster randomized pragmatic trial. The trial will examine whether patients hospitalized for medical or surgical reasons or traumatic injury who are at risk of suicide have better suicide-related postdischarge outcomes when admitted to a unit with nurses trained using the skill-building technology than those admitted to a unit with untrained nurses. The research takes place at a level 1 trauma center, which is also a safety-net hospital and academic medical center. Results: Project WISE was funded in July 2019. As of September 2021, we have completed focus groups and usability testing with 27 acute care and 3 acute and intensive care nurses. We began data collection for research aims 3 and 4 in November 2021. All research has been approved by the University of Washington institutional review board. Conclusions: Project WISE aims to further the national agenda to improve suicide prevention in health care settings by training nurses in suicide prevention with medically hospitalized patients using novel e-learning technologies. International Registered Report Identifier (IRRID): DERR1-10.2196/33695 UR - https://www.researchprotocols.org/2021/12/e33695 UR - http://dx.doi.org/10.2196/33695 UR - http://www.ncbi.nlm.nih.gov/pubmed/34914618 ID - info:doi/10.2196/33695 ER - TY - JOUR AU - Kudlow, Paul AU - Brown, Tashauna AU - Eysenbach, Gunther PY - 2021/12/10 TI - Citation Advantage of Promoted Articles in a Cross-Publisher Distribution Platform: 36-Month Follow-up to a Randomized Controlled Trial JO - J Med Internet Res SP - e34051 VL - 23 IS - 12 KW - knowledge translation KW - knowledge KW - dissemination KW - digital knowledge translation KW - digital publishing KW - e-publishing KW - open access KW - scientometrics KW - infometrics N2 - Background: There are limited evidence-based strategies that have been shown to increase the rate at which peer-reviewed articles are cited. In a previously reported randomized controlled trial, we demonstrated that promotion of article links in an online cross-publisher distribution platform (TrendMD) persistently augments citation rates after 12 months, leading to a statistically significant 50% increase in citations relative to the control. Objective: This study aims to investigate if the citation advantage of promoted articles upholds after 36 months. Methods: A total of 3200 published articles in 64 peer-reviewed journals across 8 subject areas were block randomized at the subject level to either the TrendMD group (n=1600) or the control group (n=1600) of the study. Articles were promoted in the TrendMD Network for 6 months. We compared the citation rates in both groups after 36 months. Results: At 36 months, we found the citation advantage endured; articles randomized to TrendMD showed a 28% increase in mean citations relative to the control. The difference in mean citations at 36 months for articles randomized to TrendMD versus the control was 10.52 (95% CI 3.79-17.25) and was statistically significant (P=.001). Conclusions: To our knowledge, this is the first randomized controlled trial to demonstrate how a postpublication article promotion intervention can be used to persistently augment citations of peer-reviewed articles. TrendMD is an efficient digital tool for knowledge translation and dissemination to targeted audiences to facilitate the uptake of research. UR - https://www.jmir.org/2021/12/e34051 UR - http://dx.doi.org/10.2196/34051 UR - http://www.ncbi.nlm.nih.gov/pubmed/34890350 ID - info:doi/10.2196/34051 ER - TY - JOUR AU - Appleton, Rebecca AU - Williams, Julie AU - Vera San Juan, Norha AU - Needle, J. Justin AU - Schlief, Merle AU - Jordan, Harriet AU - Sheridan Rains, Luke AU - Goulding, Lucy AU - Badhan, Monika AU - Roxburgh, Emily AU - Barnett, Phoebe AU - Spyridonidis, Spyros AU - Tomaskova, Magdalena AU - Mo, Jiping AU - Harju-Seppänen, Jasmine AU - Haime, Zoë AU - Casetta, Cecilia AU - Papamichail, Alexandra AU - Lloyd-Evans, Brynmor AU - Simpson, Alan AU - Sevdalis, Nick AU - Gaughran, Fiona AU - Johnson, Sonia PY - 2021/12/9 TI - Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review JO - J Med Internet Res SP - e31746 VL - 23 IS - 12 KW - telemental health KW - COVID-19 KW - remote care KW - telemedicine KW - mental health KW - systematic review, implementation science N2 - Background: Early in 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic. This resulted in several challenges for staff and patients, but also in benefits such as convenience or increased access for people with impaired mobility or in rural areas. There is a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. This is relevant both to future emergency adoption of telemental health and to debates on its future use in routine mental health care. Objective: To investigate the adoption and impacts of telemental health approaches during the COVID-19 pandemic, and facilitators and barriers to optimal implementation. Methods: Four databases (PubMed, PsycINFO, CINAHL, and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic. Preprint servers were also searched. Results of studies were synthesized using framework synthesis. Results: A total of 77 papers met our inclusion criteria. In most studies, the majority of contacts could be transferred to a remote form during the pandemic, and good acceptability to service users and clinicians tended to be reported, at least where the alternative to remote contacts was interrupting care. However, a range of impediments to dealing optimal care by this means were also identified. Conclusions: Implementation of telemental health allowed some continuing support to the majority of service users during the COVID-19 pandemic and has value in an emergency situation. However, not all service users can be reached by this means, and better evidence is now needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these. Trial Registration: PROSPERO International prospective register of systematic reviews CRD42021211025; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021211025 UR - https://www.jmir.org/2021/12/e31746 UR - http://dx.doi.org/10.2196/31746 UR - http://www.ncbi.nlm.nih.gov/pubmed/34709179 ID - info:doi/10.2196/31746 ER - TY - JOUR AU - MacKinnon, Ross Kinnon AU - Kia, Hannah AU - Lacombe-Duncan, Ashley PY - 2021/12/9 TI - Examining TikTok?s Potential for Community-Engaged Digital Knowledge Mobilization With Equity-Seeking Groups JO - J Med Internet Res SP - e30315 VL - 23 IS - 12 KW - trans KW - nonbinary KW - marginalized communities KW - gender-affirming care KW - digital health KW - community-engaged research KW - knowledge mobilization KW - mobile phone UR - https://www.jmir.org/2021/12/e30315 UR - http://dx.doi.org/10.2196/30315 UR - http://www.ncbi.nlm.nih.gov/pubmed/34889739 ID - info:doi/10.2196/30315 ER - TY - JOUR AU - Bailey, E. James AU - Gurgol, Cathy AU - Pan, Eric AU - Njie, Shirilyn AU - Emmett, Susan AU - Gatwood, Justin AU - Gauthier, Lynne AU - Rosas, G. Lisa AU - Kearney, M. Shannon AU - Robler, Kleindienst Samantha AU - Lawrence, H. Raymona AU - Margolis, L. Karen AU - Osunkwo, Ifeyinwa AU - Wilfley, Denise AU - Shah, O. Vallabh PY - 2021/12/7 TI - Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review JO - J Med Internet Res SP - e28503 VL - 23 IS - 12 KW - telehealth KW - scoping review KW - disparities KW - implementation science N2 - Background: Health systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US $386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities. Objective: This paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities. Methods: A systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O?Malley Scoping Review Framework and focused on PCORI?s active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study. Results: PCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71%), web-based interventions (30/41, 73%), real-time videoconferencing (15/41, 37%), remote patient monitoring (8/41, 20%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10%). The studies targeted one or more of PCORI?s priority populations, including racial and ethnic minorities (31/41, 41%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information. Conclusions: Early PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information. UR - https://www.jmir.org/2021/12/e28503 UR - http://dx.doi.org/10.2196/28503 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878986 ID - info:doi/10.2196/28503 ER - TY - JOUR AU - Nadav, Janna AU - Kaihlanen, Anu-Marja AU - Kujala, Sari AU - Laukka, Elina AU - Hilama, Pirjo AU - Koivisto, Juha AU - Keskimäki, Ilmo AU - Heponiemi, Tarja PY - 2021/12/1 TI - How to Implement Digital Services in a Way That They Integrate Into Routine Work: Qualitative Interview Study Among Health and Social Care Professionals JO - J Med Internet Res SP - e31668 VL - 23 IS - 12 KW - digital services KW - implementation KW - health and social care professionals KW - integration KW - normalization process theory KW - interview KW - social work KW - health care KW - focus groups N2 - Background: Although the COVID-19 pandemic has significantly boosted the implementation of digital services worldwide, it has become increasingly important to understand how these solutions are integrated into professionals? routine work. Professionals who are using the services are key influencers in the success of implementations. To ensure successful implementations, it is important to understand the multiprofessional perspective, especially because implementations are likely to increase even more. Objective: The aim of this study is to examine health and social care professionals? experiences of digital service implementations and to identify factors that support successful implementations and should be considered in the future to ensure that the services are integrated into professionals? routine work. Methods: A qualitative approach was used, in which 8 focus group interviews were conducted with 30 health and social care professionals from 4 different health centers in Finland. Data were analyzed using qualitative content analysis. The resulting categories were organized under the components of normalization process theory. Results: Our results suggested 14 practices that should be considered when implementing new digital services into routine work. To get professionals to understand and make sense of the new service, (1) the communication related to the implementation should be comprehensive and continuous and (2) the implementation process should be consistent. (3) A justification for the service being implemented should also be given. The best way to engage the professionals with the service is (4) to give them opportunities to influence and (5) to make sure that they have a positive attitude toward the service. To enact the new service into professionals? routine work, it is important that (6) the organization take a supportive approach by providing support from several easy and efficient sources. The professionals should also have (7) enough time to become familiar with the service, and they should have (8) enough know-how about the service. The training should be (9) targeted individually according to skills and work tasks, and (10) it should be diverse. The impact of the implementation on the professionals? work should be evaluated. The service (11) should be easy to use, and (12) usage monitoring should happen. An opportunity (13) to give feedback on the service should also be offered. Moreover, (14) the service should support professionals? work tasks. Conclusions: We introduce 14 practices for organizations and service providers on how to ensure sustainable implementation of new digital services and the smooth integration into routine work. It is important to pay more attention to comprehensive and continuing communication. Organizations should conduct a competence assessment before training in order to ensure proper alignment. Follow-ups to the implementation process should be performed to guarantee sustainability of the service. Our findings from a forerunner country of digitalization can be useful for countries that are beginning their service digitalization or further developing their digital services. UR - https://www.jmir.org/2021/12/e31668 UR - http://dx.doi.org/10.2196/31668 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855610 ID - info:doi/10.2196/31668 ER - TY - JOUR AU - Jorge, Serafim Ana Elisa AU - Bennell, Louise Kim AU - Kimp, Jared Alexander AU - Campbell, Kate Penny AU - Hinman, Shane Rana PY - 2021/12/1 TI - An e-Learning Program for Physiotherapists to Manage Knee Osteoarthritis Via Telehealth During the COVID-19 Pandemic: Real-World Evaluation Study Using Registration and Survey Data JO - JMIR Med Educ SP - e30378 VL - 7 IS - 4 KW - osteoarthritis KW - knee KW - physiotherapy KW - exercise KW - e-learning KW - telehealth KW - pain KW - education KW - implementation KW - evaluation KW - professional development KW - rehabilitation N2 - Background: The COVID-19 pandemic necessitated clinicians to transition to telehealth, often with little preparation or training. The Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis (PEAK) e-learning modules were developed to upskill physiotherapists in management of knee osteoarthritis (OA) via telehealth and in-person. In the research setting, the e-learning modules are perceived by physiotherapists as effective when they are part of a comprehensive training program for a clinical trial. However, the effectiveness of the modules on their own in a real-world setting is unknown. Objective: This study aims to evaluate the reach, effectiveness, adoption, and implementation of PEAK e-learning modules. Methods: This longitudinal study was informed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Participants were clinicians, researchers, educators, and health care students who registered for access to the modules between April 1 and November 30, 2020. Reach was evaluated by outcomes (countries, referral sources, and attrition) extracted from registration data and embedded within precourse surveys in the Learning Management System (LMS). Effectiveness was evaluated by outcomes (confidence with videoconferencing; likelihood of using education, strengthening exercise, and physical activity in a treatment plan for knee OA; usefulness of modules) measured using a 10-point numeric rating scale (NRS; score range from 1=not confident or likely or useful at all to 10=extremely confident or likely or useful) in pre- and postcourse (on completion) surveys in the LMS. Adoption and implementation were evaluated by demographic and professional characteristics and outcomes related to the use of learning and usefulness of program elements (measured via a 4-point Likert scale, from not at all useful to extremely useful) in a survey administered 4 months after module completion. Results: Broad reach was achieved, with 6720 people from 97 countries registering for access. Among registrants, there were high levels of attrition, with 36.65% (2463/6720) commencing the program and precourse survey and 19.61% (1318/6720) completing all modules and the postcourse survey. The program was effective. Learners who completed the modules demonstrated increased confidence with videoconferencing (mean change 3.1, 95% CI 3.0-3.3 NRS units) and increased likelihood of using education, strengthening and physical activity in a knee OA treatment plan, compared to precourse. Adoption and implementation of learning (n=149 respondents) occurred at 4 months. More than half of the respondents used their learning to structure in-person consultations with patients (80/142, 56.3%) and patient information booklets in their clinical practice (75/142, 52.8%). Conclusions: Findings provide evidence of the reach and effectiveness of an asynchronous self-directed e-learning program in a real-world setting among physiotherapists. The e-learning modules offer clinicians an accessible educational course to learn about best-practice knee OA management, including telehealth delivery via videoconferencing. Attrition across the e-learning program highlights the challenges of keeping learners engaged in self-directed web-based learning. UR - https://mededu.jmir.org/2021/4/e30378 UR - http://dx.doi.org/10.2196/30378 UR - http://www.ncbi.nlm.nih.gov/pubmed/34587585 ID - info:doi/10.2196/30378 ER - TY - JOUR AU - Javidan, Pedram Arshia AU - Brand, Allan AU - Cameron, Andrew AU - D'Ovidio, Tommaso AU - Persaud, Martin AU - Lewis, Kirsten AU - O'Connor, Chris PY - 2021/11/29 TI - Examination of a Canada-Wide Collaboration Platform for Order Sets: Retrospective Analysis JO - J Med Internet Res SP - e26123 VL - 23 IS - 11 KW - evidence-based medicine KW - health informatics KW - knowledge translation KW - order sets KW - Web 2.0 N2 - Background: Knowledge translation and dissemination are some of the main challenges that affect evidence-based medicine. Web 2.0 platforms promote the sharing and collaborative development of content. Executable knowledge tools, such as order sets, are a knowledge translation tool whose localization is critical to its effectiveness but a challenge for organizations to develop independently. Objective: This paper describes a Web 2.0 resource, referred to as the collaborative network (TCN), for order set development designed to share executable knowledge (order sets). This paper also analyzes the scope of its use, describes its use through network analysis, and examines the provision and use of order sets in the platform by organizational size. Methods: Data were collected from Think Research?s TxConnect platform. We measured interorganization sharing across Canadian hospitals using descriptive statistics. A weighted chi-square analysis was used to evaluate institutional size to share volumes based on institution size, with post hoc Cramer V score to measure the strength of association. Results: TCN consisted of 12,495 order sets across 683 diagnoses or processes. Between January 2010 and March 2015, a total of 131 health care organizations representing 360 hospitals in Canada downloaded order sets 105,496 times. Order sets related to acute coronary syndrome, analgesia, and venous thromboembolism were most commonly shared. COVID-19 order sets were among the most actively shared, adjusting for order set lifetime. A weighted chi-square analysis showed nonrandom downloading behavior (P<.001), with medium-sized institutions downloading content from larger institutions acting as the most significant driver of this variance (chi-gram=124.70). Conclusions: In this paper, we have described and analyzed a Web 2.0 platform for the sharing of order set content with significant network activity. The robust use of TCN to access customized order sets reflects its value as a resource for health care organizations when they develop or update their own order sets. UR - https://www.jmir.org/2021/11/e26123 UR - http://dx.doi.org/10.2196/26123 UR - http://www.ncbi.nlm.nih.gov/pubmed/34847055 ID - info:doi/10.2196/26123 ER - TY - JOUR AU - Sandbćk, Amanda AU - Christensen, Due Line AU - Larsen, Lykke Lotte AU - Primholdt Christensen, Nina AU - Kofod, Greek Frida AU - Guassora, Dorrit Ann AU - Merrild, Hoffmann Camilla AU - Assing Hvidt, Elisabeth PY - 2021/11/24 TI - Guidance for Implementing Video Consultations in Danish General Practice: Rapid Cycle Coproduction Study JO - JMIR Form Res SP - e27323 VL - 5 IS - 11 KW - general practice KW - remote consultation KW - implementation science KW - resource guide KW - communication KW - video consultation KW - coproduction KW - rapid analysis KW - workshop KW - intervention development N2 - Background: The COVID-19 pandemic has changed various spheres of health care. General practitioners (GPs) have widely replaced face-to-face consultations with telephone or video consultations (VCs) to reduce the risk of COVID-19 transmission. Using VCs for health service delivery is an entirely new way of practicing for many GPs. However, this transition process has largely been conducted with no formal guidelines, which may have caused implementation barriers. This study presents a rapid cycle coproduction approach for developing a guide to assist VC implementation in general practice. Objective: The aim of this paper is to describe the developmental phases of the VC guide to assist general practices in implementing VCs and summarize the evaluation made by general practice users. Methods: The development of a guide for VC in general practice was structured as a stepped process based on the coproduction and prototyping processes. We used an iterative framework based on rapid qualitative analyses and interdisciplinary collaborations. Thus, the guide was developed in small, repeated cycles of development, implementation, evaluation, and adaptation, with a continuous exchange between research and practice. The data collection process was structured in 3 main phases. First, we conducted a literature review, recorded observations, and held informal and semistructured interviews. Second, we facilitated coproduction with stakeholders through 4 workshops with GPs, a group interview with patient representatives, and individual revisions by GPs. Third, nationwide testing was conducted in 5 general practice clinics and was followed by an evaluation of the guide through interviews with GPs. Results: A rapid cycle coproduction approach was used to explore the needs of general practice in connection with the implementation of VC and to develop useful, relevant, and easily understandable guiding materials. Our findings suggest that a guide for VCs should include advice and recommendations regarding the organization of VCs, the technical setup, the appropriate target groups, patients? use of VCs, the performance of VCs, and the arrangements for booking a VC. Conclusions: The combination of coproduction, prototyping, small iterations, and rapid data analysis is a suitable approach when contextually rich, hands-on guide materials are urgently needed. Moreover, this method could provide an efficient way of developing relevant guide materials for general practice to aid the implementation of new technology beyond the pandemic period. UR - https://formative.jmir.org/2021/11/e27323 UR - http://dx.doi.org/10.2196/27323 UR - http://www.ncbi.nlm.nih.gov/pubmed/34821560 ID - info:doi/10.2196/27323 ER - TY - JOUR AU - Lamontagne, Marie-Eve AU - Gagnon, Marie-Pierre AU - Perreault, Kadija AU - Gauthier, Véronique PY - 2021/11/23 TI - Evaluating the Acceptability, Feasibility, and Outcomes of Two Methods Involving Patients With Disability in Developing Clinical Guidelines: Crossover Pilot Study JO - J Particip Med SP - e24319 VL - 13 IS - 3 KW - clinical practice guidelines KW - patient participation KW - traumatic brain injuries KW - clinical practice KW - patient KW - participation KW - brain injury KW - traumatic N2 - Background: Engaging patients and the public in clinical practice guideline (CPG) development is believed to contribute significantly to guideline quality, but the advantages of the various co-design strategies have not been empirically compared, making it difficult to choose one strategy over another. Objective: This pilot study aims to document the acceptability, feasibility, and outcomes of 2 methods of involving patients in outlining CPG. Methods: A single-blind crossover pragmatic study was performed with patients with traumatic brain injury. The patients experimented with 2 alternative methods of producing clinical practice recommendations (ie, a discussion group and a wiki). The participants rated the acceptability of the 2 methods, and feasibility was assessed using indicators, such as the number of participants who completed the 2 methods and the number of support interventions required. Experts, blinded to the method, independently rated the participants' outcome recommendations for clarity, accuracy, appropriateness, and usefulness. Results: We recruited 20 participants, and 16 completed the study. The acceptability of the 2 methods showed little variation, with qualitative comments expressing a slight preference for the social nature of focus groups. Thus, both methods of involving patients in CPG development appeared feasible, and the experts? opinions of the adapted recommendations were both positive, although the recommendations produced through focus groups were deemed more relevant to support clinical practice. Conclusions: Our results confirm the acceptability and feasibility of focus groups and wikis to allow patients with traumatic brain injury to participate in clinical practice guideline production. This study contributes to the scientific literature by suggesting that the 2 methods were acceptable, feasible, and produced positive outcomes. Trial Registration: ClinicalTrials.gov NCT02023138; https://clinicaltrials.gov/ct2/show/NCT02023138 UR - https://jopm.jmir.org/2021/3/e24319/ UR - http://dx.doi.org/10.2196/24319 UR - http://www.ncbi.nlm.nih.gov/pubmed/34812733 ID - info:doi/10.2196/24319 ER - TY - JOUR AU - Sasaki, Natsu AU - Obikane, Erika AU - Vedanthan, Rajesh AU - Imamura, Kotaro AU - Cuijpers, Pim AU - Shimazu, Taichi AU - Kamada, Masamitsu AU - Kawakami, Norito AU - Nishi, Daisuke PY - 2021/11/23 TI - Implementation Outcome Scales for Digital Mental Health (iOSDMH): Scale Development and Cross-sectional Study JO - JMIR Form Res SP - e24332 VL - 5 IS - 11 KW - implementation outcomes KW - acceptability KW - appropriateness KW - feasibility KW - harm N2 - Background: Digital mental health interventions are being used more than ever for the prevention and treatment of psychological problems. Optimizing the implementation aspects of digital mental health is essential to deliver the program to populations in need, but there is a lack of validated implementation outcome measures for digital mental health interventions. Objective: The primary aim of this study is to develop implementation outcome scales of digital mental health for different levels of stakeholders involved in the implementation process: users, providers, and managers or policy makers. The secondary aim is to validate the developed scale for users. Methods: We developed English and Japanese versions of the implementation outcome scales for digital mental health (iOSDMH) based on the literature review and panel discussions with experts in implementation research and web-based psychotherapy. The study developed acceptability, appropriateness, feasibility, satisfaction, and harm as the outcome measures for users, providers, and managers or policy makers. We conducted evidence-based interventions via the internet using UTSMeD, a website for mental health information (N=200). Exploratory factor analysis (EFA) was conducted to assess the structural validity of the iOSDMH for users. Satisfaction, which consisted of a single item, was not included in the EFA. Results: The iOSDMH was developed for users, providers, and managers or policy makers. The iOSDMH contains 19 items for users, 11 items for providers, and 14 items for managers or policy makers. Cronbach ? coefficients indicated intermediate internal consistency for acceptability (?=.665) but high consistency for appropriateness (?=.776), feasibility (?=.832), and harm (?=.777) of the iOSDMH for users. EFA revealed 3-factor structures, indicating acceptability and appropriateness as close concepts. Despite the similarity between these 2 concepts, we inferred that acceptability and appropriateness should be used as different factors, following previous studies. Conclusions: We developed iOSDMH for users, providers, and managers. Psychometric assessment of the scales for users demonstrated acceptable reliability and validity. Evaluating the components of digital mental health implementation is a major step forward in implementation science. UR - https://formative.jmir.org/2021/11/e24332 UR - http://dx.doi.org/10.2196/24332 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817391 ID - info:doi/10.2196/24332 ER - TY - JOUR AU - Biau, Sandrine AU - Bonnet, Emmanuel AU - Dagenais, Christian AU - De Allegri, Manuela AU - Traoré, Zoumana AU - Ouedraogo, Wahabo Abdoul AU - Sow, Abdramane AU - Dubois-Nguyen, Karina AU - Ridde, Valéry PY - 2021/11/16 TI - Using Information and Communication Technologies to Engage Citizens in Health System Governance in Burkina Faso: Protocol for Action Research JO - JMIR Res Protoc SP - e28780 VL - 10 IS - 11 KW - health governance KW - ICTs KW - citizen participation KW - responsiveness KW - social responsibility KW - Burkina Faso KW - technology platforms KW - democracy KW - health systems KW - equity KW - West Africa KW - public health KW - participation KW - health policy N2 - Background: Health systems are complex systems involving a vast range of actors. In West Africa, they are often not accessible or responsive. Burkina Faso has widely expressed, in its public health policy, the need to improve both access to quality care and health system responsiveness. There is also a strong wish to give more voice to citizens. To support Burkinabč institutions in achieving these goals, we have developed an action research (AR) protocol. Objective: This paper presents the protocol that will address citizens? participation in health policies and their empowerment through the expression of opinions, for accountability, as well as the strengthening of the health system using information and communication technologies (ICTs). Methods: Our approach will consist of (1) enabling people to express their opinions on the health system by means of a toll-free (TF) service coupled with an interactive voice server (IVS); (2) building an information base with anonymous and reliable data; and (3) conducting information awareness-raising activities, including knowledge transfer (KT) and advocacy, social integration activities, development of OpenData platforms, and the capitalization and media coverage of governance issues. For this purpose, the AR project will be implemented in Burkina Faso. The design uses a concurrent mixed-methods approach. This AR project will evaluate the acceptability, process, effectiveness, and economic costs of the device?s implementation. We will also analyze the potential for the data collected by the device to be used to improve practices. Results: Data collection is in progress; the TF number was officially launched on July 1, 2020, and data collection is planned to continue throughout 2021. By using mixed methods, our AR will be approached from a variety of perspectives. Mixed methods will support us in combining the partial insights into sophisticated realities from qualitative inquiries with the data analyses produced by quantitative research. Conclusions: This AR is expected to add knowledge on how to increase the empowerment of the population, especially the most vulnerable, to participate in democratic processes and enjoy and exercise their human rights. This protocol recommends implementing a low-cost, contextually adapted technology, associated with an evidence-based approach and carried out on a significant scale. The originality of this approach lies in the fact that it introduces a real AR dimension with local communities and nongovernmental organizations (NGOs), combined with an integrated strategy of KT and application throughout the project for all stakeholders. International Registered Report Identifier (IRRID): DERR1-10.2196/28780 UR - https://www.researchprotocols.org/2021/11/e28780 UR - http://dx.doi.org/10.2196/28780 UR - http://www.ncbi.nlm.nih.gov/pubmed/34783671 ID - info:doi/10.2196/28780 ER - TY - JOUR AU - Yakovchenko, Vera AU - McInnes, Keith D. AU - Petrakis, Ann Beth AU - Gillespie, Chris AU - Lipschitz, M. Jessica AU - McCullough, B. Megan AU - Richardson, Lorilei AU - Vetter, Brian AU - Hogan, P. Timothy PY - 2021/11/15 TI - Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework JO - JMIR Mhealth Uhealth SP - e31037 VL - 9 IS - 11 KW - implementation science KW - implementation facilitation KW - texting KW - veterans KW - eHealth KW - self-management KW - digital health KW - digital medicine N2 - Background: The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. Objective: We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. Methods: Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. Results: We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different opinions on incorporating patient-generated data into care planning. (3) Value: Supply-side value relied on the flexibility of the aTS and its impact on staff workload whereas demand-side value was driven by patient perceptions of the psychological and behavioral impacts of the aTS. (4) Adopters: Limited clarity on staff roles and responsibilities presented challenges in incorporating the aTS into clinical processes. (5) Organization: Staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered usage. (6) Wider system: Staff focused on enhancing aTS interoperability with the electronic medical record. (7) Embedding and adaptation over time: The interplay of aTS versatility, patient and staff demands, and broader societal changes in preferences for communicating health information facilitated aTS implementation. Conclusions: VHA?s new aTS has the potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain the aTS. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are most relevant to self-management. Trial Registration: ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349 UR - https://mhealth.jmir.org/2021/11/e31037 UR - http://dx.doi.org/10.2196/31037 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779779 ID - info:doi/10.2196/31037 ER - TY - JOUR AU - Cher, Y. Benjamin A. AU - Wilson, A. Eric AU - Pinsky, M. Alexa AU - Townshend, F. Ryan AU - Wolski, V. Ann AU - Broderick, Michael AU - Milen, M. Allison AU - Lau, Audrey AU - Singh, Amrit AU - Cinti, K. Sandro AU - Engelke, G. Carl AU - Saha, K. Anjan PY - 2021/11/1 TI - Utility of a Telephone Triage Hotline in Response to the COVID-19 Pandemic: Longitudinal Observational Study JO - J Med Internet Res SP - e28105 VL - 23 IS - 11 KW - triage KW - telephone KW - COVID-19 KW - utility KW - telemedicine KW - telehealth KW - patient information KW - concern KW - implementation KW - innovation KW - hospital N2 - Background: During the initial months of the COVID-19 pandemic, rapidly rising disease prevalence in the United States created a demand for patient-facing information exchanges that addressed questions and concerns about the disease. One approach to managing increased patient volumes during a pandemic involves the implementation of telephone-based triage systems. During a pandemic, telephone triage hotlines can be employed in innovative ways to conserve medical resources and offer useful population-level data about disease symptomatology and risk factor profiles. Objective: The aim of this study is to describe and evaluate the COVID-19 telephone triage hotline used by a large academic medical center in the midwestern United States. Methods: Michigan Medicine established a telephone hotline to triage inbound patient calls related to COVID-19. For calls received between March 24, 2020, and May 5, 2020, we described total call volume, data reported by callers including COVID-19 risk factors and symptomatology, and distribution of callers to triage algorithm endpoints. We also described symptomatology reported by callers who were directed to the institutional patient portal (online medical visit questionnaire). Results: A total of 3929 calls (average 91 calls per day) were received by the call center during the study period. The maximum total number of daily calls peaked at 211 on March 24, 2020. Call volumes were the highest from 6 AM to 11 AM and during evening hours. Callers were most often directed to the online patient portal (1654/3929, 42%), nursing hotlines (1338/3929, 34%), or employee health services (709/3929, 18%). Cough (126/370 of callers, 34%), shortness of breath (101/370, 27%), upper respiratory infection (28/111, 25%), and fever (89/370, 24%) were the most commonly reported symptoms. Immunocompromised state (23/370, 6%) and age >65 years (18/370, 5%) were the most commonly reported risk factors. Conclusions: The triage algorithm successfully diverted low-risk patients to suitable algorithm endpoints, while directing high-risk patients onward for immediate assessment. Data collected from hotline calls also enhanced knowledge of symptoms and risk factors that typified community members, demonstrating that pandemic hotlines can aid in the clinical characterization of novel diseases. UR - https://www.jmir.org/2021/11/e28105 UR - http://dx.doi.org/10.2196/28105 UR - http://www.ncbi.nlm.nih.gov/pubmed/34559669 ID - info:doi/10.2196/28105 ER - TY - JOUR AU - Kikuchi, Satoru AU - Kodama, Kota AU - Sengoku, Shintaro PY - 2021/10/21 TI - The Significance of Alliance Networks in Research and Development of Digital Health Products for Diabetes: Observational Study JO - JMIR Diabetes SP - e32446 VL - 6 IS - 4 KW - digital health KW - alliance KW - network KW - wearable device KW - diabetes N2 - Background: Digital health has been advancing owing to technological progress by means of smart devices and artificial intelligence, among other developments. In the field of diabetes especially, there are many active use cases of digital technology supporting the treatment of diabetes and improving lifestyle. In the innovation ecosystem, new alliance networks are formed not only by medical device companies and pharmaceutical companies, but also by information and communications technology companies and start-ups. While understanding and utilizing the network structure is important to increase the competitive advantage of companies, there is a lack of previous research describing the structure of alliance networks and the factors that lead to their formation in digital health. Objective: The aim of this study was to explore the significance of alliance networks, focusing on digital health for diabetes, in effectively implementing processes, from the research and development of products or services to their launch and market penetration. Methods: First, we listed the companies and contracts related to digital health for diabetes, visualized the change in the number of companies and the connections between companies in each industry, and analyzed the overview of the network. Second, we calculated the degree, betweenness centrality, and eigenvector centrality of each company in each year. Next, we analyzed the relationship between network centrality and market competitiveness by using annual sales as a parameter of company competitiveness. We also compared the network centrality of each company by industry or headquarters location (or both) and analyzed the characteristics of companies with higher centrality. Finally, we analyzed the relationship between network centrality and the number of products certified or approved by the US Food and Drug Administration. Results: We found the degree centrality of companies was correlated with an increase in their sales. The betweenness and eigenvector centralities of medical devices companies located in the United States were significantly higher than those outside the United States (P=.04 and .005, respectively). Finally, the degree, betweenness, and eigenvector centralities were correlated with an increase in the number of Class III, but not of Class I nor II, medical device products. Conclusions: These findings give rise to new insights into industry ecosystem for digital health and its requirement and expect a contribution to research and development practices in the field of digital health. UR - https://diabetes.jmir.org/2021/4/e32446 UR - http://dx.doi.org/10.2196/32446 UR - http://www.ncbi.nlm.nih.gov/pubmed/34673525 ID - info:doi/10.2196/32446 ER - TY - JOUR AU - Porter, Gwenndolyn AU - Michaud, L. Tzeyu AU - Schwab, J. Robert AU - Hill, L. Jennie AU - Estabrooks, A. Paul PY - 2021/10/20 TI - Reach Outcomes and Costs of Different Physician Referral Strategies for a Weight Management Program Among Rural Primary Care Patients: Type 3 Hybrid Effectiveness-Implementation Trial JO - JMIR Form Res SP - e28622 VL - 5 IS - 10 KW - weight management KW - rural KW - RE-AIM KW - hybrid effectiveness-implementation KW - primary care KW - obesity KW - physicians KW - digital health KW - health technology KW - mobile phone N2 - Background: Rural residents are at high risk for obesity; however, little resources exist to address this disproportional burden of disease. Primary care may provide an opportunity to connect primary care patients with overweight and obesity to effective weight management programming. Objective: The purpose of this study is to examine the utility of different physician referral and engagement processes for improving the reach of an evidence-based and technology-delivered weight management program with counseling support for rural primary care patients. Methods: A total of 5 rural primary care physicians were randomly assigned a sequence of four referral strategies: point-of-care (POC) referral with active telephone follow-up (ATF); POC referral, no ATF; a population health registry?derived letter referral with ATF; and letter referral, no ATF. For registry-derived referrals, physicians screened a list of patients with BMI ?25 and approved patients for participation to receive a personalized referral letter via mail. Results: Out of a potential 991 referrals, 573 (57.8%) referrals were made over 16 weeks, and 98 (9.9%) patients were enrolled in the program (58/98, 59.2% female). Differences based on letter (485/991, 48.9%) versus POC (506/991, 51.1%) referrals were identified for completion (100% vs 7%; P<.001) and for proportion screened (36% vs 12%; P<.001) but not for proportion enrolled (12% vs 8%; P=.10). Patients receiving ATF were more likely to be screened (47% vs 7%; P<.001) and enrolled (15% vs 7%; P<.001) than those not receiving ATF. On the basis of the number of referrals made in each condition, we found variations in the proportion and number of enrollees (POC with ATF: 27/190, 50%; POC no ATF: 14/316, 41%; letter ATF: 30/199; 15.1%; letter no ATF: 27/286, 9.4%). Across all conditions, participants were representative of the racial and ethnic characteristics of the region (60% female, P=.15; 94% White individuals, P=.60; 94% non-Hispanic, P=.19). Recruitment costs totaled US $6192, and the overall recruitment cost per enrolled participant was US $63. Cost per enrolled participant ranged from POC with ATF (US $47), registry-derived letter without ATF (US $52), and POC without ATF (US $56) to registry-derived letter with ATF (US $91). Conclusions: Letter referral with ATF appears to be the best option for enrolling a large number of patients in a digitally delivered weight management program; however, POC with ATF and letters without ATF yielded similar numbers at a lower cost. The best referral option is likely dependent on the best fit with clinical resources. Trial Registration: ClinicalTrials.gov NCT03690557; http://clinicaltrials.gov/ct2/show/NCT03690557 UR - https://formative.jmir.org/2021/10/e28622 UR - http://dx.doi.org/10.2196/28622 UR - http://www.ncbi.nlm.nih.gov/pubmed/34668873 ID - info:doi/10.2196/28622 ER - TY - JOUR AU - Follmann, Andreas AU - Ruhl, Alexander AU - Gösch, Michael AU - Felzen, Marc AU - Rossaint, Rolf AU - Czaplik, Michael PY - 2021/10/18 TI - Augmented Reality for Guideline Presentation in Medicine: Randomized Crossover Simulation Trial for Technically Assisted Decision-making JO - JMIR Mhealth Uhealth SP - e17472 VL - 9 IS - 10 KW - augmented reality KW - smart glasses KW - wearables KW - guideline presentation KW - decision support KW - triage N2 - Background: Guidelines provide instructions for diagnostics and therapy in modern medicine. Various mobile devices are used to represent the potential complex decision trees. An example of time-critical decisions is triage in case of a mass casualty incident. Objective: In this randomized controlled crossover study, the potential of augmented reality for guideline presentation was evaluated and compared with the guideline presentation provided in a tablet PC as a conventional device. Methods: A specific Android app was designed for use with smart glasses and a tablet PC for the presentation of a triage algorithm as an example for a complex guideline. Forty volunteers simulated a triage based on 30 fictional patient descriptions, each with technical support from smart glasses and a tablet PC in a crossover trial design. The time to come to a decision and the accuracy were recorded and compared between both devices. Results: A total of 2400 assessments were performed by the 40 volunteers. A significantly faster time to triage was achieved in total with the tablet PC (median 12.8 seconds, IQR 9.4-17.7; 95% CI 14.1-14.9) compared to that to triage with smart glasses (median 17.5 seconds, IQR 13.2-22.8, 95% CI 18.4-19.2; P=.001). Considering the difference in the triage time between both devices, the additional time needed with the smart glasses could be reduced significantly in the course of assessments (21.5 seconds, IQR 16.5-27.3, 95% CI 21.6-23.2) in the first run, 17.4 seconds (IQR 13-22.4, 95% CI 17.6-18.9) in the second run, and 14.9 seconds (IQR 11.7-18.6, 95% CI 15.2-16.3) in the third run (P=.001). With regard to the accuracy of the guideline decisions, there was no significant difference between both the devices. Conclusions: The presentation of a guideline on a tablet PC as well as through augmented reality achieved good results. The implementation with smart glasses took more time owing to their more complex operating concept but could be accelerated in the course of the study after adaptation. Especially in a non?time-critical working area where hands-free interfaces are useful, a guideline presentation with augmented reality can be of great use during clinical management. UR - https://mhealth.jmir.org/2021/10/e17472 UR - http://dx.doi.org/10.2196/17472 UR - http://www.ncbi.nlm.nih.gov/pubmed/34661548 ID - info:doi/10.2196/17472 ER - TY - JOUR AU - Flood-Grady, Elizabeth AU - Solberg, B. Lauren AU - Baralt, Claire AU - Meyer, Meghan AU - Stevens, Jeff AU - Krieger, L. Janice PY - 2021/10/8 TI - Engaging Institutional Stakeholders to Develop and Implement Guidelines for Recruiting Participants in Research Studies Using Social Media: Mixed Methods, Multi-Phase Process JO - J Med Internet Res SP - e23312 VL - 23 IS - 10 KW - social media KW - research recruitment KW - stakeholder engagement KW - health communication N2 - Background: Limited regulatory guidance surrounding the use of social media channels for participant recruitment is an interdisciplinary challenge. Establishing stakeholder-informed procedures is essential for ethical and effective use of social media for participant recruitment. Objective: This study aims to provide replicable procedures for developing and implementing guidelines for using social media to recruit participants in research studies. Methods: Social media use cases at the university were used to identify institutional stakeholders for the initiative. After establishing workflow procedures, a scoping review of web-based materials about recruitment and research on the internet and social media from 19 peer institutions and 2 federal agencies was conducted to inform the structure of the policies and procedures. End users (investigators and study coordinators; N=14) also provided feedback on the policies and procedures and implementation. Results: Representatives (n=7) from 5 institutional offices and 15 subject-matter experts from 5 areas were identified as stakeholders in the development of policies and procedures. Peers with web-based materials (n=16) identified in the scoping review revealed 4 themes that served as a basis for developing our policies and procedures. End user feedback further informed the policies and procedures and implementation. A centrally managed social media account for communicating with participants and hosting advertising campaigns on social media was also established and, when combined with the policies and procedures, resulted in 39 advertising campaigns, and 2846 participants were enrolled in health and clinical research studies. Conclusions: Our policies and procedures allow research teams to harness the potential of social media to increase study recruitment and participation; the transparent, stakeholder-informed process can be replicated by institutional administrators to establish policies and procedures that meet the interests and needs of their research community. UR - https://www.jmir.org/2021/10/e23312 UR - http://dx.doi.org/10.2196/23312 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623319 ID - info:doi/10.2196/23312 ER - TY - JOUR AU - Lenaerts, Gerlinde AU - Bekkering, E. Geertruida AU - Goossens, Martine AU - De Coninck, Leen AU - Delvaux, Nicolas AU - Cordyn, Sam AU - Adriaenssens, Jef AU - Aertgeerts, Bert AU - Vankrunkelsven, Patrik PY - 2021/10/5 TI - A Tool to Assess the Trustworthiness of Evidence-Based Point-of-Care Information for Health Care Professionals (CAPOCI): Design and Validation Study JO - J Med Internet Res SP - e27174 VL - 23 IS - 10 KW - evidence-based medicine KW - evidence-based practice KW - point-of-care systems KW - health care quality KW - information science KW - practice guidelines as a topic N2 - Background: User-friendly information at the point of care for health care professionals should be well structured, rapidly accessible, comprehensive, and trustworthy. The reliability of information and the associated methodological process must be clear. There is no standard tool to evaluate the trustworthiness of such point-of-care (POC) information. Objective: We aim to develop and validate a new tool for assessment of trustworthiness of evidence-based POC resources to enhance the quality of POC resources and facilitate evidence-based practice. Methods: We designed the Critical Appraisal of Point-of-Care Information (CAPOCI) tool based on the criteria important for assessment of trustworthiness of POC information, reported in a previously published review. A group of health care professionals and methodologists (the authors of this paper) defined criteria for the CAPOCI tool in an iterative process of discussion and pilot testing until consensus was reached. In the next step, all criteria were subject to content validation with a Delphi study. We invited an international panel of 10 experts to rate their agreement with the relevance and wording of the criteria and to give feedback. Consensus was reached when 70% of the experts agreed. When no consensus was reached, we reformulated the criteria based on the experts? comments for a next round of the Delphi study. This process was repeated until consensus was reached for each criterion. In a last step, the interrater reliability of the CAPOCI tool was calculated with a 2-tailed Kendall tau correlation coefficient to quantify the agreement between 2 users who piloted the CAPOCI tool on 5 POC resources. Two scoring systems were tested: a 3-point ordinal scale and a 7-point Likert scale. Results: After validation, the CAPOCI tool was designed with 11 criteria that focused on methodological quality and author-related information. The criteria assess authorship, literature search, use of preappraised evidence, critical appraisal of evidence, expert opinions, peer review, timeliness and updating, conflict of interest, and commercial support. Interrater agreement showed substantial agreement between 2 users for scoring with the 3-point ordinal scale (?=.621, P<.01) and scoring with the 7-point Likert scale (?=.677, P<.01). Conclusions: The CAPOCI tool may support validation teams in the assessment of trustworthiness of POC resources. It may also provide guidance for producers of POC resources. UR - https://www.jmir.org/2021/10/e27174 UR - http://dx.doi.org/10.2196/27174 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609314 ID - info:doi/10.2196/27174 ER - TY - JOUR AU - Snow-Hill, L. Nyssa AU - Donenberg, Geri AU - Feil, G. Edward AU - Smith, R. David AU - Floyd, R. Brenikki AU - Leve, Craig PY - 2021/9/30 TI - A Technology-Based Training Tool for a Health Promotion and Sex Education Program for Justice-Involved Youth: Development and Usability Study JO - JMIR Form Res SP - e31185 VL - 5 IS - 9 KW - health education KW - sexual behavior KW - juvenile delinquency KW - feasibility studies KW - evidence-based practice KW - adolescent health services KW - inservice training KW - implementation science KW - organizational innovation KW - technology KW - risk reduction behavior KW - mobile phone KW - health technology KW - health promotion KW - sexual health N2 - Background: Justice-involved youth are especially vulnerable to mental health distress, substance misuse, and risky sexual activity, amplifying the need for evidence-based programs (EBPs). Yet, uptake of EBPs in the justice system is challenging because staff training is costly in time and effort. Hence, justice-involved youth experience increasing health disparities despite the availability of EBPs. Objective: To counter these challenges, this study develops and pilot-tests a prototype of a technology-based training tool that teaches juvenile justice staff to deliver a uniquely tailored EBP for justice-involved youth?PHAT (Preventing HIV/AIDS Among Teens) Life. PHAT Life is a comprehensive sex education, mental health, and substance use EBP collaboratively designed and tested with guidance from key stakeholders and community members. The training tool addresses implementation barriers that impede uptake and sustainment of EBPs, including staff training and support and implementation costs. Methods: Staff (n=11) from two juvenile justice settings pilot-tested the technology-based training tool, which included five modules. Participants completed measures of HIV and sexually transmitted infection (STI) knowledge, sex education confidence, and implementation outcomes such as training satisfaction, adoption, implementation, acceptability, appropriateness, and sustainability. PHAT Life trainers assessed fidelity through two activity role plays participants submitted upon completing the training modules. Results: Participants demonstrated increases in HIV and STI knowledge (t10=3.07; P=.01), and were very satisfied (mean 4.42, SD 0.36) with the training tool and the PHAT Life curriculum. They believed that the training tool and curriculum could be adopted, implemented, and sustained within their settings as an appropriate and acceptable intervention and training. Conclusions: Overall, the results from this pilot test demonstrate feasibility and support continuing efforts toward completing the training tool and evaluating it within a fully powered randomized controlled trial. Ultimately, this study will provide a scalable option for disseminating an EBP and offers a more cost-effective and sustainable way to train staff in an EBP. UR - https://formative.jmir.org/2021/9/e31185 UR - http://dx.doi.org/10.2196/31185 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591028 ID - info:doi/10.2196/31185 ER - TY - JOUR AU - Qua, Kelli AU - Yu, Fei AU - Patel, Tanha AU - Dave, Gaurav AU - Cornelius, Katherine AU - Pelfrey, M. Clara PY - 2021/9/29 TI - Scholarly Productivity Evaluation of KL2 Scholars Using Bibliometrics and Federal Follow-on Funding: Cross-Institution Study JO - J Med Internet Res SP - e29239 VL - 23 IS - 9 KW - bibliometrics KW - Clinical and Translational Science Award KW - KL2 KW - translational research KW - career development N2 - Background: Evaluating outcomes of the clinical and translational research (CTR) training of a Clinical and Translational Science Award (CTSA) hub (eg, the KL2 program) requires the selection of reliable, accessible, and standardized measures. As measures of scholarly success usually focus on publication output and extramural funding, CTSA hubs have started to use bibliometrics to evaluate the impact of their supported scholarly activities. However, the evaluation of KL2 programs across CTSAs is limited, and the use of bibliometrics and follow-on funding is minimal. Objective: This study seeks to evaluate scholarly productivity, impact, and collaboration using bibliometrics and federal follow-on funding of KL2 scholars from 3 CTSA hubs and to define and assess CTR training success indicators. Methods: The sample included KL2 scholars from 3 CTSA institutions (A-C). Bibliometric data for each scholar in the sample were collected from both SciVal and iCite, including scholarly productivity, citation impact, and research collaboration. Three federal follow-on funding measures (at the 5-year, 8-year, and overall time points) were collected internally and confirmed by examining a federal funding database. Both descriptive and inferential statistical analyses were computed using SPSS to assess the bibliometric and federal follow-on funding results. Results: A total of 143 KL2 scholars were included in the sample with relatively equal groups across the 3 CTSA institutions. The included KL2 scholars produced more publications and citation counts per year on average at the 8-year time point (3.75 publications and 26.44 citation counts) than the 5-year time point (3.4 publications vs 26.16 citation counts). Overall, the KL2 publications from all 3 institutions were cited twice as much as others in their fields based on the relative citation ratio. KL2 scholars published work with researchers from other US institutions over 2 times (5-year time point) or 3.5 times (8-year time point) more than others in their research fields. Within 5 years and 8 years postmatriculation, 44.1% (63/143) and 51.7% (74/143) of KL2 scholars achieved federal funding, respectively. The KL2-scholars of Institution C had a significantly higher citation rate per publication than the other institutions (P<.001). Institution A had a significantly lower rate of nationally field-weighted collaboration than did the other institutions (P<.001). Institution B scholars were more likely to have received federal funding than scholars at Institution A or C (P<.001). Conclusions: Multi-institutional data showed a high level of scholarly productivity, impact, collaboration, and federal follow-on funding achieved by KL2 scholars. This study provides insights on the use of bibliometric and federal follow-on funding data to evaluate CTR training success across institutions. CTSA KL2 programs and other CTR career training programs can benefit from these findings in terms of understanding metrics of career success and using that knowledge to develop highly targeted strategies to support early-stage career development of CTR investigators. UR - https://www.jmir.org/2021/9/e29239 UR - http://dx.doi.org/10.2196/29239 UR - http://www.ncbi.nlm.nih.gov/pubmed/34586077 ID - info:doi/10.2196/29239 ER - TY - JOUR AU - Shikako, Keiko AU - Mogo, I. Ebele R. AU - Grand-Maison, Valerie AU - Simpson, Robert AU - Pritchard-Wiart, Lesley AU - Majnemer, Annette AU - PY - 2021/9/16 TI - Designing User-Centered Mobile Health Initiatives to Promote Healthy Behaviors for Children With Disabilities: Development and Usability Study JO - JMIR Form Res SP - e23877 VL - 5 IS - 9 KW - implementation research KW - mobile health KW - children with disabilities KW - physical activity promotion KW - digital health KW - inclusive leisure participation KW - mobile phone N2 - Background: The gap between research and its practical application in community settings limits its impact on public health. Closing this gap has the potential to improve the well-being of underserved groups, such as children with disabilities. Mobile health has the potential to improve access to community resources and support for underserved populations, thereby encouraging improved health behaviors. Objective: In this feasibility pilot study, we describe the development of the mobile app Jooay. Jooay was developed in partnership with stakeholders to facilitate access to leisure and physical activity community programs for children and youth with disabilities. We also reflect on the lessons learned throughout the implementation process that are relevant for improving the health behaviors of children with disabilities. Methods: We used a participatory action research approach to develop the app. We also administered a survey to current Jooay users and analyzed various app usage indicators to explore use patterns, user feedback, and preferences. Finally, we critically appraised the implementation process through a best practices for implementation research framework. Results: We developed a product that responds to users? identified need to find information and follows accessibility and user-centered design standards. The analysis of usage data revealed that access to the Jooay app is concentrated in urban areas. Perceptions, attitudes, and information needs varied according to the type of user. The use of the mobile app changed over time, and usage decreased after the app was downloaded, indicating a need for the sustained engagement of app users. Users found value in the ability to identify activities that they would not otherwise know about. However, app use alone was not sufficient to improve participation. Although the app was developed based on users? active input in multiple iterations, we encountered challenges with survey recruitment and attrition, suggesting the need for more seamless and engaging means for collecting data within this population. Conclusions: Interactions between users and the app can sustain user engagement and behavior change. We will improve the app?s next iterations by using the information gained from this study to conduct a larger study to assess the relationship among social and material deprivation, urban design, and access to inclusive and adaptive leisure programs. This study will inform the improvement of app listings to improve the use of Jooay by different user groups and promote health through mobile apps for marginalized groups. UR - https://formative.jmir.org/2021/9/e23877 UR - http://dx.doi.org/10.2196/23877 UR - http://www.ncbi.nlm.nih.gov/pubmed/34528886 ID - info:doi/10.2196/23877 ER - TY - JOUR AU - Wharton-Smith, Alexandra AU - Baker, Kevin AU - Roca-Feltrer, Arantxa AU - Rodrigues, Maria AU - Richardson, Sol AU - Bonnington, A. Craig AU - Rassi, Christian AU - Marasciulo, Madeleine AU - Enosse, Sonia AU - Saute, Francisco AU - Aide, Pedro AU - Macete, Eusebio AU - Candrinho, Baltazar PY - 2021/9/15 TI - Assessment of the Feasibility, Acceptability, and Impact of Implementing Seasonal Malaria Chemoprevention in Nampula Province, Mozambique: Protocol for a Hybrid Effectiveness-Implementation Study JO - JMIR Res Protoc SP - e27855 VL - 10 IS - 9 KW - malaria KW - seasonal malaria chemoprevention KW - sulfadoxine-pyrimethamine amodiaquine KW - resistance KW - children under five KW - implementation research KW - Mozambique KW - Africa KW - mobile phone N2 - Background: Malaria is a significant cause of morbidity and mortality in children aged under 5 years in Mozambique. The World Health Organization recommends seasonal malaria chemoprevention (SMC), the administration of four monthly courses of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ), to children aged 3-59 months during rainy season. However, as resistance to SP is widespread in East and Southern Africa, SMC has so far only been implemented across the Sahel in West Africa. Objective: This protocol describes the first phase of a pilot project that aims to assess the protective effect of SP and AQ when used for SMC and investigate the levels of molecular markers of resistance of Plasmodium falciparum to antimalarial medicines in the study districts. In addition, it is important to understand whether SMC is a feasible and acceptable intervention in the context of Nampula Province, Mozambique. Methods: This study will adopt a hybrid effectiveness-implementation design to conduct a mixed methods evaluation with six objectives: a molecular marker study, a nonrandomized controlled trial, an analysis of reported malaria morbidity indicators, a documentation exercise of the contextual SMC adaptation, an acceptability and feasibility assessment, and a coverage and quality assessment. Results: Ethical approval for this study was granted by the Mozambican Ministry of Health National Bioethics Committee on September 15, 2020. Data collection began in October 2020, and data analysis is expected to be completed by August 2021. Conclusions: This research will make a unique contribution to our understanding of whether the combination of SP and AQ, when used for SMC, can confer a protective effect against malaria in children aged 3-59 months in a region where malaria transmission is seasonal and SP resistance is expected to be high. If the project is successful, subsequent phases are expected to provide a more comprehensive assessment of the effectiveness and sustainability of SMCs. International Registered Report Identifier (IRRID): DERR1-10.2196/27855 UR - https://www.researchprotocols.org/2021/9/e27855 UR - http://dx.doi.org/10.2196/27855 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524109 ID - info:doi/10.2196/27855 ER - TY - JOUR AU - Abdelkader, Wael AU - Navarro, Tamara AU - Parrish, Rick AU - Cotoi, Chris AU - Germini, Federico AU - Iorio, Alfonso AU - Haynes, Brian R. AU - Lokker, Cynthia PY - 2021/9/9 TI - Machine Learning Approaches to Retrieve High-Quality, Clinically Relevant Evidence From the Biomedical Literature: Systematic Review JO - JMIR Med Inform SP - e30401 VL - 9 IS - 9 KW - machine learning KW - bioinformatics KW - information retrieval KW - evidence-based medicine KW - literature databases KW - systematic review KW - accuracy KW - medical literature KW - clinical support KW - clinical care N2 - Background: The rapid growth of the biomedical literature makes identifying strong evidence a time-consuming task. Applying machine learning to the process could be a viable solution that limits effort while maintaining accuracy. Objective: The goal of the research was to summarize the nature and comparative performance of machine learning approaches that have been applied to retrieve high-quality evidence for clinical consideration from the biomedical literature. Methods: We conducted a systematic review of studies that applied machine learning techniques to identify high-quality clinical articles in the biomedical literature. Multiple databases were searched to July 2020. Extracted data focused on the applied machine learning model, steps in the development of the models, and model performance. Results: From 3918 retrieved studies, 10 met our inclusion criteria. All followed a supervised machine learning approach and applied, from a limited range of options, a high-quality standard for the training of their model. The results show that machine learning can achieve a sensitivity of 95% while maintaining a high precision of 86%. Conclusions: Machine learning approaches perform well in retrieving high-quality clinical studies. Performance may improve by applying more sophisticated approaches such as active learning and unsupervised machine learning approaches. UR - https://medinform.jmir.org/2021/9/e30401 UR - http://dx.doi.org/10.2196/30401 UR - http://www.ncbi.nlm.nih.gov/pubmed/34499041 ID - info:doi/10.2196/30401 ER - TY - JOUR AU - Jing, Xia PY - 2021/8/27 TI - The Unified Medical Language System at 30 Years and How It Is Used and Published: Systematic Review and Content Analysis JO - JMIR Med Inform SP - e20675 VL - 9 IS - 8 KW - Unified Medical Language System KW - systematic literature analysis KW - biomedical informatics KW - health informatics N2 - Background: The Unified Medical Language System (UMLS) has been a critical tool in biomedical and health informatics, and the year 2021 marks its 30th anniversary. The UMLS brings together many broadly used vocabularies and standards in the biomedical field to facilitate interoperability among different computer systems and applications. Objective: Despite its longevity, there is no comprehensive publication analysis of the use of the UMLS. Thus, this review and analysis is conducted to provide an overview of the UMLS and its use in English-language peer-reviewed publications, with the objective of providing a comprehensive understanding of how the UMLS has been used in English-language peer-reviewed publications over the last 30 years. Methods: PubMed, ACM Digital Library, and the Nursing & Allied Health Database were used to search for studies. The primary search strategy was as follows: UMLS was used as a Medical Subject Headings term or a keyword or appeared in the title or abstract. Only English-language publications were considered. The publications were screened first, then coded and categorized iteratively, following the grounded theory. The review process followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: A total of 943 publications were included in the final analysis. Moreover, 32 publications were categorized into 2 categories; hence the total number of publications before duplicates are removed is 975. After analysis and categorization of the publications, UMLS was found to be used in the following emerging themes or areas (the number of publications and their respective percentages are given in parentheses): natural language processing (230/975, 23.6%), information retrieval (125/975, 12.8%), terminology study (90/975, 9.2%), ontology and modeling (80/975, 8.2%), medical subdomains (76/975, 7.8%), other language studies (53/975, 5.4%), artificial intelligence tools and applications (46/975, 4.7%), patient care (35/975, 3.6%), data mining and knowledge discovery (25/975, 2.6%), medical education (20/975, 2.1%), degree-related theses (13/975, 1.3%), digital library (5/975, 0.5%), and the UMLS itself (150/975, 15.4%), as well as the UMLS for other purposes (27/975, 2.8%). Conclusions: The UMLS has been used successfully in patient care, medical education, digital libraries, and software development, as originally planned, as well as in degree-related theses, the building of artificial intelligence tools, data mining and knowledge discovery, foundational work in methodology, and middle layers that may lead to advanced products. Natural language processing, the UMLS itself, and information retrieval are the 3 most common themes that emerged among the included publications. The results, although largely related to academia, demonstrate that UMLS achieves its intended uses successfully, in addition to achieving uses broadly beyond its original intentions. UR - https://medinform.jmir.org/2021/8/e20675 UR - http://dx.doi.org/10.2196/20675 UR - http://www.ncbi.nlm.nih.gov/pubmed/34236337 ID - info:doi/10.2196/20675 ER - TY - JOUR AU - Lyles, Rees Courtney AU - Adler-Milstein, Julia AU - Thao, Crishyashi AU - Lisker, Sarah AU - Nouri, Sarah AU - Sarkar, Urmimala PY - 2021/8/26 TI - Alignment of Key Stakeholders? Priorities for Patient-Facing Tools in Digital Health: Mixed Methods Study JO - J Med Internet Res SP - e24890 VL - 23 IS - 8 KW - medical informatics KW - medical informatics apps KW - information technology KW - implementation science KW - mixed methods N2 - Background: There is widespread agreement on the promise of patient-facing digital health tools to transform health care. Yet, few tools are in widespread use or have documented clinical effectiveness. Objective: The aim of this study was to gain insight into the gap between the potential of patient-facing digital health tools and real-world uptake. Methods: We interviewed and surveyed experts (in total, n=24) across key digital health stakeholder groups?venture capitalists, digital health companies, payers, and health care system providers or leaders?guided by the Consolidated Framework for Implementation Research. Results: Our findings revealed that external policy, regulatory demands, internal organizational workflow, and integration needs often take priority over patient needs and patient preferences for digital health tools, which lowers patient acceptance rates. We discovered alignment, across all 4 stakeholder groups, in the desire to engage both patients and frontline health care providers in broader dissemination and evaluation of digital health tools. However, major areas of misalignment between stakeholder groups have stymied the progress of digital health tool uptake?venture capitalists and companies focused on external policy and regulatory demands, while payers and providers focused on internal organizational workflow and integration needs. Conclusions: Misalignment of the priorities of digital health companies and their funders with those of providers and payers requires direct attention to improve uptake of patient-facing digital health tools and platforms. UR - https://www.jmir.org/2021/8/e24890 UR - http://dx.doi.org/10.2196/24890 UR - http://www.ncbi.nlm.nih.gov/pubmed/34435966 ID - info:doi/10.2196/24890 ER - TY - JOUR AU - Lapăo, Velez Luís AU - Peyroteo, Mariana AU - Maia, Melanie AU - Seixas, Jorge AU - Gregório, Joăo AU - Mira da Silva, Miguel AU - Heleno, Bruno AU - Correia, César Jorge PY - 2021/8/26 TI - Implementation of Digital Monitoring Services During the COVID-19 Pandemic for Patients With Chronic Diseases: Design Science Approach JO - J Med Internet Res SP - e24181 VL - 23 IS - 8 KW - primary healthcare KW - information systems KW - telemedicine KW - implementation KW - design science research KW - COVID-19 KW - monitoring KW - chronic disease KW - elderly KW - digital health N2 - Background: The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection. Objective: The aim of this project was to support primary health care provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. Methods: For the rapid design and implementation of a digital platform to support primary health care services, we followed the Design Science implementation framework: (1) problem identification and motivation, (2) definition of the objectives aligned with goal-oriented care, (3) artefact design and development based on Scrum, (4) solution demonstration, (5) evaluation, and (6) communication. Results: The digital platform was developed for the specific objectives of the project and successfully piloted in 3 primary health care centers in the Lisbon Health Region. Health professionals (n=53) were able to remotely manage their first patients safely and thoroughly, with high degrees of satisfaction. Conclusions: Although still in the first steps of implementation, its positive uptake, by both health care providers and patients, is a promising result. There were several limitations including the low number of participating health care units. Further research is planned to deploy the platform to many more primary health care centers and evaluate the impact on patient?s health related outcomes. UR - https://www.jmir.org/2021/8/e24181 UR - http://dx.doi.org/10.2196/24181 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313591 ID - info:doi/10.2196/24181 ER - TY - JOUR AU - Tai-Seale, Ming AU - Rosen, Rebecca AU - Ruo, Bernice AU - Hogarth, Michael AU - Longhurst, A. Christopher AU - Lander, Lina AU - Walker, L. Amanda AU - Stults, D. Cheryl AU - Chan, Albert AU - Mazor, Kathleen AU - Garber, Lawrence AU - Millen, Marlene PY - 2021/8/26 TI - Implementation of Patient Engagement Tools in Electronic Health Records to Enhance Patient-Centered Communication: Protocol for Feasibility Evaluation and Preliminary Results JO - JMIR Res Protoc SP - e30431 VL - 10 IS - 8 KW - electronic health record KW - patient portal KW - patient?physician communication KW - agenda setting KW - patient priorities KW - patient engagement KW - health care teams KW - electronic health record documentation KW - standard work KW - digital health N2 - Background: Patient?physician communication during clinical encounters is essential to ensure quality of care. Many studies have attempted to improve patient?physician communication. Incorporating patient priorities into agenda setting and medical decision-making are fundamental to patient-centered communication. Efficient and scalable approaches are needed to empower patients to speak up and prepare physicians to respond. Leveraging electronic health records (EHRs) in engaging patients and health care teams has the potential to enhance the integration of patient priorities in clinical encounters. A systematic approach to eliciting and documenting patient priorities before encounters could facilitate effective communication in such encounters. Objective: In this paper, we report the design and implementation of a set of EHR tools built into clinical workflows for facilitating patient?physician joint agenda setting and the documentation of patient concerns in the EHRs for ambulatory encounters. Methods: We engaged health information technology leaders and users in three health care systems for developing and implementing a set of EHR tools. The goal of these tools is to standardize the elicitation of patient priorities by using a previsit ?patient important issue? questionnaire distributed through the patient portal to the EHR. We built additional EHR documentation tools to facilitate patient?staff communication when the staff records the vital signs and the reason for the visit in the EHR while in the examination room, with a simple transmission method for physicians to incorporate patient concerns in EHR notes. Results: The study is ongoing. The anticipated completion date for survey data collection is November 2021. A total of 34,037 primary care patients from three health systems (n=26,441; n=5136; and n=2460 separately recruited from each system) used the previsit patient important issue questionnaire in 2020. The adoption of the digital previsit questionnaire during the COVID-19 pandemic was much higher in one health care system because it expanded the use of the questionnaire from physicians participating in trials to all primary care providers midway through the year. It also required the use of this previsit questionnaire for eCheck-ins, which are required for telehealth encounters. Physicians and staff suggested anecdotally that this questionnaire helped patient?clinician communication, particularly during the COVID-19 pandemic. Conclusions: EHR tools have the potential to facilitate the integration of patient priorities into agenda setting and documentation in real-world primary care practices. Early results suggest the feasibility and acceptability of such digital tools in three health systems. EHR tools can support patient engagement and clinicians? work during in-person and telehealth visits. They could potentially exert a sustained influence on patient and clinician communication behaviors in contrast to prior ad hoc educational efforts targeting patients or clinicians. Trial Registration: ClinicalTrials.gov NCT03385512; https://clinicaltrials.gov/ct2/show/NCT03385512 International Registered Report Identifier (IRRID): DERR1-10.2196/30431 UR - https://www.researchprotocols.org/2021/8/e30431 UR - http://dx.doi.org/10.2196/30431 UR - http://www.ncbi.nlm.nih.gov/pubmed/34435960 ID - info:doi/10.2196/30431 ER - TY - JOUR AU - Fung, Kenneth AU - Cheng, Sheng-Li AU - Ning, Xuan AU - Li, Tai-Wai Alan AU - Zhang, Jingxuan AU - Liu, Jing-Wen Jenny AU - Hilario, T. Carla AU - Cheng, Xiaojing AU - Yu, Miao AU - Jia, Cun-Xian AU - Gao, Jianguo AU - Wong, Pui-Hing Josephine PY - 2021/8/26 TI - Mental Health Promotion and Stigma Reduction Among University Students Using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) Framework: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e25592 VL - 10 IS - 8 KW - China KW - implementation science KW - intervention KW - mental health KW - stigma reduction KW - university students N2 - Background: Rapid urbanization, academic pressures, and developmental life transition stressors contribute to mental health stress for postsecondary students in China. Effective prevention, early identification, and timely intervention are challenged by stigma, a lack of mental health literacy, and inadequate mental health resources. Objective: Our implementation science (IS) research project is aimed at evaluating the use of an evidence-informed mental health promotion intervention named Acceptance and Commitment to Empowerment ? Linking Youth and ?Xin? (hearts) (ACE-LYNX) to promote university student mental health in Jinan, China. Methods: We will engage and collaborate with Shandong Mental Health Center, the provincial mental health center, and six local universities in different regions of Jinan. The ACE-LYNX intervention aims to reduce social stigma against mental illness, enhance mental health literacy, and improve access to quality mental health care by increasing interdisciplinary collaboration and forming a mental health network. It is based on two evidence-based approaches, Acceptance and Commitment Therapy (ACT) and Group Empowerment Psychoeducation (GEP), and it will be delivered through online learning and in-person group training. The project will train 90 interdisciplinary professionals using the model. They will in turn train 15 professionals and 20 students at each university. The project will adopt the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework, which provides a structure to examine the process and outcomes of implementation using mixed methods comprising quantitative and qualitative approaches along five dimensions: reach, efficacy, adoption, implementation, and maintenance. Results: Over the course of the project, 720 champions will be directly trained. They will contribute to developing a formal and informal mental health network, strengthened by student-led mental health initiatives and professional-led initiatives to promote collaborative care and facilitated care pathways. We anticipate that our project will reach out to 11,000 to 18,000 students. Conclusions: This IS protocol will outline our unique intervention model and key steps to contextualize, implement, and evaluate community-based mental health intervention. International Registered Report Identifier (IRRID): PRR1-10.2196/25592 UR - https://www.researchprotocols.org/2021/8/e25592 UR - http://dx.doi.org/10.2196/25592 UR - http://www.ncbi.nlm.nih.gov/pubmed/34435956 ID - info:doi/10.2196/25592 ER - TY - JOUR AU - Cresswell, Kathrin AU - Sheikh, Aziz AU - Franklin, Dean Bryony AU - Krasuska, Marta AU - The Nguyen, Hung AU - Hinder, Susan AU - Lane, Wendy AU - Mozaffar, Hajar AU - Mason, Kathy AU - Eason, Sally AU - Potts, Henry AU - Williams, Robin PY - 2021/8/19 TI - Interorganizational Knowledge Sharing to Establish Digital Health Learning Ecosystems: Qualitative Evaluation of a National Digital Health Transformation Program in England JO - J Med Internet Res SP - e23372 VL - 23 IS - 8 KW - digital transformation KW - health system KW - learning ecosystem N2 - Background: The English Global Digital Exemplar (GDE) program is one of the first concerted efforts to create a digital health learning ecosystem across a national health service. Objective: This study aims to explore mechanisms that support or inhibit the exchange of interorganizational digital transformation knowledge. Methods: We conducted a formative qualitative evaluation of the GDE program. We used semistructured interviews with clinical, technical, and managerial staff; national program managers and network leaders; nonparticipant observations of knowledge transfer activities through attending meetings, workshops, and conferences; and documentary analysis of policy documents. The data were thematically analyzed by drawing on a theory-informed sociotechnical coding framework. We used a mixture of deductive and inductive methods, supported by NVivo software, to facilitate coding. Results: We conducted 341 one-on-one and 116 group interviews, observed 86 meetings, and analyzed 245 documents from 36 participating provider organizations. We also conducted 51 high-level interviews with policy makers and vendors; performed 77 observations of national meetings, workshops, and conferences; and analyzed 80 national documents. Formal processes put in place by the GDE program to initiate and reinforce knowledge transfer and learning have accelerated the growth of informal knowledge networking and helped establish the foundations of a learning ecosystem. However, formal networks were most effective when supported by informal networking. The benefits of networking were enhanced (and costs reduced) by geographical proximity, shared culture and context, common technological functionality, regional and strategic alignments, and professional agendas. Conclusions: Knowledge exchange is most effective when sustained through informal networking driven by the mutual benefits of sharing knowledge and convergence between group members in their organizational and technological setting and goals. Policy interventions need to enhance incentives and reduce barriers to sharing across the ecosystem, be flexible in tailoring formal interventions to emerging needs, and promote informal knowledge sharing. UR - https://www.jmir.org/2021/8/e23372 UR - http://dx.doi.org/10.2196/23372 UR - http://www.ncbi.nlm.nih.gov/pubmed/34420927 ID - info:doi/10.2196/23372 ER - TY - JOUR AU - Smith-MacDonald, Lorraine AU - Jones, Chelsea AU - Sevigny, Phillip AU - White, Allison AU - Laidlaw, Alexa AU - Voth, Melissa AU - Mikolas, Cynthia AU - Heber, Alexandra AU - Greenshaw, J. Andrew AU - Brémault-Phillips, Suzette PY - 2021/8/12 TI - The Experience of Key Stakeholders During the Implementation and Use of Trauma Therapy via Digital Health for Military, Veteran, and Public Safety Personnel: Qualitative Thematic Analysis JO - JMIR Form Res SP - e26369 VL - 5 IS - 8 KW - trauma KW - mental health KW - telemedicine KW - therapy KW - rehabilitation KW - digital health KW - psychotherapy KW - military KW - veteran KW - first responder KW - public safety personnel KW - teletherapy KW - telepsychiatry KW - mobile phone N2 - Background: Exposure to occupational stressors and potentially psychologically traumatic events experienced by public safety personnel (eg, paramedics, police, fire, and correctional officers), military members, and veterans can lead to the development of posttraumatic stress injuries and other mental health disorders. Providing emergency services during COVID-19 has intensified the challenges. Owing to COVID-19 restrictions, mental health service providers offering support to these populations have had to rapidly pivot to use digital versus in-person methods of service delivery. Objective: This paper aims to explore the experience of mental health service providers regarding digital health service delivery, including the current state of digital mental health service delivery, barriers to and facilitators of the use of digital health for mental health service delivery experienced during the pandemic, and recommendations for implementing and integrating digital health into regular mental health service delivery. Methods: This embedded mixed-methods study included questionnaires and focus groups with key stakeholders (N=31) with knowledge and experience in providing mental health services. Data analysis included descriptive, quantitative, and qualitative thematic analyses. Results: The following three themes emerged: being forced into change, daring to deliver mental health services using digital health, and future possibilities offered by digital health. In each theme, participants? responses reflected their perceptions of service providers, organizations, and clients. The findings offer considerations regarding for whom and at what point in treatment digital health delivery is appropriate; recommendations for training, support, resources, and guidelines for digitally delivering trauma therapy; and a better understanding of factors influencing mental health service providers? perceptions and acceptance of digital health for mental health service delivery. Conclusions: The results indicate the implementation of digital health for mental health service delivery to military members, public safety personnel, and veterans. As the COVID-19 pandemic continues, remote service delivery methods for trauma therapy are urgently needed to support the well-being of those who have served and continue to serve. UR - https://formative.jmir.org/2021/8/e26369 UR - http://dx.doi.org/10.2196/26369 UR - http://www.ncbi.nlm.nih.gov/pubmed/34387549 ID - info:doi/10.2196/26369 ER - TY - JOUR AU - Jambaulikar, D. Guruprasad AU - Marshall, Andrew AU - Hasdianda, Adrian Mohammad AU - Cao, Chenzhe AU - Chen, Paul AU - Miyawaki, Steven AU - Baugh, W. Christopher AU - Zhang, Haipeng AU - McCabe, Jonathan AU - Su, Jennifer AU - Landman, B. Adam AU - Chai, Ray Peter PY - 2021/8/4 TI - Electronic Paper Displays in Hospital Operations: Proposal for Deployment and Implementation JO - JMIR Form Res SP - e30862 VL - 5 IS - 8 KW - electronic ink KW - patient satisfaction KW - display systems KW - whiteboards KW - hospital KW - deployment KW - proposal KW - implementation KW - communication KW - engagement KW - efficiency KW - usage N2 - Background: Display signage is ubiquitous and essential in hospitals to serve several clerical, operational, and clinical functions, including displaying notices, providing directions, and presenting clinical information. These functions improve efficiency and patient engagement, reduce errors, and enhance the continuity of care. Over time, signage has evolved from analog approaches such as whiteboards and handwritten notices to digital displays such as liquid crystal displays, light emitting diodes, and, now, electronic ink displays. Electronic ink displays are paper-like displays that are not backlit and show content by aligning microencapsulated color beads in response to an applied electric current. Power is only required to generate content and not to retain it. These displays are very readable, with low eye strain; minimize the emission of blue light; require minimal power; and can be driven by several data sources, ranging from virtual servers to electronic health record systems. These attributes make adapting electronic ink displays to hospitals an ideal use case. Objective: In this paper, we aimed to outline the use of signage and displays in hospitals with a focus on electronic ink displays. We aimed to assess the advantages and limitations of using these displays in hospitals and outline the various public-facing and patient-facing applications of electronic ink displays. Finally, we aimed to discuss the technological considerations and an implementation framework that must be followed when adopting and deploying electronic ink displays. Methods: The public-facing applications of electronic ink displays include signage and way-finders, timetables for shared workspaces, and noticeboards and bulletin boards. The clinical display applications may be smaller form factors such as door signs or bedside cards. The larger, ?40-inch form factors may be used within patient rooms or at clinical command centers as a digital whiteboard to display general information, patient and clinician information, and care plans. In all these applications, such displays could replace analog whiteboards, noticeboards, and even other digital screens. Results: We are conducting pilot research projects to delineate best use cases and practices in adopting electronic ink displays in clinical settings. This will entail liaising with key stakeholders, gathering objective logistical and feasibility data, and, ultimately, quantifying and describing the effect on clinical care and patient satisfaction. Conclusions: There are several use cases in a clinical setting that may lend themselves perfectly to electronic ink display use. The main considerations to be studied in this adoption are network connectivity, content management, privacy and security robustness, and detailed comparison with existing modalities. Electronic ink displays offer a superior opportunity to future-proof existing practices. There is a need for theoretical considerations and real-world testing to determine if the advantages outweigh the limitations of electronic ink displays. UR - https://formative.jmir.org/2021/8/e30862 UR - http://dx.doi.org/10.2196/30862 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346904 ID - info:doi/10.2196/30862 ER - TY - JOUR AU - Erskine, Natalie AU - Hendricks, Sharief PY - 2021/7/28 TI - The Use of Twitter by Medical Journals: Systematic Review of the Literature JO - J Med Internet Res SP - e26378 VL - 23 IS - 7 KW - Twitter KW - social media KW - medical journals KW - impact N2 - Background: Medical journals use Twitter to engage and disseminate their research articles and implement a range of strategies to maximize reach and impact. Objective: This study aims to systematically review the literature to synthesize and describe the different Twitter strategies used by medical journals and their effectiveness on journal impact and readership metrics. Methods: A systematic search of the literature before February 2020 in four electronic databases (PubMed, Web of Science, Scopus, and ScienceDirect) was conducted. Articles were reviewed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Results: The search identified 44 original research studies that evaluated Twitter strategies implemented by medical journals and analyzed the relationship between Twitter metrics and alternative and citation-based metrics. The key findings suggest that promoting publications on Twitter improves citation-based and alternative metrics for academic medical journals. Moreover, implementing different Twitter strategies maximizes the amount of attention that publications and journals receive. The four key Twitter strategies implemented by many medical journals are tweeting the title and link of the article, infographics, podcasts, and hosting monthly internet-based journal clubs. Each strategy was successful in promoting the publications. However, different metrics were used to measure success. Conclusions: Four key Twitter strategies are implemented by medical journals: tweeting the title and link of the article, infographics, podcasts, and hosting monthly internet-based journal clubs. In this review, each strategy was successful in promoting publications but used different metrics to measure success. Thus, it is difficult to conclude which strategy is most effective. In addition, the four strategies have different costs and effects on dissemination and readership. We recommend that journals and researchers incorporate a combination of Twitter strategies to maximize research impact and capture audiences with a variety of learning methods. UR - https://www.jmir.org/2021/7/e26378 UR - http://dx.doi.org/10.2196/26378 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319238 ID - info:doi/10.2196/26378 ER - TY - JOUR AU - Monzani, Alice AU - Tagliaferri, Francesco AU - Bellone, Simonetta AU - Genoni, Giulia AU - Rabbone, Ivana PY - 2021/7/23 TI - A Global Overview of COVID-19 Research in the Pediatric Field: Bibliometric Review JO - JMIR Pediatr Parent SP - e24791 VL - 4 IS - 3 KW - COVID-19 KW - SARS-CoV-2 KW - children KW - pediatrics KW - bibliometric review KW - publications KW - research KW - literature KW - review N2 - Background: Since the beginning of the COVID-19 pandemic, a great number of papers have been published in the pediatric field. Objective: We aimed to assess research around the globe on COVID-19 in the pediatric field by bibliometric analysis, identifying publication trends and topic dissemination and showing the relevance of publishing authors, institutions, and countries. Methods: The Scopus database was comprehensively searched for all indexed documents published between January 1, 2020, and June 11, 2020, dealing with COVID-19 in the pediatric population (0-18 years). A machine learning bibliometric methodology was applied to evaluate the total number of papers and citations, journal and publication types, the top productive institutions and countries and their scientific collaboration, and core keywords. Results: A total of 2301 papers were retrieved, with an average of 4.8 citations per article. Of this, 1078 (46.9%) were research articles, 436 (18.9%) were reviews, 363 (15.8%) were letters, 186 (8.1%) were editorials, 7 (0.3%) were conference papers, and 231 (10%) were categorized as others. The studies were published in 969 different journals, headed by The Lancet. The retrieved papers were published by a total of 12,657 authors from 114 countries. The most productive countries were the United States, China, and Italy. The four main clusters of keywords were pathogenesis and clinical characteristics (keyword occurrences: n=2240), public health issues (n=352), mental health (n=82), and therapeutic aspects (n=70). Conclusions: In the pediatric field, a large number of articles were published within a limited period on COVID-19, testifying to the rush to spread new findings on the topic in a timely manner. The leading authors, countries, and institutions evidently belonged to the most impacted geographical areas. A focus on the pediatric population was often included in general articles, and pediatric research about COVID-19 mainly focused on the clinical features, public health issues, and psychological impact of the disease. UR - https://pediatrics.jmir.org/2021/3/e24791 UR - http://dx.doi.org/10.2196/24791 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081597 ID - info:doi/10.2196/24791 ER - TY - JOUR AU - Fecho, Karamarie AU - Bizon, Chris AU - Miller, Frederick AU - Schurman, Shepherd AU - Schmitt, Charles AU - Xue, William AU - Morton, Kenneth AU - Wang, Patrick AU - Tropsha, Alexander PY - 2021/7/20 TI - A Biomedical Knowledge Graph System to Propose Mechanistic Hypotheses for Real-World Environmental Health Observations: Cohort Study and Informatics Application JO - JMIR Med Inform SP - e26714 VL - 9 IS - 7 KW - knowledge graph KW - knowledge representation KW - data exploration KW - generalizability KW - discovery KW - open science KW - immune-mediated disease N2 - Background: Knowledge graphs are a common form of knowledge representation in biomedicine and many other fields. We developed an open biomedical knowledge graph?based system termed Reasoning Over Biomedical Objects linked in Knowledge Oriented Pathways (ROBOKOP). ROBOKOP consists of both a front-end user interface and a back-end knowledge graph. The ROBOKOP user interface allows users to posit questions and explore answer subgraphs. Users can also posit questions through direct Cypher query of the underlying knowledge graph, which currently contains roughly 6 million nodes or biomedical entities and 140 million edges or predicates describing the relationship between nodes, drawn from over 30 curated data sources. Objective: We aimed to apply ROBOKOP to survey data on workplace exposures and immune-mediated diseases from the Environmental Polymorphisms Registry (EPR) within the National Institute of Environmental Health Sciences. Methods: We analyzed EPR survey data and identified 45 associations between workplace chemical exposures and immune-mediated diseases, as self-reported by study participants (n= 4574), with 20 associations significant at P<.05 after false discovery rate correction. We then used ROBOKOP to (1) validate the associations by determining whether plausible connections exist within the ROBOKOP knowledge graph and (2) propose biological mechanisms that might explain them and serve as hypotheses for subsequent testing. We highlight the following three exemplar associations: carbon monoxide-multiple sclerosis, ammonia-asthma, and isopropanol-allergic disease. Results: ROBOKOP successfully returned answer sets for three queries that were posed in the context of the driving examples. The answer sets included potential intermediary genes, as well as supporting evidence that might explain the observed associations. Conclusions: We demonstrate real-world application of ROBOKOP to generate mechanistic hypotheses for associations between workplace chemical exposures and immune-mediated diseases. We expect that ROBOKOP will find broad application across many biomedical fields and other scientific disciplines due to its generalizability, speed to discovery and generation of mechanistic hypotheses, and open nature. UR - https://medinform.jmir.org/2021/7/e26714 UR - http://dx.doi.org/10.2196/26714 UR - http://www.ncbi.nlm.nih.gov/pubmed/34283031 ID - info:doi/10.2196/26714 ER - TY - JOUR AU - Moran, Addy AU - Hampton, Shawn AU - Dowson, Scott AU - Dagdelen, John AU - Trewartha, Amalie AU - Ceder, Gerbrand AU - Persson, Kristin AU - Saxon, Elise AU - Barker, Andrew AU - Charles, Lauren AU - Webb-Robertson, Bobbie-Jo PY - 2021/7/16 TI - Online Interactive Platform for COVID-19 Literature Visual Analytics: Platform Development Study JO - J Med Internet Res SP - e26995 VL - 23 IS - 7 KW - COVID-19 KW - visual analytics KW - natural language processing KW - scientific literature KW - software KW - online platform KW - literature KW - interactive KW - publish KW - research KW - tool KW - pattern KW - usability N2 - Background: Papers on COVID-19 are being published at a high rate and concern many different topics. Innovative tools are needed to aid researchers to find patterns in this vast amount of literature to identify subsets of interest in an automated fashion. Objective: We present a new online software resource with a friendly user interface that allows users to query and interact with visual representations of relationships between publications. Methods: We publicly released an application called PLATIPUS (Publication Literature Analysis and Text Interaction Platform for User Studies) that allows researchers to interact with literature supplied by COVIDScholar via a visual analytics platform. This tool contains standard filtering capabilities based on authors, journals, high-level categories, and various research-specific details via natural language processing and dozens of customizable visualizations that dynamically update from a researcher?s query. Results: PLATIPUS is available online and currently links to over 100,000 publications and is still growing. This application has the potential to transform how COVID-19 researchers use public literature to enable their research. Conclusions: The PLATIPUS application provides the end user with a variety of ways to search, filter, and visualize over 100,00 COVID-19 publications. UR - https://www.jmir.org/2021/7/e26995 UR - http://dx.doi.org/10.2196/26995 UR - http://www.ncbi.nlm.nih.gov/pubmed/34138726 ID - info:doi/10.2196/26995 ER - TY - JOUR AU - Lantoine, Joséphine AU - Brysse, Anne AU - Dideberg, Vinciane AU - Claes, Kathleen AU - Symoens, Sofie AU - Coucke, Wim AU - Benoit, Valérie AU - Rombout, Sonia AU - De Rycke, Martine AU - Seneca, Sara AU - Van Laer, Lut AU - Wuyts, Wim AU - Corveleyn, Anniek AU - Van Den Bogaert, Kris AU - Rydlewski, Catherine AU - Wilkin, Françoise AU - Ravoet, Marie AU - Fastré, Elodie AU - Capron, Arnaud AU - Vandevelde, Monique Nathalie PY - 2021/7/12 TI - Frequency of Participation in External Quality Assessment Programs Focused on Rare Diseases: Belgian Guidelines for Human Genetics Centers JO - JMIR Med Inform SP - e27980 VL - 9 IS - 7 KW - human genetics KW - external quality assessment KW - quality control KW - proficiency testing KW - frequency KW - genetic testing KW - rare diseases KW - cost-effectiveness KW - surveillance, public health authorities KW - public health KW - health informatics KW - medical informatics KW - genetics KW - algorithm N2 - Background: Participation in quality controls, also called external quality assessment (EQA) schemes, is required for the ISO15189 accreditation of the Medical Centers of Human Genetics. However, directives on the minimal frequency of participation in genetic quality control schemes are lacking or too heterogeneous, with a possible impact on health care quality. Objective: The aim of this project is to develop Belgian guidelines on the frequency of participation in quality controls for genetic testing in the context of rare diseases. Methods: A group of experts analyzed 90 EQA schemes offered by accredited providers and focused on analyses used for the diagnosis of rare diseases. On that basis, the experts developed practical recommendations about the minimal frequencies of participation of the Medical Centers of Human Genetics in quality controls and how to deal with poor performances and change management. These guidelines were submitted to the Belgian Accreditation Body and then reviewed and approved by the Belgian College of Human Genetics and Rare Diseases and by the National Institute for Health and Disability Insurance. Results: The guidelines offer a decisional algorithm for the minimal frequency of participation in human genetics EQA schemes. This algorithm has been developed taking into account the scopes of the EQA schemes, the levels of experience, and the annual volumes of the Centers of Human Genetics in the performance of the tests considered. They include three key principles: (1) the recommended annual assessment of all genetic techniques and technological platforms, if possible through EQAs covering the technique, genotyping, and clinical interpretation; (2) the triennial assessment of the genotyping and interpretation of specific germline mutations and pharmacogenomics analyses; and (3) the documentation of actions undertaken in the case of poor performances and the participation to quality control the following year. The use of a Bayesian statistical model has been proposed to help the Centers of Human Genetics to determine the theoretical number of tests that should be annually performed to achieve a certain threshold of performance (eg, a maximal error rate of 1%). Besides, the guidelines insist on the role and responsibility of the national public health authorities in the follow-up of the quality of analyses performed by the Medical Centers of Human Genetics and in demonstrating the cost-effectiveness and rationalization of participation frequency in these quality controls. Conclusions: These guidelines have been developed based on the analysis of a large panel of EQA schemes and data collected from the Belgian Medical Centers of Human Genetics. They are applicable to other countries and will facilitate and improve the quality management and financing systems of the Medical Centers of Human Genetics. UR - https://medinform.jmir.org/2021/7/e27980 UR - http://dx.doi.org/10.2196/27980 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255700 ID - info:doi/10.2196/27980 ER - TY - JOUR AU - Haun, N. Jolie AU - Paykel, Jacquelyn AU - Melillo, Christine PY - 2021/6/29 TI - Transforming Health and Resiliency Through Integration of Values-based Experiences: Implementation of an Electronic Evidence-based Whole Health Clinical Program JO - JMIR Form Res SP - e26030 VL - 5 IS - 6 KW - virtual care KW - group medical appointment KW - complementary and integrative health KW - veteran KW - implementation N2 - Background: Complementary and integrative health (CIH) is the foundation of the Department of Veterans Affairs (VA) Whole Health System program (WH), including Transforming Health and Resiliency through Integration of Values-based Experiences (THRIVE). The global COVID-19 pandemic prompted an urgent need to provide services such as THRIVE while following guidelines for social distancing. Objective: The objective of this paper was to describe the systematic implementation of THRIVE using an electronic delivery model. Methods: The study involved an observational clinical program implementation project using the RE-AIM framework to contextualize the implementation strategies and results, and then the implementation of an electronically delivered CIH group medical appointment program (eTHRIVE). Results: Clinical staff transitioned to 100% electronic delivery of the THRIVE curriculum using the new eTHRIVE delivery model. The current electronic delivery model, eTHRIVE, has effectively enrolled 10-12 veterans per cohort, with 8 cohorts, totaling 87 veterans to date. eTHRIVE attrition has been 6% (5/87) since initiation. Conclusions: The current climate of the VA WH programmatic initiative combined with the public health needs during a global pandemic prompted the move of THRIVE program into an electronic format to broaden scalability and reach. UR - https://formative.jmir.org/2021/6/e26030 UR - http://dx.doi.org/10.2196/26030 UR - http://www.ncbi.nlm.nih.gov/pubmed/34184996 ID - info:doi/10.2196/26030 ER - TY - JOUR AU - Emwodew, Delelegn AU - Melese, Tesfahun AU - Takele, Adamu AU - Mesfin, Nebiyu AU - Tariku, Binyam PY - 2021/6/24 TI - Knowledge and Attitude Toward Evidence-Based Medicine and Associated Factors Among Medical Interns in Amhara Regional State Teaching Hospitals, Northwest Ethiopia: Cross-sectional Study JO - JMIR Med Educ SP - e28739 VL - 7 IS - 2 KW - knowledge KW - attitude KW - evidence-based medicine KW - teaching hospitals N2 - Background: Evidence-based medicine (EBM) is widely accepted in medicine. It is necessary to improve the knowledge and attitudes of medical students in the use of evidence. In Ethiopia, little is known about medical students? knowledge and attitudes toward EBM. Objective: This study aimed to assess the knowledge and attitudes toward EBM and its associated factors among medical interns in teaching hospitals. Methods: A cross-sectional survey was conducted using a random sample of medical interns in teaching hospitals in Ethiopia. Multivariable logistic regression analyses were used to identify the factors associated with the knowledge and attitudes toward EBM. Adjusted odds ratio (AOR) with 95% confidence interval and P?.05 was used to quantify strength of association between variables. Results: Out of a sample of 423 medical interns, 403 completed the questionnaire (95.3% response rate). Overall, 68.0% (274/403 of respondents had a favorable attitude toward EBM and 57.1% (230/403) had good knowledge of EBM. The majority (355/403, 88.1%) of participants had internet access. Only 19.6% (79/403) of respondents had received EBM-related training. Respondents? knowledge of EBM was associated with previous EBM training (AOR 2.947, 95% CI 1.648-5.268, P<.001), understanding of sensitivity (AOR 2.836, 95% CI 1.824-4.408, P=.003), and internet access (AOR 2.914, 95% CI 1.494-5.685, P=.002). The use of an electronic database as a source of information (AOR 1.808, 95% CI 1.143-2.861, P=.01) and understanding of absolute risk reduction (AOR 2.750, 95% CI 1.105-6.841, P=.03) were predictors of positive attitudes. Conclusions: This study demonstrates a lack of formal EBM training and awareness of basic concepts of EBM among medical interns. Medical intern attitudes toward EBM are relatively good. To enhance EBM knowledge and skills, formal teaching of EBM should be integrated into medical education. UR - https://mededu.jmir.org/2021/2/e28739/ UR - http://dx.doi.org/10.2196/28739 UR - http://www.ncbi.nlm.nih.gov/pubmed/34185012 ID - info:doi/10.2196/28739 ER - TY - JOUR AU - Lee, Hung-Yi Andy AU - Aaronson, Emily AU - Hibbert, A. Kathryn AU - Flynn, H. Micah AU - Rutkey, Hayley AU - Mort, Elizabeth AU - Sonis, D. Jonathan AU - Safavi, C. Kyan PY - 2021/6/24 TI - Design and Implementation of a Real-time Monitoring Platform for Optimal Sepsis Care in an Emergency Department: Observational Cohort Study JO - J Med Internet Res SP - e26946 VL - 23 IS - 6 KW - electronic monitoring platform KW - sepsis KW - quality improvement N2 - Background: Sepsis is the leading cause of death in US hospitals. Compliance with bundled care, specifically serial lactates, blood cultures, and antibiotics, improves outcomes but is often delayed or missed altogether in a busy practice environment. Objective: This study aims to design, implement, and validate a novel monitoring and alerting platform that provides real-time feedback to frontline emergency department (ED) providers regarding adherence to bundled care. Methods: This single-center, prospective, observational study was conducted in three phases: the design and technical development phase to build an initial version of the platform; the pilot phase to test and refine the platform in the clinical setting; and the postpilot rollout phase to fully implement the study intervention. Results: During the design and technical development, study team members and stakeholders identified the criteria for patient inclusion, selected bundle measures from the Center for Medicare and Medicaid Sepsis Core Measure for alerting, and defined alert thresholds, message content, delivery mechanisms, and recipients. Additional refinements were made based on 70 provider survey results during the pilot phase, including removing alerts for vasopressor initiation and modifying text in the pages to facilitate patient identification. During the 48 days of the postpilot rollout phase, 15,770 ED encounters were tracked and 711 patient encounters were included in the active monitoring cohort. In total, 634 pages were sent at a rate of 0.98 per attending physician shift. Overall, 38.3% (272/711) patients had at least one page. The missing bundle elements that triggered alerts included: antibiotics 41.6% (136/327), repeat lactate 32.4% (106/327), blood cultures 20.8% (68/327), and initial lactate 5.2% (17/327). Of the missing Sepsis Core Measures elements for which a page was sent, 38.2% (125/327) were successfully completed on time. Conclusions: A real-time sepsis care monitoring and alerting platform was created for the ED environment. The high proportion of patients with at least one alert suggested the significant potential for such a platform to improve care, whereas the overall number of alerts per clinician suggested a low risk of alarm fatigue. The study intervention warrants a more rigorous evaluation to ensure that the added alerts lead to better outcomes for patients with sepsis. UR - https://www.jmir.org/2021/6/e26946/ UR - http://dx.doi.org/10.2196/26946 UR - http://www.ncbi.nlm.nih.gov/pubmed/34185009 ID - info:doi/10.2196/26946 ER - TY - JOUR AU - Aminoff, Hedvig AU - Meijer, Sebastiaan AU - Arnelo, Urban AU - Groth, Kristina PY - 2021/6/21 TI - Modeling the Implementation Context of a Telemedicine Service: Work Domain Analysis in a Surgical Setting JO - JMIR Form Res SP - e26505 VL - 5 IS - 6 KW - telemedicine KW - telementoring KW - implementation context KW - surgical guidance KW - health technology KW - usability KW - work domain analysis KW - cognitive work analysis N2 - Background: A telemedicine service enabling remote surgical consultation had shown promising results. When the service was to be scaled up, it was unclear how contextual variations among different clinical sites could affect the clinical outcomes and implementation of the service. It is generally recognized that contextual factors and work system complexities affect the implementation and outcomes of telemedicine. However, it is methodologically challenging to account for context in complex health care settings. We conducted a work domain analysis (WDA), an engineering method for modeling and analyzing complex work environments, to investigate and represent contextual influences when a telemedicine service was to be scaled up to multiple hospitals. Objective: We wanted to systematically characterize the implementation contexts at the clinics participating in the scale-up process. Conducting a WDA would allow us to identify, in a systematic manner, the functional constraints that shape clinical work at the implementation sites and set the sites apart. The findings could then be valuable for informed implementation and assessment of the telemedicine service. Methods: We conducted observations and semistructured interviews with a variety of stakeholders. Thematic analysis was guided by concepts derived from the WDA framework. We identified objects, functions, priorities, and values that shape clinical procedures. An iterative ?discovery and modeling? approach allowed us to first focus on one clinic and then readjust the scope as our understanding of the work systems deepened. Results: We characterized three sets of constraints (ie, facets) in the domain: the treatment facet, administrative facet (providing resources for procedures), and development facet (training, quality improvement, and research). The constraints included medical equipment affecting treatment options; administrative processes affecting access to staff and facilities; values and priorities affecting assessments during endoscopic retrograde cholangiopancreatography; and resources for conducting the procedure. Conclusions: The surgical work system is embedded in multiple sets of constraints that can be modeled as facets of the system. We found variations between the implementation sites that might interact negatively with the telemedicine service. However, there may be enough motivation and resources to overcome these initial disruptions given that values and priorities are shared across the sites. Contrasting the development facets at different sites highlighted the differences in resources for training and research. In some cases, this could indicate a risk that organizational demands for efficiency and effectiveness might be prioritized over the long-term outcomes provided by the telemedicine service, or a reduced willingness or ability to accept a service that is not yet fully developed or adapted. WDA proved effective in representing and analyzing these complex clinical contexts in the face of technological change. The models serve as examples of how to analyze and represent a complex sociotechnical context during telemedicine design, implementation, and assessment. UR - https://formative.jmir.org/2021/6/e26505 UR - http://dx.doi.org/10.2196/26505 UR - http://www.ncbi.nlm.nih.gov/pubmed/34152278 ID - info:doi/10.2196/26505 ER - TY - JOUR AU - Archambault, Patrick AU - Turcotte, Stéphane AU - Smith, Y. Pascal AU - Said Abasse, Kassim AU - Paquet, Catherine AU - Côté, André AU - Gomez, Dario AU - Khechine, Hager AU - Gagnon, Marie-Pierre AU - Tremblay, Melissa AU - Elazhary, Nicolas AU - Légaré, France AU - PY - 2021/6/18 TI - Intention to Use Wiki-Based Knowledge Tools: Survey of Quebec Emergency Health Professionals JO - JMIR Med Inform SP - e24649 VL - 9 IS - 6 KW - knowledge management KW - knowledge translation KW - implementation science KW - collaborative writing applications KW - wikis KW - trauma care N2 - Background: Clinical decision support systems are information technologies that assist clinicians in making better decisions. Their adoption has been limited because their content is difficult to adapt to local contexts and slow to adapt to emerging evidence. Collaborative writing applications such as wikis have the potential to increase access to existing and emerging evidence-based knowledge at the point of care, standardize emergency clinical decision making, and quickly adapt this knowledge to local contexts. However, little is known about the factors influencing health professionals? use of wiki-based knowledge tools. Objective: This study aims to measure emergency physicians? (EPs) and other acute care health professionals? (ACHPs) intentions to use wiki-based knowledge tools in trauma care and identify determinants of this intention that can be used in future theory-based interventions for promoting the use of wiki-based knowledge tools in trauma care. Methods: In total, 266 EPs and 907 ACHPs (nurses, respiratory therapists, and pharmacists) from 12 Quebec trauma centers were asked to answer a survey based on the theory of planned behavior (TPB). The TPB constructs were measured using a 7-point Likert scale. Descriptive statistics and Pearson correlations between the TPB constructs and intention were calculated. Multiple linear regression analysis was conducted to identify the salient beliefs. Results: Among the eligible participants, 57.1% (152/266) of EPs and 31.9% (290/907) of ACHPs completed the questionnaire. For EPs, we found that attitude, perceived behavioral control (PBC), and subjective norm (SN) were significant determinants of the intention to use wiki-based knowledge tools and explained 62% of its variance. None of the sociodemographic variables were related to EPs? intentions to use wiki-based knowledge tools. The regression model identified two normative beliefs ("approval by physicians" and "approval by patients") and two behavioral beliefs ("refreshes my memory" and "reduces errors"). For ACHPs, attitude, PBC, SN, and two sociodemographic variables (profession and the previous personal use of a wiki) were significantly related to the intention to use wiki-based knowledge tools and explained 60% of the variance in behavioral intention. The final regression model for ACHPs included two normative beliefs ("approval by the hospital trauma team" and "people less comfortable with information technology"), one control belief ("time constraints"), and one behavioral belief ("access to evidence"). Conclusions: The intentions of EPs and ACHPs to use wiki-based knowledge tools to promote best practices in trauma care can be predicted in part by attitude, SN, and PBC. We also identified salient beliefs that future theory-based interventions should promote for the use of wiki-based knowledge tools in trauma care. These interventions will address the barriers to using wiki-based knowledge tools, find ways to ensure the quality of their content, foster contributions, and support the exploration of wiki-based knowledge tools as potential effective knowledge translation tools in trauma care. UR - https://medinform.jmir.org/2021/6/e24649 UR - http://dx.doi.org/10.2196/24649 UR - http://www.ncbi.nlm.nih.gov/pubmed/34142977 ID - info:doi/10.2196/24649 ER - TY - JOUR AU - Taneja, L. Sonia AU - Passi, Monica AU - Bhattacharya, Sumona AU - Schueler, A. Samuel AU - Gurram, Sandeep AU - Koh, Christopher PY - 2021/6/17 TI - Social Media and Research Publication Activity During Early Stages of the COVID-19 Pandemic: Longitudinal Trend Analysis JO - J Med Internet Res SP - e26956 VL - 23 IS - 6 KW - coronavirus KW - COVID-19 KW - social media KW - gastroenterology KW - SARS-CoV-2 KW - research KW - literature KW - dissemination KW - Twitter KW - preprint N2 - Background: The COVID-19 pandemic has highlighted the importance of rapid dissemination of scientific and medical discoveries. Current platforms available for the distribution of scientific and clinical research data and information include preprint repositories and traditional peer-reviewed journals. In recent times, social media has emerged as a helpful platform to share scientific and medical discoveries. Objective: This study aimed to comparatively analyze activity on social media (specifically, Twitter) and that related to publications in the form of preprint and peer-reviewed journal articles in the context of COVID-19 and gastroenterology during the early stages of the COVID-19 pandemic. Methods: COVID-19?related data from Twitter (tweets and user data) and articles published in preprint servers (bioRxiv and medRxiv) as well as in the PubMed database were collected and analyzed during the first 6 months of the pandemic, from December 2019 through May 2020. Global and regional geographic and gastrointestinal organ?specific social media trends were compared to preprint and publication activity. Any relationship between Twitter activity and preprint articles published and that between Twitter activity and PubMed articles published overall, by organ system, and by geographic location were identified using Spearman?s rank-order correlation. Results: Over the 6-month period, 73,079 tweets from 44,609 users, 7164 journal publications, and 4702 preprint publications were retrieved. Twitter activity (ie, number of tweets) peaked in March 2020, whereas preprint and publication activity (ie, number of articles published) peaked in April 2020. Overall, strong correlations were identified between trends in Twitter activity and preprint and publication activity (P<.001 for both). COVID-19 data across the three platforms mainly concentrated on pulmonology or critical care, but when analyzing the field of gastroenterology specifically, most tweets pertained to pancreatology, most publications focused on hepatology, and most preprints covered hepatology and luminal gastroenterology. Furthermore, there were significant positive associations between trends in Twitter and publication activity for all gastroenterology topics (luminal gastroenterology: P=.009; hepatology and inflammatory bowel disease: P=.006; gastrointestinal endoscopy: P=.007), except pancreatology (P=.20), suggesting that Twitter activity did not correlate with publication activity for this topic. Finally, Twitter activity was the highest in the United States (7331 tweets), whereas PubMed activity was the highest in China (1768 publications). Conclusions: The COVID-19 pandemic has highlighted the potential of social media as a vehicle for disseminating scientific information during a public health crisis. Sharing and spreading information on COVID-19 in a timely manner during the pandemic has been paramount; this was achieved at a much faster pace on social media, particularly on Twitter. Future investigation could demonstrate how social media can be used to augment and promote scholarly activity, especially as the world begins to increasingly rely on digital or virtual platforms. Scientists and clinicians should consider the use of social media in augmenting public awareness regarding their scholarly pursuits. UR - https://www.jmir.org/2021/6/e26956 UR - http://dx.doi.org/10.2196/26956 UR - http://www.ncbi.nlm.nih.gov/pubmed/33974550 ID - info:doi/10.2196/26956 ER - TY - JOUR AU - An, Ning AU - Mattison, John AU - Chen, Xinyu AU - Alterovitz, Gil PY - 2021/6/14 TI - Team Science in Precision Medicine: Study of Coleadership and Coauthorship Across Health Organizations JO - J Med Internet Res SP - e17137 VL - 23 IS - 6 KW - precision medicine KW - team science N2 - Background: Interdisciplinary collaborations bring lots of benefits to researchers in multiple areas, including precision medicine. Objective: This viewpoint aims at studying how cross-institution team science would affect the development of precision medicine. Methods: Publications of organizations on the eHealth Catalogue of Activities were collected in 2015 and 2017. The significance of the correlation between coleadership and coauthorship among different organizations was calculated using the Pearson chi-square test of independence. Other nonparametric tests examined whether organizations with coleaders publish more and better papers than organizations without coleaders. Results: A total of 374 publications from 69 organizations were analyzed in 2015, and 7064 papers from 87 organizations were analyzed in 2017. Organizations with coleadership published more papers (P<.001, 2015 and 2017), which received higher citations (Z=?13.547, P<.001, 2017), compared to those without coleadership. Organizations with coleaders tended to publish papers together (P<.001, 2015 and 2017). Conclusions: Our findings suggest that organizations in the field of precision medicine could greatly benefit from institutional-level team science. As a result, stronger collaboration is recommended. UR - https://www.jmir.org/2021/6/e17137 UR - http://dx.doi.org/10.2196/17137 UR - http://www.ncbi.nlm.nih.gov/pubmed/34125070 ID - info:doi/10.2196/17137 ER - TY - JOUR AU - Madar, Ronni AU - Ugon, Adrien AU - Ivankovi?, Damir AU - Tsopra, Rosy PY - 2021/6/11 TI - A Web Interface for Antibiotic Prescription Recommendations in Primary Care: User-Centered Design Approach JO - J Med Internet Res SP - e25741 VL - 23 IS - 6 KW - clinical decision support system KW - visualization KW - usability KW - clinical practice guidelines KW - antibiotic KW - primary care N2 - Background: Antibiotic misuse is a serious public health problem worldwide. National health authorities release clinical practice guidelines (CPGs) to guide general practitioners (GPs) in their choice of antibiotics. However, despite the large-scale dissemination of CPGs, GPs continue to prescribe antibiotics that are not recommended as first-line treatments. This nonadherence to recommendations may be due to GPs misunderstanding the CPGs. A web interface displaying antibiotic prescription recommendations and their justifications could help to improve the comprehensibility and readability of CPGs, thereby increasing the adoption of recommendations regarding antibiotic treatment. Objective: This study aims to design and evaluate a web interface for antibiotic prescription displaying both the recommended antibiotics and their justifications in the form of antibiotic properties. Methods: A web interface was designed according to the same principles as e-commerce interfaces and was assessed by 117 GPs. These GPs were asked to answer 17 questions relating to the usefulness, user-friendliness, and comprehensibility and readability of the interface, and their satisfaction with it. Responses were recorded on a 4-point Likert scale (ranging from ?absolutely disagree? to ?absolutely agree?). At the end of the evaluation, the GPs were allowed to provide optional, additional free comments. Results: The antibiotic prescription web interface consists of three main sections: a clinical summary section, a filter section, and a recommended antibiotics section. The majority of GPs appreciated the clinical summary (90/117, 76.9%) and filter (98/117, 83.8%) sections, whereas 48.7% (57/117) of them reported difficulty reading some of the icons in the recommended antibiotics section. Overall, 82.9% (97/117) of GPs found the display of drug properties useful, and 65.8% (77/117) reported that the web interface improved their understanding of CPG recommendations. Conclusions: The web interface displaying antibiotic recommendations and their properties can help doctors understand the rationale underlying CPG recommendations regarding antibiotic treatment, but further improvements are required before its implementation into a clinical decision support system. UR - https://www.jmir.org/2021/6/e25741 UR - http://dx.doi.org/10.2196/25741 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114958 ID - info:doi/10.2196/25741 ER - TY - JOUR AU - Kim, Gyungha AU - Jeon, Hwawoo AU - Park, Kee Sung AU - Choi, Suk Yong AU - Lim, Yoonseob PY - 2021/6/8 TI - A Care Knowledge Management System Based on an Ontological Model of Caring for People With Dementia: Knowledge Representation and Development Study JO - J Med Internet Res SP - e25968 VL - 23 IS - 6 KW - caregiver KW - caregiver for person with dementia KW - knowledge model KW - ontology KW - knowledge management KW - semantic reasoning N2 - Background: Caregivers of people with dementia find it extremely difficult to choose the best care method because of complex environments and the variable symptoms of dementia. To alleviate this care burden, interventions have been proposed that use computer- or web-based applications. For example, an automatic diagnosis of the condition can improve the well-being of both the person with dementia and the caregiver. Other interventions support the individual with dementia in living independently. Objective: The aim of this study was to develop an ontology-based care knowledge management system for people with dementia that will provide caregivers with a care guide suited to the environment and to the individual patient?s symptoms. This should also enable knowledge sharing among caregivers. Methods: To build the care knowledge model, we reviewed existing ontologies that contain concepts and knowledge descriptions relating to the care of those with dementia, and we considered dementia care manuals. The basic concepts of the care ontology were confirmed by experts in Korea. To infer the different care methods required for the individual dementia patient, the reasoning rules as defined in Semantic Web Rule Languages and Prolog were utilized. The accuracy of the care knowledge in the ontological model and the usability of the proposed system were evaluated by using the Pellet reasoner and OntOlogy Pitfall Scanner!, and a survey and interviews were conducted with caregivers working in care centers in Korea. Results: The care knowledge model contains six top-level concepts: care knowledge, task, assessment, person, environment, and medical knowledge. Based on this ontological model of dementia care, caregivers at a dementia care facility in Korea were able to access the care knowledge easily through a graphical user interface. The evaluation by the care experts showed that the system contained accurate care knowledge and a level of assessment comparable to normal assessment tools. Conclusions: In this study, we developed a care knowledge system that can provide caregivers with care guides suited to individuals with dementia. We anticipate that the system could reduce the workload of caregivers. UR - https://www.jmir.org/2021/6/e25968 UR - http://dx.doi.org/10.2196/25968 UR - http://www.ncbi.nlm.nih.gov/pubmed/34100762 ID - info:doi/10.2196/25968 ER - TY - JOUR AU - Christie, Liane Hannah AU - Boots, Maria Lizzy Mitzy AU - Hermans, Ivo AU - Govers, Mark AU - Tange, Johannes Huibert AU - Verhey, Josef Frans Rochus AU - de Vugt, Majolein PY - 2021/6/3 TI - Business Models of eHealth Interventions to Support Informal Caregivers of People With Dementia in the Netherlands: Analysis of Case Studies JO - JMIR Aging SP - e24724 VL - 4 IS - 2 KW - eHealth KW - dementia KW - caregiving KW - implementation KW - business modeling N2 - Background: In academic research contexts, eHealth interventions for caregivers of people with dementia have shown ample evidence of effectiveness. However, they are rarely implemented in practice, and much can be learned from their counterparts (commercial, governmental, or other origins) that are already being used in practice. Objective: This study aims to examine a sample of case studies of eHealth interventions to support informal caregivers of people with dementia that are currently used in the Netherlands; to investigate what strategies are used to ensure the desirability, feasibility, viability, and sustainability of the interventions; and to apply the lessons learned from this practical, commercial implementation perspective to academically developed eHealth interventions for caregivers of people with dementia. Methods: In step 1, experts (N=483) in the fields of dementia and eHealth were contacted and asked to recommend interventions that met the following criteria: delivered via the internet; suitable for informal caregivers of people with dementia; accessible in the Netherlands, either in Dutch or in English; and used in practice. The contacted experts were academics working on dementia and psychosocial innovations, industry professionals from eHealth software companies, clinicians, patient organizations, and people with dementia and their caregivers. In step 2, contact persons from the suggested eHealth interventions participated in a semistructured telephone interview. The results were analyzed using a multiple case study methodology. Results: In total, the response rate was 7.5% (36/483), and 21 eHealth interventions for caregivers of people with dementia were recommended. Furthermore, 43% (9/21) of the interventions met all 4 criteria and were included in the sample for the case study analysis. Of these 9 interventions, 4 were found to have developed sustainable business models and 5 were implemented in a more exploratory manner and relied on research grants to varying extents, although some had also developed preliminary business models. Conclusions: These findings suggest that the desirability, feasibility, and viability of eHealth interventions for caregivers of people with dementia are linked to their integration into larger structures, their ownership and support of content internally, their development of information and communication technology services externally, and their offer of fixed, low pricing. The origin of the case studies was also important, as eHealth interventions that had originated in an academic research context less reliably found their way to sustainable implementation. In addition, careful selection of digital transformation strategies, more intersectoral cooperation, and more funding for implementation and business modeling research are recommended to help future developers bring eHealth interventions for caregivers of people with dementia into practice. UR - https://aging.jmir.org/2021/2/e24724 UR - http://dx.doi.org/10.2196/24724 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081009 ID - info:doi/10.2196/24724 ER - TY - JOUR AU - Fonner, A. Virginia AU - Kennedy, Samuel AU - Desai, Rohan AU - Eichberg, Christie AU - Martin, Lisa AU - Meissner, G. Eric PY - 2021/5/27 TI - Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study JO - JMIR Form Res SP - e22513 VL - 5 IS - 5 KW - HIV KW - mHealth KW - text messaging KW - video calling KW - implementation science KW - mobile phone N2 - Background: Patient-provider communication is critical for engaging and retaining people living with HIV in care, especially among medically case-managed patients in need of service coordination and adherence support. Expanding patient-provider communication channels to include mobile health modalities, such as text messaging and video calling, has the potential to facilitate communication and ultimately improve clinical outcomes. However, the implementation of these communication modalities in clinical settings has not been well characterized. Objective: The purpose of this study is to understand patient and provider perspectives on the acceptability of and preferences for using text messaging and video calling as a means of communication; perceived factors relevant to adoption, appropriateness, and feasibility; and organizational perspectives on implementation within an HIV clinic in South Carolina. Methods: We conducted 26 semistructured in-depth interviews among patients receiving case management services (n=12) and clinic providers (n=14) using interview guides and content analysis informed by the Proctor taxonomy of implementation outcomes and the Consolidated Framework for Implementation Research. Participants were purposefully sampled to obtain maximum variation in terms of age and gender for patients and clinic roles for providers. The data were analyzed using quantitative and qualitative content analyses. Results: Most patients (11/12, 92%) and providers (12/14, 86%) agreed that they should have the capacity to text message and/or video call each other. Although consensus was not reached, most preferred using a secure messaging app rather than standard text messaging because of the enhanced security features. Perceived benefits to adoption included the added convenience of text messaging, and potential barriers included the cost and access of smartphone-based technology for patients. From an organizational perspective, some providers were concerned that offering text messaging could lead to unreasonable expectations of instant access and increased workload. Conclusions: Patients and providers perceived text messaging and video calling as acceptable, appropriate, and feasible and felt that these expanded modes of communication could help meet patients? needs while being safe and not excessively burdensome. Although patients and providers mostly agreed on implementation barriers and facilitators, several differences emerged. Taking both perspectives into account when using implementation frameworks is critical for expanding mobile health?based communication, especially as implementation requires active participation from providers and patients. UR - https://formative.jmir.org/2021/5/e22513 UR - http://dx.doi.org/10.2196/22513 UR - http://www.ncbi.nlm.nih.gov/pubmed/34042596 ID - info:doi/10.2196/22513 ER - TY - JOUR AU - Chan, K. Alex AU - Wu, Constance AU - Cheung, Andrew AU - Succi, D. Marc PY - 2021/5/25 TI - Characterization of an Open-Access Medical News Platform?s Readership During the COVID-19 Pandemic: Retrospective Observational Study JO - J Med Internet Res SP - e26666 VL - 23 IS - 5 KW - COVID-19 KW - internet KW - medical news KW - text summaries KW - readership trends KW - news KW - media KW - open access KW - literature KW - web-based health information KW - survey KW - cross-sectional KW - trend N2 - Background: There are many alternatives to direct journal access, such as podcasts, blogs, and news sites, that allow physicians and the general public to stay up to date with medical literature. However, there is a scarcity of literature that investigates the readership characteristics of open-access medical news sites and how these characteristics may have shifted during the COVID-19 pandemic. Objective: This study aimed to assess readership and survey data to characterize open-access medical news readership trends related to the COVID-19 pandemic and overall readership trends regarding pandemic-related information delivery. Methods: Anonymous, aggregate readership data were obtained from 2 Minute Medicine, an open-access, physician-run medical news organization that has published over 8000 original, physician-written texts and visual summaries of new medical research since 2013. In this retrospective observational study, the average number of article views, number of actions (defined as the sum of the number of views, shares, and outbound link clicks), read times, and bounce rates (probability of leaving a page in <30 s) were compared between COVID-19 articles published from January 1 to May 31, 2020 (n=40) and non?COVID-19 articles (n=145) published in the same time period. A voluntary survey was also sent to subscribed 2 Minute Medicine readers to further characterize readership demographics and preferences, which were scored on a Likert scale. Results: COVID-19 articles had a significantly higher median number of views than non?COVID-19 articles (296 vs 110; U=748.5; P<.001). There were no significant differences in average read times (P=.12) or bounce rates (P=.12). Non?COVID-19 articles had a higher median number of actions than COVID-19 articles (2.9 vs 2.5; U=2070.5; P=.02). On a Likert scale of 1 (strongly disagree) to 5 (strongly agree), our survey data revealed that 65.5% (78/119) of readers agreed or strongly agreed that they preferred staying up to date with emerging literature about COVID-19 by using sources such as 2 Minute Medicine instead of journals. A greater proportion of survey respondents also indicated that open-access news sources were one of their primary sources for staying informed (86/120, 71.7%) compared to the proportion who preferred direct journal article access (61/120, 50.8%). The proportion of readers indicating they were reading one or less full-length medical studies a month were lower following introduction to 2 Minute Medicine compared to prior (21/120, 17.5% vs 38/120, 31.6%; P=.005). Conclusions: The readership significantly increased for one open-access medical literature platform during the pandemic. This reinforces the idea that open-access, physician-written sources of medical news represent an important alternative to direct journal access for readers who want to stay up to date with medical literature. UR - https://www.jmir.org/2021/5/e26666 UR - http://dx.doi.org/10.2196/26666 UR - http://www.ncbi.nlm.nih.gov/pubmed/33866307 ID - info:doi/10.2196/26666 ER - TY - JOUR AU - Kariithi, Edward AU - Sharma, Monisha AU - Kemunto, Emily AU - Lagat, Harison AU - Otieno, George AU - Wamuti, M. Beatrice AU - Katz, A. David AU - Obong'o, Christopher AU - Macharia, Paul AU - Bosire, Rose AU - Masyuko, Sarah AU - Mugambi, Mary AU - Levin, E. Carol AU - Liu, Wenjia AU - Roy Paladhi, Unmesha AU - Weiner, J. Bryan AU - Farquhar, Carey PY - 2021/5/20 TI - Using Assisted Partner Services for HIV Testing and the Treatment of Males and Their Female Sexual Partners: Protocol for an Implementation Science Study JO - JMIR Res Protoc SP - e27262 VL - 10 IS - 5 KW - implementation science KW - assisted partner notification services KW - HIV testing and counseling KW - linkage to care KW - western Kenya N2 - Background: Despite the effective scale-up of HIV testing and treatment programs, only 75% of people living with HIV (PLWH) globally know their status, and this rate is lower among men. This highlights the importance of implementing HIV testing and linkage interventions with a high uptake in this population. In a cluster randomized controlled trial conducted in Kenya between 2013 and 2015, we found that assisted partner services (APS) for HIV-exposed partners of newly diagnosed PLWH safely reached more HIV-exposed individuals with HIV testing compared with client referral alone. However, more data are needed to evaluate APS implementation in a real-world setting. Objective: This study aims to evaluate the effectiveness, acceptability, fidelity, and cost of APS when integrated into existing HIV testing services (HTS) in Western Kenya. Methods: Our study team from the University of Washington and PATH is integrating APS into 31 health facilities in Western Kenya. We are enrolling females newly diagnosed with HIV (index clients) who consent to receiving APS, their male sexual partners, and female sexual partners of male sexual partners who tested HIV positive. Female index clients and sexual partners testing HIV positive will be followed up at 6 weeks, 6 months, and 12 months postenrollment to assess linkage to care, antiretroviral therapy initiation, and HIV viral load suppression. We will evaluate the acceptability, fidelity, and cost of real-world implementation of APS via in-depth interviews conducted with national, county, and subcounty-level policy makers responsible for HTS. Facility health staff providing HTS and APS, in addition to staff working with the study project team, will also be interviewed. We will also conduct direct observations of facility infrastructure and clinical procedures and extract data from the facilities and county and national databases. Results: As of March 2020, we have recruited 1724 female index clients, 3201 male partners, and 1585 female partners. We have completed study recruitment as well as 6-week (2936/2973, 98.75%), 6-month (1596/1641, 97.25%), and 12-month (725/797, 90.9%) follow-up visits. Preliminary analyses show that facilities scaling up APS identify approximately 12-18 new HIV-positive males for every 100 men contacted and tested. We are currently completing the remaining follow-up interviews and incorporating an HIV self-testing component into the study in response to the COVID-19 pandemic. Conclusions: The results will help bridge the gap between clinical research findings and real-world practice and provide guidance regarding optimal strategies for APS integration into routine HIV service delivery. International Registered Report Identifier (IRRID): DERR1-10.2196/27262 UR - https://www.researchprotocols.org/2021/5/e27262 UR - http://dx.doi.org/10.2196/27262 UR - http://www.ncbi.nlm.nih.gov/pubmed/34014172 ID - info:doi/10.2196/27262 ER - TY - JOUR AU - Cohn, F. Wendy AU - Canan, E. Chelsea AU - Knight, Sarah AU - Waldman, Lena Ava AU - Dillingham, Rebecca AU - Ingersoll, Karen AU - Schexnayder, Julie AU - Flickinger, E. Tabor PY - 2021/4/28 TI - An Implementation Strategy to Expand Mobile Health Use in HIV Care Settings: Rapid Evaluation Study Using the Consolidated Framework for Implementation Research JO - JMIR Mhealth Uhealth SP - e19163 VL - 9 IS - 4 KW - mHealth KW - smartphone KW - mobile health KW - implementation strategy KW - implementation science KW - Consolidated Framework for Implementation Research KW - HIV care engagement KW - viral suppression N2 - Background: Mobile health (mHealth) apps can provide support to people living with a chronic disease by offering resources for communication, self-management, and social support. PositiveLinks (PL) is a clinic-deployed mHealth app designed to improve the health of people with HIV. In a pilot study, PL users experienced considerable improvements in care engagement and viral load suppression. To promote its expansion to other HIV clinics, we developed an implementation strategy consisting of training resources and on-demand program support. Objective: The objective of our study was to conduct an interim analysis of the barriers and facilitators to PL implementation at early adopting sites to guide optimization of our implementation strategy. Methods: Semistructured interviews with stakeholders at PL expansion sites were conducted. Analysis of interviews identified facilitators and barriers that were mapped to 22 constructs of the Consolidated Framework for Implementation Research (CFIR). The purpose of the analysis was to identify the facilitators and barriers to PL implementation in order to adapt the PL implementation strategy. Four Ryan White HIV clinics were included. Interviews were conducted with one health care provider, two clinic managers, and five individuals who coordinated site PL activities. Results: Ten common facilitators and eight common barriers were identified. Facilitators to PL implementation included PL?s fit with patient and clinic needs, PL training resources, and sites? early engagement with their information technology personnel. Most barriers were specific to mHealth, including access to Wi-Fi networks, maintaining patient smartphone access, patient privacy concerns, and lack of clarity on how to obtain approvals for mHealth use. Conclusions: The CFIR is a useful framework for evaluating mHealth interventions. Although PL training resources were viewed favorably, we identified important barriers to PL implementation in a sample of Ryan White clinics. This enabled our team to expand guidance on identifying information technology stakeholders and procuring and managing mobile resources. Ongoing evaluation results continue to inform improvements to the PL implementation strategy, facilitating PL access for future expansion sites. UR - https://mhealth.jmir.org/2021/4/e19163 UR - http://dx.doi.org/10.2196/19163 UR - http://www.ncbi.nlm.nih.gov/pubmed/33908893 ID - info:doi/10.2196/19163 ER - TY - JOUR AU - Tang, Lu AU - Liu, Wenlin AU - Thomas, Benjamin AU - Tran, Nga Hong Thoai AU - Zou, Wenxue AU - Zhang, Xueying AU - Zhi, Degui PY - 2021/4/26 TI - Texas Public Agencies? Tweets and Public Engagement During the COVID-19 Pandemic: Natural Language Processing Approach JO - JMIR Public Health Surveill SP - e26720 VL - 7 IS - 4 KW - COVID-19 KW - public health agencies KW - natural language processing KW - Twitter KW - health belief model KW - public engagement KW - social media KW - belief KW - public health KW - engagement KW - communication KW - strategy KW - content analysis KW - dissemination N2 - Background: The ongoing COVID-19 pandemic is characterized by different morbidity and mortality rates across different states, cities, rural areas, and diverse neighborhoods. The absence of a national strategy for battling the pandemic also leaves state and local governments responsible for creating their own response strategies and policies. Objective: This study examines the content of COVID-19?related tweets posted by public health agencies in Texas and how content characteristics can predict the level of public engagement. Methods: All COVID-19?related tweets (N=7269) posted by Texas public agencies during the first 6 months of 2020 were classified in terms of each tweet?s functions (whether the tweet provides information, promotes action, or builds community), the preventative measures mentioned, and the health beliefs discussed, by using natural language processing. Hierarchical linear regressions were conducted to explore how tweet content predicted public engagement. Results: The information function was the most prominent function, followed by the action or community functions. Beliefs regarding susceptibility, severity, and benefits were the most frequently covered health beliefs. Tweets that served the information or action functions were more likely to be retweeted, while tweets that served the action and community functions were more likely to be liked. Tweets that provided susceptibility information resulted in the most public engagement in terms of the number of retweets and likes. Conclusions: Public health agencies should continue to use Twitter to disseminate information, promote action, and build communities. They need to improve their strategies for designing social media messages about the benefits of disease prevention behaviors and audiences? self-efficacy. UR - https://publichealth.jmir.org/2021/4/e26720 UR - http://dx.doi.org/10.2196/26720 UR - http://www.ncbi.nlm.nih.gov/pubmed/33847587 ID - info:doi/10.2196/26720 ER - TY - JOUR AU - Seljelid, Berit AU - Varsi, Cecilie AU - Solberg Nes, Lise AU - Řystese, Astrid Kristin AU - Břrřsund, Elin PY - 2021/4/8 TI - A Digital Patient-Provider Communication Intervention (InvolveMe): Qualitative Study on the Implementation Preparation Based on Identified Facilitators and Barriers JO - J Med Internet Res SP - e22399 VL - 23 IS - 4 KW - eHealth KW - digital communication KW - secure messages KW - digital symptom assessment KW - implementation KW - tailoring KW - Consolidated Framework for Implementation Research KW - CFIR KW - facilitators KW - barriers KW - stakeholders N2 - Background: Chronic health conditions are affecting an increasing number of individuals, who experience various symptoms that decrease their quality of life. Digital communication interventions that enable patients to report their symptoms have been shown to positively impact chronic disease management by improving access to care, patient-provider communication, clinical outcomes, and health-related quality of life. These interventions have the potential to prepare patients and health care providers (HCPs) before visits and improve patient-provider communication. Despite the recent rapid development and increasing number of digital communication interventions that have shown positive research results, barriers to realizing the benefits offered through these types of interventions still exist. Objective: The aim of this study is to prepare for the implementation of a digital patient-provider communication intervention in the daily workflow at 2 outpatient clinics by identifying potential determinants of implementation using the Consolidated Framework for Implementation Research (CFIR) to tailor the use of digital communication intervention to the intended context and identify key aspects for an implementation plan. Methods: A combination of focus groups, workshops, and project steering committee meetings was conducted with HCPs (n=14) and patients (n=2) from 2 outpatient clinics at a university hospital. The CFIR was used to guide data collection and analysis. Transcripts, written minutes, and notes were analyzed and coded into 5 CFIR domains using thematic analysis. Results: Data were examined and analyzed into 18 CFIR constructs relevant to the study purpose. On the basis of the identified determinants, important intervention tailoring includes adjustments to the digital features and adjustments to fit the clinical workflow and a decision to conduct a future pilot study. Furthermore, it was decided to provide the intervention to patients as early as possible in their disease trajectory, with tailored information about its use. Key aspects for the implementation plan encompassed maintaining the identified engagement and positive attitude, involving key stakeholders in the implementation process, and providing the needed support and training. Conclusions: This study offers insight into the involvement of stakeholders in the tailoring and implementation planning of a digital communication intervention in clinical practice. Stakeholder involvement in the identification of implementation facilitators and barriers can contribute to the tailoring of digital communication interventions and how they are used and can also inform systematic and targeted implementation planning. UR - https://www.jmir.org/2021/4/e22399 UR - http://dx.doi.org/10.2196/22399 UR - http://www.ncbi.nlm.nih.gov/pubmed/33830063 ID - info:doi/10.2196/22399 ER - TY - JOUR AU - Staras, Stephanie AU - Tauscher, S. Justin AU - Rich, Natalie AU - Samarah, Esaa AU - Thompson, A. Lindsay AU - Vinson, M. Michelle AU - Muszynski, J. Michael AU - Shenkman, A. Elizabeth PY - 2021/3/31 TI - Using a Clinical Workflow Analysis to Enhance eHealth Implementation Planning: Tutorial and Case Study JO - JMIR Mhealth Uhealth SP - e18534 VL - 9 IS - 3 KW - workflow KW - implementation science KW - primary care KW - eHealth KW - stakeholder engagement UR - https://mhealth.jmir.org/2021/3/e18534 UR - http://dx.doi.org/10.2196/18534 UR - http://www.ncbi.nlm.nih.gov/pubmed/33626016 ID - info:doi/10.2196/18534 ER - TY - JOUR AU - Coetzee, Timothy AU - Ball, Price Mad AU - Boutin, Marc AU - Bronson, Abby AU - Dexter, T. David AU - English, A. Rebecca AU - Furlong, Patricia AU - Goodman, D. Andrew AU - Grossman, Cynthia AU - Hernandez, F. Adrian AU - Hinners, E. Jennifer AU - Hudson, Lynn AU - Kennedy, Annie AU - Marchisotto, Jane Mary AU - Matrisian, Lynn AU - Myers, Elizabeth AU - Nowell, Benjamin W. AU - Nosek, A. Brian AU - Sherer, Todd AU - Shore, Carolyn AU - Sim, Ida AU - Smolensky, Luba AU - Williams, Christopher AU - Wood, Julie AU - Terry, F. Sharon PY - 2021/3/29 TI - Data Sharing Goals for Nonprofit Funders of Clinical Trials JO - J Participat Med SP - e23011 VL - 13 IS - 1 KW - clinical trial KW - biomedical research KW - data sharing KW - patients UR - https://jopm.jmir.org/2021/1/e23011 UR - http://dx.doi.org/10.2196/23011 UR - http://www.ncbi.nlm.nih.gov/pubmed/33779573 ID - info:doi/10.2196/23011 ER - TY - JOUR AU - Feofanova, Valeryevna Elena AU - Zhang, Guo-Qiang AU - Lhatoo, Samden AU - Metcalf, A. Ginger AU - Boerwinkle, Eric AU - Venner, Eric PY - 2021/3/26 TI - The Implementation Science for Genomic Health Translation (INSIGHT) Study in Epilepsy: Protocol for a Learning Health Care System JO - JMIR Res Protoc SP - e25576 VL - 10 IS - 3 KW - genomic medicine KW - electronic health record KW - implementation KW - genetics KW - prototype KW - decision support N2 - Background: Genomic medicine is poised to improve care for common complex diseases such as epilepsy, but additional clinical informatics and implementation science research is needed for it to become a part of the standard of care. Epilepsy is an exemplary complex neurological disorder for which DNA diagnostics have shown to be advantageous for patient care. Objective: We designed the Implementation Science for Genomic Health Translation (INSIGHT) study to leverage the fact that both the clinic and testing laboratory control the development and customization of their respective electronic health records and clinical reporting platforms. Through INSIGHT, we can rapidly prototype and benchmark novel approaches to incorporating clinical genomics into patient care. Of particular interest are clinical decision support tools that take advantage of domain knowledge from clinical genomics and can be rapidly adjusted based on feedback from clinicians. Methods: Building on previously developed evidence and infrastructure components, our model includes the following: establishment of an intervention-ready genomic knowledge base for patient care, creation of a health informatics platform and linking it to a clinical genomics reporting system, and scaling and evaluation of INSIGHT following established implementation science principles. Results: INSIGHT was approved by the Institutional Review Board at the University of Texas Health Science Center at Houston on May 15, 2020, and is designed as a 2-year proof-of-concept study beginning in December 2021. By design, 120 patients from the Texas Comprehensive Epilepsy Program are to be enrolled to test the INSIGHT workflow. Initial results are expected in the first half of 2023. Conclusions: INSIGHT?s domain-specific, practical but generalizable approach may help catalyze a pathway to accelerate translation of genomic knowledge into impactful interventions in patient care. International Registered Report Identifier (IRRID): PRR1-10.2196/25576 UR - https://www.researchprotocols.org/2021/3/e25576 UR - http://dx.doi.org/10.2196/25576 UR - http://www.ncbi.nlm.nih.gov/pubmed/33769305 ID - info:doi/10.2196/25576 ER - TY - JOUR AU - Trinkley, E. Katy AU - Kroehl, E. Miranda AU - Kahn, G. Michael AU - Allen, A. Larry AU - Bennett, D. Tellen AU - Hale, Gary AU - Haugen, Heather AU - Heckman, Simeon AU - Kao, P. David AU - Kim, Janet AU - Matlock, M. Daniel AU - Malone, C. Daniel AU - Page 2nd, L. Robert AU - Stine, Jessica AU - Suresh, Krithika AU - Wells, Lauren AU - Lin, Chen-Tan PY - 2021/3/22 TI - Applying Clinical Decision Support Design Best Practices With the Practical Robust Implementation and Sustainability Model Versus Reliance on Commercially Available Clinical Decision Support Tools: Randomized Controlled Trial JO - JMIR Med Inform SP - e24359 VL - 9 IS - 3 KW - PRISM KW - implementation science KW - clinical decision support systems KW - RE-AIM KW - congestive heart failure N2 - Background: Limited consideration of clinical decision support (CDS) design best practices, such as a user-centered design, is often cited as a key barrier to CDS adoption and effectiveness. The application of CDS best practices is resource intensive; thus, institutions often rely on commercially available CDS tools that are created to meet the generalized needs of many institutions and are not user centered. Beyond resource availability, insufficient guidance on how to address key aspects of implementation, such as contextual factors, may also limit the application of CDS best practices. An implementation science (IS) framework could provide needed guidance and increase the reproducibility of CDS implementations. Objective: This study aims to compare the effectiveness of an enhanced CDS tool informed by CDS best practices and an IS framework with a generic, commercially available CDS tool. Methods: We conducted an explanatory sequential mixed methods study. An IS-enhanced and commercial CDS alert were compared in a cluster randomized trial across 28 primary care clinics. Both alerts aimed to improve beta-blocker prescribing for heart failure. The enhanced alert was informed by CDS best practices and the Practical, Robust, Implementation, and Sustainability Model (PRISM) IS framework, whereas the commercial alert followed vendor-supplied specifications. Following PRISM, the enhanced alert was informed by iterative, multilevel stakeholder input and the dynamic interactions of the internal and external environment. Outcomes aligned with PRISM?s evaluation measures, including patient reach, clinician adoption, and changes in prescribing behavior. Clinicians exposed to each alert were interviewed to identify design features that might influence adoption. The interviews were analyzed using a thematic approach. Results: Between March 15 and August 23, 2019, the enhanced alert fired for 61 patients (106 alerts, 87 clinicians) and the commercial alert fired for 26 patients (59 alerts, 31 clinicians). The adoption and effectiveness of the enhanced alert were significantly higher than those of the commercial alert (62% vs 29% alerts adopted, P<.001; 14% vs 0% changed prescribing, P=.006). Of the 21 clinicians interviewed, most stated that they preferred the enhanced alert. Conclusions: The results of this study suggest that applying CDS best practices with an IS framework to create CDS tools improves implementation success compared with a commercially available tool. Trial Registration: ClinicalTrials.gov NCT04028557; http://clinicaltrials.gov/ct2/show/NCT04028557 UR - https://medinform.jmir.org/2021/3/e24359 UR - http://dx.doi.org/10.2196/24359 UR - http://www.ncbi.nlm.nih.gov/pubmed/33749610 ID - info:doi/10.2196/24359 ER - TY - JOUR AU - Lu, Zhao-Hua AU - Wang, Xiaoqing Jade AU - Li, Xintong PY - 2021/3/19 TI - Revealing Opinions for COVID-19 Questions Using a Context Retriever, Opinion Aggregator, and Question-Answering Model: Model Development Study JO - J Med Internet Res SP - e22860 VL - 23 IS - 3 KW - natural language processing KW - question-answering systems KW - language summarization KW - machine learning KW - life and medical sciences KW - COVID-19 KW - public health KW - coronavirus literature N2 - Background: COVID-19 has challenged global public health because it is highly contagious and can be lethal. Numerous ongoing and recently published studies about the disease have emerged. However, the research regarding COVID-19 is largely ongoing and inconclusive. Objective: A potential way to accelerate COVID-19 research is to use existing information gleaned from research into other viruses that belong to the coronavirus family. Our objective is to develop a natural language processing method for answering factoid questions related to COVID-19 using published articles as knowledge sources. Methods: Given a question, first, a BM25-based context retriever model is implemented to select the most relevant passages from previously published articles. Second, for each selected context passage, an answer is obtained using a pretrained bidirectional encoder representations from transformers (BERT) question-answering model. Third, an opinion aggregator, which is a combination of a biterm topic model and k-means clustering, is applied to the task of aggregating all answers into several opinions. Results: We applied the proposed pipeline to extract answers, opinions, and the most frequent words related to six questions from the COVID-19 Open Research Dataset Challenge. By showing the longitudinal distributions of the opinions, we uncovered the trends of opinions and popular words in the articles published in the five time periods assessed: before 1990, 1990-1999, 2000-2009, 2010-2018, and since 2019. The changes in opinions and popular words agree with several distinct characteristics and challenges of COVID-19, including a higher risk for senior people and people with pre-existing medical conditions; high contagion and rapid transmission; and a more urgent need for screening and testing. The opinions and popular words also provide additional insights for the COVID-19?related questions. Conclusions: Compared with other methods of literature retrieval and answer generation, opinion aggregation using our method leads to more interpretable, robust, and comprehensive question-specific literature reviews. The results demonstrate the usefulness of the proposed method in answering COVID-19?related questions with main opinions and capturing the trends of research about COVID-19 and other relevant strains of coronavirus in recent years. UR - https://www.jmir.org/2021/3/e22860 UR - http://dx.doi.org/10.2196/22860 UR - http://www.ncbi.nlm.nih.gov/pubmed/33739287 ID - info:doi/10.2196/22860 ER - TY - JOUR AU - Chiu, Yen-Lin AU - Lee, Yu-Chen AU - Tsai, Chin-Chung PY - 2021/3/18 TI - Internet-Specific Epistemic Beliefs in Medicine and Intention to Use Evidence-Based Online Medical Databases Among Health Care Professionals: Cross-sectional Survey JO - J Med Internet Res SP - e20030 VL - 23 IS - 3 KW - evidence-based medicine (EBM) KW - health care professionals KW - internet-specific epistemic beliefs KW - medical informatics N2 - Background: Evidence-based medicine has been regarded as a prerequisite for ensuring health care quality. The increase in health care professionals? adoption of web-based medical information and the lack of awareness of alternative access to evidence-based online resources suggest the need for an investigation of their information-searching behaviors of using evidence-based online medical databases. Objective: The main purposes of this study were to (1) modify and validate the internet-specific epistemic beliefs in medicine (ISEBM) questionnaire and (2) explore the associations between health care professionals? demographics, ISEBM, and intention to use evidence-based online medical databases for clinical practice. Methods: Health care professionals in a university-affiliated teaching hospital were surveyed using the ISEBM questionnaire. The partial least squares-structural equation modeling was conducted to analyze the reliability and validity of ISEBM. Furthermore, the structural model was analyzed to examine the possible linkages between health professionals? demographics, ISEBM, and intention to utilize the evidence-based online medical databases for clinical practice. Results: A total of 273 health care professionals with clinical working experience were surveyed. The results of the measurement model analysis indicated that all items had significant loadings ranging from 0.71 to 0.92 with satisfactory composite reliability values ranging from 0.87 to 0.94 and average variance explained values ranging from 0.70 to 0.84. The results of the structural relationship analysis revealed that the source of internet-based medical knowledge (path coefficient ?0.26, P=.01) and justification of internet-based knowing in medicine (path coefficient 0.21, P=.001) were correlated with the intention to use evidence-based online medical databases. However, certainty and simplicity of internet-based medical knowledge were not. In addition, gender (path coefficient 0.12, P=.04) and academic degree (path coefficient 0.15, P=.004) were associated with intention to use evidence-based online medical databases for clinical practice. Conclusions: Advancing health care professionals? ISEBM regarding source and justification may encourage them to retrieve valid medical information through evidence-based medical databases. Moreover, providing support for specific health care professionals (ie, females, without a master?s degree) may promote their intention to use certain databases for clinical practice. UR - https://www.jmir.org/2021/3/e20030 UR - http://dx.doi.org/10.2196/20030 UR - http://www.ncbi.nlm.nih.gov/pubmed/33734092 ID - info:doi/10.2196/20030 ER - TY - JOUR AU - Boet, Sylvain AU - Etherington, Cole AU - Lam, Sandy AU - Lę, Maxime AU - Proulx, Laurie AU - Britton, Meghan AU - Kenna, Julie AU - Przybylak-Brouillard, Antoine AU - Grimshaw, Jeremy AU - Grantcharov, Teodor AU - Singh, Sukhbir PY - 2021/3/16 TI - Implementation of the Operating Room Black Box Research Program at the Ottawa Hospital Through Patient, Clinical, and Organizational Engagement: Case Study JO - J Med Internet Res SP - e15443 VL - 23 IS - 3 KW - patient safety KW - implementation science KW - quality improvement KW - health personnel KW - operating rooms N2 - Background: A large proportion of surgical patient harm is preventable; yet, our ability to systematically learn from these incidents and improve clinical practice remains limited. The Operating Room Black Box was developed to address the need for comprehensive assessments of clinical performance in the operating room. It captures synchronized audio, video, patient, and environmental clinical data in real time, which are subsequently analyzed by a combination of expert raters and software-based algorithms. Despite its significant potential to facilitate research and practice improvement, there are many potential implementation challenges at the institutional, clinician, and patient level. This paper summarizes our approach to implementation of the Operating Room Black Box at a large academic Canadian center. Objective: We aimed to contribute to the development of evidence-based best practices for implementing innovative technology in the operating room for direct observation of the clinical performance by using the case of the Operating Room Black Box. Specifically, we outline the systematic approach to the Operating Room Black Box implementation undertaken at our center. Methods: Our implementation approach included seeking support from hospital leadership; building frontline support and a team of champions among patients, nurses, anesthesiologists, and surgeons; accounting for stakeholder perceptions using theory-informed qualitative interviews; engaging patients; and documenting the implementation process, including barriers and facilitators, using the consolidated framework for implementation research. Results: During the 12-month implementation period, we conducted 23 stakeholder engagement activities with over 200 participants. We recruited 10 clinician champions representing nursing, anesthesia, and surgery. We formally interviewed 15 patients and 17 perioperative clinicians and identified key themes to include in an information campaign run as part of the implementation process. Two patient partners were engaged and advised on communications as well as grant and protocol development. Many anticipated and unanticipated challenges were encountered at all levels. Implementation was ultimately successful, with the Operating Room Black Box installed in August 2018, and data collection beginning shortly thereafter. Conclusions: This paper represents the first step toward evidence-guided implementation of technologies for direct observation of performance for research and quality improvement in surgery. With technology increasingly being used in health care settings, the health care community should aim to optimize implementation processes in the best interest of health care professionals and patients. UR - https://www.jmir.org/2021/3/e15443 UR - http://dx.doi.org/10.2196/15443 UR - http://www.ncbi.nlm.nih.gov/pubmed/33724199 ID - info:doi/10.2196/15443 ER - TY - JOUR AU - Martinez-Garcia, Alicia AU - Naranjo-Saucedo, Belén Ana AU - Rivas, Antonio Jose AU - Romero Tabares, Antonio AU - Marín Cassinello, Ana AU - Andrés-Martín, Anselmo AU - Sánchez Laguna, José Francisco AU - Villegas, Roman AU - Pérez León, Paula Francisco De AU - Moreno Conde, Jesús AU - Parra Calderón, Luis Carlos PY - 2021/3/10 TI - A Clinical Decision Support System (KNOWBED) to Integrate Scientific Knowledge at the Bedside: Development and Evaluation Study JO - JMIR Med Inform SP - e13182 VL - 9 IS - 3 KW - evidence-based medicine KW - clinical decision support system KW - scientific knowledge integration N2 - Background: The evidence-based medicine (EBM) paradigm requires the development of health care professionals? skills in the efficient search of evidence in the literature, and in the application of formal rules to evaluate this evidence. Incorporating this methodology into the decision-making routine of clinical practice will improve the patients? health care, increase patient safety, and optimize resources use. Objective: The aim of this study is to develop and evaluate a new tool (KNOWBED system) as a clinical decision support system to support scientific knowledge, enabling health care professionals to quickly carry out decision-making processes based on EBM during their routine clinical practice. Methods: Two components integrate the KNOWBED system: a web-based knowledge station and a mobile app. A use case (bronchiolitis pathology) was selected to validate the KNOWBED system in the context of the Paediatrics Unit of the Virgen Macarena University Hospital (Seville, Spain). The validation was covered in a 3-month pilot using 2 indicators: usability and efficacy. Results: The KNOWBED system has been designed, developed, and validated to support clinical decision making in mobility based on standards that have been incorporated into the routine clinical practice of health care professionals. Using this tool, health care professionals can consult existing scientific knowledge at the bedside, and access recommendations of clinical protocols established based on EBM. During the pilot project, 15 health care professionals participated and accessed the system for a total of 59 times. Conclusions: The KNOWBED system is a useful and innovative tool for health care professionals. The usability surveys filled in by the system users highlight that it is easy to access the knowledge base. This paper also sets out some improvements to be made in the future. UR - https://medinform.jmir.org/2021/3/e13182 UR - http://dx.doi.org/10.2196/13182 UR - http://www.ncbi.nlm.nih.gov/pubmed/33709932 ID - info:doi/10.2196/13182 ER - TY - JOUR AU - Vahidy, Farhaan AU - Jones, L. Stephen AU - Tano, E. Mauricio AU - Nicolas, Carlos Juan AU - Khan, A. Osman AU - Meeks, R. Jennifer AU - Pan, P. Alan AU - Menser, Terri AU - Sasangohar, Farzan AU - Naufal, George AU - Sostman, Dirk AU - Nasir, Khurram AU - Kash, A. Bita PY - 2021/2/23 TI - Rapid Response to Drive COVID-19 Research in a Learning Health Care System: Rationale and Design of the Houston Methodist COVID-19 Surveillance and Outcomes Registry (CURATOR) JO - JMIR Med Inform SP - e26773 VL - 9 IS - 2 KW - COVID-19 KW - SARS-CoV-2 KW - data science KW - data curation KW - electronic health records KW - learning health system KW - databases, factual N2 - Background: The COVID-19 pandemic has exacerbated the challenges of meaningful health care digitization. The need for rapid yet validated decision-making requires robust data infrastructure. Organizations with a focus on learning health care (LHC) systems tend to adapt better to rapidly evolving data needs. Few studies have demonstrated a successful implementation of data digitization principles in an LHC context across health care systems during the COVID-19 pandemic. Objective: We share our experience and provide a framework for assembling and organizing multidisciplinary resources, structuring and regulating research needs, and developing a single source of truth (SSoT) for COVID-19 research by applying fundamental principles of health care digitization, in the context of LHC systems across a complex health care organization. Methods: Houston Methodist (HM) comprises eight tertiary care hospitals and an expansive primary care network across Greater Houston, Texas. During the early phase of the pandemic, institutional leadership envisioned the need to streamline COVID-19 research and established the retrospective research task force (RRTF). We describe an account of the structure, functioning, and productivity of the RRTF. We further elucidate the technical and structural details of a comprehensive data repository?the HM COVID-19 Surveillance and Outcomes Registry (CURATOR). We particularly highlight how CURATOR conforms to standard health care digitization principles in the LHC context. Results: The HM COVID-19 RRTF comprises expertise in epidemiology, health systems, clinical domains, data sciences, information technology, and research regulation. The RRTF initially convened in March 2020 to prioritize and streamline COVID-19 observational research; to date, it has reviewed over 60 protocols and made recommendations to the institutional review board (IRB). The RRTF also established the charter for CURATOR, which in itself was IRB-approved in April 2020. CURATOR is a relational structured query language database that is directly populated with data from electronic health records, via largely automated extract, transform, and load procedures. The CURATOR design enables longitudinal tracking of COVID-19 cases and controls before and after COVID-19 testing. CURATOR has been set up following the SSoT principle and is harmonized across other COVID-19 data sources. CURATOR eliminates data silos by leveraging unique and disparate big data sources for COVID-19 research and provides a platform to capitalize on institutional investment in cloud computing. It currently hosts deeply phenotyped sociodemographic, clinical, and outcomes data of approximately 200,000 individuals tested for COVID-19. It supports more than 30 IRB-approved protocols across several clinical domains and has generated numerous publications from its core and associated data sources. Conclusions: A data-driven decision-making strategy is paramount to the success of health care organizations. Investment in cross-disciplinary expertise, health care technology, and leadership commitment are key ingredients to foster an LHC system. Such systems can mitigate the effects of ongoing and future health care catastrophes by providing timely and validated decision support. UR - https://medinform.jmir.org/2021/2/e26773 UR - http://dx.doi.org/10.2196/26773 UR - http://www.ncbi.nlm.nih.gov/pubmed/33544692 ID - info:doi/10.2196/26773 ER - TY - JOUR AU - Haldeman, Scott AU - Nordin, Margareta AU - Tavares, Patricia AU - Mullerpatan, Rajani AU - Kopansky-Giles, Deborah AU - Setlhare, Vincent AU - Chou, Roger AU - Hurwitz, Eric AU - Treanor, Caroline AU - Hartvigsen, Jan AU - Schneider, Michael AU - Gay, Ralph AU - Moss, Jean AU - Haldeman, Joan AU - Gryfe, David AU - Wilkey, Adam AU - Brown, Richard AU - Outerbridge, Geoff AU - Eberspaecher, Stefan AU - Carroll, Linda AU - Engelbrecht, Reginald AU - Graham, Kait AU - Cashion, Nathan AU - Ince, Stefanie AU - Moon, Erin PY - 2021/2/17 TI - Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative JO - JMIR Public Health Surveill SP - e25484 VL - 7 IS - 2 KW - COVID-19 KW - spinal disorders KW - evidence-based care KW - physical distancing care KW - clinical guides KW - low- and middle-income communities KW - telehealth KW - telemedicine KW - evidence-based KW - spine KW - guide KW - management N2 - Background: The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. Objective: The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. Methods: Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. Results: The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient?s spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions. Conclusions: The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping.These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication. UR - http://publichealth.jmir.org/2021/2/e25484/ UR - http://dx.doi.org/10.2196/25484 UR - http://www.ncbi.nlm.nih.gov/pubmed/33471778 ID - info:doi/10.2196/25484 ER - TY - JOUR AU - Bernardo, Theresa AU - Sobkowich, Edward Kurtis AU - Forrest, Othmer Russell AU - Stewart, Silva Luke AU - D'Agostino, Marcelo AU - Perez Gutierrez, Enrique AU - Gillis, Daniel PY - 2021/2/9 TI - Collaborating in the Time of COVID-19: The Scope and Scale of Innovative Responses to a Global Pandemic JO - JMIR Public Health Surveill SP - e25935 VL - 7 IS - 2 KW - crowdsourcing KW - artificial intelligence KW - collaboration KW - personal protective equipment KW - big data KW - AI KW - COVID-19 KW - innovation KW - information sharing KW - communication KW - teamwork KW - knowledge KW - dissemination UR - http://publichealth.jmir.org/2021/2/e25935/ UR - http://dx.doi.org/10.2196/25935 UR - http://www.ncbi.nlm.nih.gov/pubmed/33503001 ID - info:doi/10.2196/25935 ER - TY - JOUR AU - Christie, Liane Hannah AU - Boots, Maria Lizzy Mitzy AU - Tange, Johannes Huibert AU - Verhey, Josef Frans Rochus AU - de Vugt, Elizabeth Marjolein PY - 2021/2/5 TI - Implementations of Evidence-Based eHealth Interventions for Caregivers of People With Dementia in Municipality Contexts (Myinlife and Partner in Balance): Evaluation Study JO - JMIR Aging SP - e21629 VL - 4 IS - 1 KW - eHealth KW - mHealth KW - implementation science KW - dementia KW - caregiving KW - municipality N2 - Background: Very few evidence-based eHealth interventions for caregivers of people with dementia are implemented into practice. Municipalities are one promising context in which to implement these interventions due to their available policy and innovation incentives regarding (dementia) caregiving and prevention. In this study, two evidence-based eHealth interventions for caregivers of people with dementia (Partner in Balance and Myinlife) were implemented in 8 municipalities in the Euregion Meuse-Rhine. Partner in Balance is a blended care, 8-week, self-management intervention intervention designed to aid caregivers of people with dementia in adapting to their new roles that is delivered through coaches in participating health care organizations who are trained to use it to offer online support to their clients. Myinlife is an eHealth/mHealth intervention integrated into the Dutch Alzheimer?s Association website and available from the App Store or Google Play, designed to help caregivers of people with dementia use their social network to better organize care and share positive (caregiving) experiences. Objective: This study?s objectives were to evaluate the success of the implementation of Myinlife and Partner in Balance and investigate determinants of their successful implementation in the municipality context. Methods: This study collected eHealth use data, Partner in Balance coach evaluation questionnaires, and information on implementation determinants. This was done by conducting interviews with the municipality officials based on the measurement instrument for determinants of implementation (MIDI). These data from multiple sources and perspectives were integrated and analyzed to form a total picture of the determinants (barriers and facilitators to implementation in the municipality context). Results: The municipality implementation of Partner in Balance and Myinlife showed varying levels of success. In the end, 3 municipalities planned to continue the implementation of Partner in Balance, while none planned to continue the implementation of Myinlife. The 2 Partner in Balance municipalities that did not consider the implementation to be successful viewed the implementation as an external project. For Myinlife, it was clear that more face-to-face contact was needed to engage the implementing municipality and target groups. Successful implementations were linked to implementer self-efficacy and sense of ownership, which seemed to be absent in unsuccessful implementations. Conclusions: The experiences of implementing these interventions suggested that this implementation context was feasible regarding the required budget and infrastructure. The need to foster sense of ownership and self-efficacy in implementers will be integrated into future implementation protocols as part of standard implementation materials for municipalities and organizations implementing Myinlife and Partner in Balance. UR - http://aging.jmir.org/2021/1/e21629/ UR - http://dx.doi.org/10.2196/21629 UR - http://www.ncbi.nlm.nih.gov/pubmed/33544085 ID - info:doi/10.2196/21629 ER - TY - JOUR AU - Lord, E. Sarah AU - Campbell, C. Aimee N. AU - Brunette, F. Mary AU - Cubillos, Leonardo AU - Bartels, M. Sophia AU - Torrey, C. William AU - Olson, L. Ardis AU - Chapman, H. Steven AU - Batsis, A. John AU - Polsky, Daniel AU - Nunes, V. Edward AU - Seavey, M. Katherine AU - Marsch, A. Lisa PY - 2021/1/28 TI - Workshop on Implementation Science and Digital Therapeutics for Behavioral Health JO - JMIR Ment Health SP - e17662 VL - 8 IS - 1 KW - mHealth KW - mobile health KW - digital health KW - telemedicine KW - eHealth KW - behavioral sciences KW - substance-related disorders KW - mental health KW - implementation science UR - https://mental.jmir.org/2021/1/e17662 UR - http://dx.doi.org/10.2196/17662 UR - http://www.ncbi.nlm.nih.gov/pubmed/33507151 ID - info:doi/10.2196/17662 ER - TY - JOUR AU - James, M. Hannah AU - Papoutsi, Chrysanthi AU - Wherton, Joseph AU - Greenhalgh, Trisha AU - Shaw, E. Sara PY - 2021/1/26 TI - Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework JO - J Med Internet Res SP - e23775 VL - 23 IS - 1 KW - delivery of health care KW - remote consultation KW - telemedicine KW - videoconferencing KW - spread and scale-up KW - sustainability KW - mobile phone KW - COVID-19 KW - remote care KW - consultation KW - review N2 - Background: COVID-19 has thrust video consulting into the limelight, as health care practitioners worldwide shift to delivering care remotely. Evidence suggests that video consulting is acceptable, safe, and effective in selected conditions and settings. However, research to date has mostly focused on initial adoption, with limited consideration of how video consulting can be mainstreamed and sustained. Objective: This study sought to do the following: (1) review and synthesize reported opportunities, challenges, and lessons learned in the scale-up, spread, and sustainability of video consultations, and (2) identify transferable insights that can inform policy and practice. Methods: We identified papers through systematic searches in PubMed, CINAHL, and Web of Science. Included articles reported on synchronous, video-based consultations that had spread to more than one setting beyond an initial pilot or feasibility stage, and were published since 2010. We used the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework to synthesize findings relating to 7 domains: an understanding of the health condition(s) for which video consultations were being used, the material properties of the technological platform and relevant peripherals, the value proposition for patients and developers, the role of the adopter system, organizational factors, wider macro-level considerations, and emergence over time. Results: We identified 13 papers describing 10 different video consultation services in 6 regions, covering the following: (1) video-to-home services, connecting providers directly to the patient; (2) hub-and-spoke models, connecting a provider at a central hub to a patient at a rural center; and (3) large-scale top-down evaluations scaled up or spread across a national health administration. Services covered rehabilitation, geriatrics, cancer surgery, diabetes, and mental health, as well as general specialist care and primary care. Potential enablers of spread and scale-up included embedded leadership and the presence of a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation (of technology and services) over time. Challenges tended to be related to service development, such as the absence of a long-term strategic plan, resistance to change, cost and reimbursement issues, and the technical experience of staff. There was limited articulation of the challenges to scale-up and spread of video consultations. This was combined with a lack of theorization, with papers tending to view spread and scale-up as the sum of multiple technical implementations, rather than theorizing the distinct processes required to achieve widespread adoption. Conclusions: There remains a significant lack of evidence that can support the spread and scale-up of video consulting. Given the recent pace of change due to COVID-19, a more definitive evidence base is urgently needed to support global efforts and match enthusiasm for extending use. UR - http://www.jmir.org/2021/1/e23775/ UR - http://dx.doi.org/10.2196/23775 UR - http://www.ncbi.nlm.nih.gov/pubmed/33434141 ID - info:doi/10.2196/23775 ER - TY - JOUR AU - Waters, A. Erika AU - Foust, L. Jeremy AU - Scherer, D. Laura AU - McQueen, Amy AU - Taber, M. Jennifer PY - 2021/1/25 TI - Adherence of Internet-Based Cancer Risk Assessment Tools to Best Practices in Risk Communication: Content Analysis JO - J Med Internet Res SP - e23318 VL - 23 IS - 1 KW - health communication KW - personalized medicine KW - internet KW - risk assessment N2 - Background: Internet-based risk assessment tools offer a potential avenue for people to learn about their cancer risk and adopt risk-reducing behaviors. However, little is known about whether internet-based risk assessment tools adhere to scientific evidence for what constitutes good risk communication strategies. Furthermore, their quality may vary from a user experience perspective. Objective: This study aims to understand the extent to which current best practices in risk communication have been applied to internet-based cancer risk assessment tools. Methods: We conducted a search on August 6, 2019, to identify websites that provided personalized assessments of cancer risk or the likelihood of developing cancer. Each website (N=39) was coded according to standardized criteria and focused on 3 categories: general website characteristics, accessibility and credibility, and risk communication formats and strategies. Results: Some best practices in risk communication were more frequently adhered to by websites. First, we found that undefined medical terminology was widespread, impeding comprehension for those with limited health literacy. For example, 90% (35/39) of websites included technical language that the general public may find difficult to understand, yet only 23% (9/39) indicated that medical professionals were their intended audience. Second, websites lacked sufficient information for users to determine the credibility of the risk assessment, making it difficult to judge the scientific validity of their risk. For instance, only 59% (23/39) of websites referenced the scientific model used to calculate the user?s cancer risk. Third, practices known to foster unbiased risk comprehension, such as adding qualitative labels to quantitative numbers, were used by only 15% (6/39) of websites. Conclusions: Limitations in risk communication strategies used by internet-based cancer risk assessment tools were common. By observing best practices, these tools could limit confusion and cultivate understanding to help people make informed decisions and motivate people to engage in risk-reducing behaviors. UR - http://www.jmir.org/2021/1/e23318/ UR - http://www.ncbi.nlm.nih.gov/pubmed/33492238 ID - info:pmid/33492238 ER - TY - JOUR AU - Batterham, J. Philip AU - Calear, L. Alison AU - Farrer, Louise AU - Gulliver, Amelia AU - Kurz, Ella PY - 2021/1/22 TI - Efficacy of a Transdiagnostic Self-Help Internet Intervention for Reducing Depression, Anxiety, and Suicidal Ideation in Adults: Randomized Controlled Trial JO - J Med Internet Res SP - e22698 VL - 23 IS - 1 KW - depression KW - anxiety KW - randomized controlled trial KW - internet KW - implementation science N2 - Background: Low-intensity self-guided mental health interventions that are delivered on the web may meet the needs and preferences of adults with mild to moderate symptoms. However, few clinical trials have examined the effectiveness of self-guided transdiagnostic interventions within a naturalistic setting. Objective: This randomized controlled trial (RCT) tests the effectiveness of the video-based transdiagnostic intervention FitMindKit in reducing depression symptoms (primary outcome), anxiety symptoms, disability, and suicidal ideation, relative to an attention-matched control condition called HealthWatch. Methods: The RCT was conducted with adults living in the Australian Capital Territory, Australia. Participants (n=1986) were recruited through the web using social media advertisements, screened for psychological distress, and then randomized to receive one of two 4-week programs: FitMindKit (12-module psychotherapy intervention) or HealthWatch (12-module program providing general health information). Participants were assessed at baseline and at 4 weeks postbaseline. To maintain the ecological validity of the trial, participants completed brief assessments and interventions without direct researcher contact or incentives. Results: Mixed model repeated-measures analyses of variance demonstrated that FitMindKit significantly improved depression symptoms (F1,701.7=3.97; P=.047), along with panic symptoms (F1,706.5=5.59; P=.02) and social anxiety symptoms (F1,680.0=12.37; P<.001), relative to the attention control condition. There were no significant effects on other outcomes. Conclusions: Self-guided transdiagnostic interventions can be beneficial when delivered directly to end users through the internet. Despite low adherence and small effect sizes, the availability of such interventions is likely to fill a critical gap in the accessibility of mental health services for the community. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001688279; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376113. International Registered Report Identifier (IRRID): RR2-10.1016/j.conctc.2019.100341 UR - https://www.jmir.org/2021/1/e22698 UR - http://dx.doi.org/10.2196/22698 UR - http://www.ncbi.nlm.nih.gov/pubmed/33480860 ID - info:doi/10.2196/22698 ER - TY - JOUR AU - Meherali, Salima AU - Hartling, Lisa AU - Scott, D. Shannon PY - 2021/1/20 TI - Cultural Adaptation of Digital Knowledge Translation Tools for Acute Otitis Media in Low- to Middle-Income Countries: Mixed Methods Usability Study JO - JMIR Form Res SP - e13908 VL - 5 IS - 1 KW - acute otitis media KW - knowledge translation KW - pediatric KW - parent?s experiences KW - information needs KW - global health N2 - Background: Acute otitis media (AOM) is the most common pediatric bacterial ear infection. AOM presents challenges to parents who lack accurate information. Digital knowledge translation tools offer a promising approach to communicating complex health information. We developed AOM knowledge translation tools for Canadian parents and augmented them for Pakistani parent end users. Objective: This pilot study aimed to (1) develop AOM knowledge translation tools for Canadian parents, (2) adapt the knowledge translation tools across cultural contexts, and (3) evaluate the usability of the adapted knowledge translation tools. Methods: Parents? perceptions of the translated knowledge translation tools? usability were explored using a mixed-methods design. We recruited parent participants from a hospital in Pakistan to complete usability surveys (n=47) and focus group interviews (n=21). Descriptive statistics and content analysis were used to analyze data. Results: Usability results showed the usefulness and effectiveness of both adapted knowledge translation tools. Parents reported preferring a digital media narrative format in their own language. Findings revealed that culturally adapted knowledge translation tools are effective in transferring health information to parents. Conclusions: Digital knowledge translation tools offer a promising approach to improving health literacy and communicating complex health information to parents of children with AOM. Culturally adapting the tools generated important knowledge that will contribute to knowledge translation advancements. Evaluation of the tool effectiveness is a critical next step to exploring the impact of knowledge translation tools on child health outcomes. UR - http://formative.jmir.org/2021/1/e13908/ UR - http://dx.doi.org/10.2196/13908 UR - http://www.ncbi.nlm.nih.gov/pubmed/33470942 ID - info:doi/10.2196/13908 ER - TY - JOUR AU - Yank, Veronica AU - Gale, C. Randall AU - Nevedal, Andrea AU - Okwara, Leonore AU - Koenig, J. Christopher AU - Trivedi, B. Ranak AU - Dupke, J. Nancy AU - Kabat, Margaret AU - Asch, M. Steven PY - 2021/1/7 TI - Improving Uptake of a National Web-Based Psychoeducational Workshop for Informal Caregivers of Veterans: Mixed Methods Implementation Evaluation JO - J Med Internet Res SP - e16495 VL - 23 IS - 1 KW - web-based workshop KW - implementation science KW - behavioral intervention technology KW - informal caregiver KW - family caregiver KW - veteran KW - psychoeducation KW - self-management KW - outreach KW - marketing N2 - Background: Although web-based psychoeducational programs may be an efficient, accessible, and scalable option for improving participant well-being, they seldom are sustained beyond trial publication. Implementation evaluations may help optimize program uptake, but few are performed. When the US Department of Veterans Affairs (VA) launched the web-based psychoeducational workshop Building Better Caregivers (BBC) for informal caregivers of veterans nationwide in 2013, the workshop did not enroll as many caregivers as anticipated. Objective: This study aims to identify the strengths and weaknesses of initial implementation, strategies likely to improve workshop uptake, whether the VA adopted these strategies, and whether workshop enrollment changed. Methods: We used mixed methods and the Promoting Action on Research Implementation in Health Services (PARIHS) implementation evaluation framework. In stage 1, we conducted semistructured interviews with caregivers, local staff, and regional and national VA leaders and surveys with caregivers and staff. We collected and analyzed survey and interview data concurrently and integrated the results to identify implementation strengths and weaknesses, and strategies likely to improve workshop uptake. In stage 2, we reinterviewed national leaders to determine whether the VA adopted recommended strategies and used national data to determine whether workshop enrollment changed over time. Results: A total of 54 caregivers (n=32, 59%), staff (n=13, 24%), and regional (n=5, 9%) and national (n=4, 7%) leaders were interviewed. We received survey responses from 72% (23/32) of caregivers and 77% (10/13) of local staff. In stage 1, survey and interview results were consistent across multiple PARIHS constructs. Although participants from low-enrollment centers reported fewer implementation strengths and more weaknesses, qualitative themes were consistent across high- and low-enrollment centers, and across caregiver, staff, and leadership respondent groups. Identified strengths included belief in a positive workshop impact and the use of some successful outreach approaches. Implementation weaknesses included missed opportunities to improve outreach and to better support local staff. From these, we identified and recommended new and enhanced implementation strategies?increased investment in outreach and marketing capabilities; tailoring outreach strategies to multiple stakeholder groups; use of campaigns that are personal, repeated, and detailed, and have diverse delivery options; recurrent training and mentoring for new staff; and comprehensive data management and reporting capabilities. In stage 2, we determined that the VA had adopted several of these strategies in 2016. In the 3 years before and after adoption, cumulative BBC enrollment increased from 2139 (2013-2015) to 4030 (2016-2018) caregivers. Conclusions: This study expands the limited implementation science literature on best practices to use when implementing web-based psychoeducational programs. We found that robust outreach and marketing strategies and support for local staff were critical to the implementation success of the BBC workshop. Other health systems may want to deploy these strategies when implementing their web-based programs. UR - https://www.jmir.org/2021/1/e16495 UR - http://dx.doi.org/10.2196/16495 UR - http://www.ncbi.nlm.nih.gov/pubmed/33410759 ID - info:doi/10.2196/16495 ER - TY - JOUR AU - Zimba, Rebecca AU - Kulkarni, Sarah AU - Berry, Amanda AU - You, William AU - Mirzayi, Chloe AU - Westmoreland, Drew AU - Parcesepe, Angela AU - Waldron, Levi AU - Rane, Madhura AU - Kochhar, Shivani AU - Robertson, McKaylee AU - Maroko, Andrew AU - Grov, Christian AU - Nash, Denis PY - 2020/12/31 TI - SARS-CoV-2 Testing Service Preferences of Adults in the United States: Discrete Choice Experiment JO - JMIR Public Health Surveill SP - e25546 VL - 6 IS - 4 KW - COVID-19 KW - SARS-CoV-2 KW - discrete choice experiment KW - implementation science KW - engagement KW - testing KW - cohort study KW - stated preference study KW - pandemic N2 - Background: Ascertaining preferences for SARS-CoV-2 testing and incorporating findings into the design and implementation of strategies for delivering testing services may enhance testing uptake and engagement, a prerequisite to reducing onward transmission. Objective: This study aims to determine important drivers of decisions to obtain a SARS-CoV-2 test in the context of increasing community transmission. Methods: We used a discrete choice experiment to assess preferences for SARS-CoV-2 test type, specimen type, testing venue, and results turnaround time. Participants (n=4793) from the US national longitudinal Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study completed our online survey from July 30 to September 8, 2020. We estimated the relative importance of testing method attributes and part-worth utilities of attribute levels, and simulated the uptake of an optimized testing scenario relative to the current typical testing scenario of polymerase chain reaction (PCR) via nasopharyngeal swab in a provider?s office or urgent care clinic with results in >5 days. Results: Test result turnaround time had the highest relative importance (30.4%), followed by test type (28.3%), specimen type (26.2%), and venue (15.0%). In simulations, immediate or same-day test results, both PCR and serology, or oral specimens substantially increased testing uptake over the current typical testing option. Simulated uptake of a hypothetical testing scenario of PCR and serology via a saliva sample at a pharmacy with same-day results was 97.7%, compared to 0.6% for the current typical testing scenario, with 1.8% opting for no test. Conclusions: Testing strategies that offer both PCR and serology with noninvasive methods and rapid turnaround time would likely have the most uptake and engagement among residents in communities with increasing community transmission of SARS-CoV-2. UR - http://publichealth.jmir.org/2020/4/e25546/ UR - http://dx.doi.org/10.2196/25546 UR - http://www.ncbi.nlm.nih.gov/pubmed/33315584 ID - info:doi/10.2196/25546 ER - TY - JOUR AU - Yamada, Tomohide AU - Yoneoka, Daisuke AU - Hiraike, Yuta AU - Hino, Kimihiro AU - Toyoshiba, Hiroyoshi AU - Shishido, Akira AU - Noma, Hisashi AU - Shojima, Nobuhiro AU - Yamauchi, Toshimasa PY - 2020/12/30 TI - Deep Neural Network for Reducing the Screening Workload in Systematic Reviews for Clinical Guidelines: Algorithm Validation Study JO - J Med Internet Res SP - e22422 VL - 22 IS - 12 KW - machine learning KW - evidence-based medicine KW - systematic review KW - meta-analysis KW - clinical guideline KW - deep learning KW - neural network N2 - Background: Performing systematic reviews is a time-consuming and resource-intensive process. Objective: We investigated whether a machine learning system could perform systematic reviews more efficiently. Methods: All systematic reviews and meta-analyses of interventional randomized controlled trials cited in recent clinical guidelines from the American Diabetes Association, American College of Cardiology, American Heart Association (2 guidelines), and American Stroke Association were assessed. After reproducing the primary screening data set according to the published search strategy of each, we extracted correct articles (those actually reviewed) and incorrect articles (those not reviewed) from the data set. These 2 sets of articles were used to train a neural network?based artificial intelligence engine (Concept Encoder, Fronteo Inc). The primary endpoint was work saved over sampling at 95% recall (WSS@95%). Results: Among 145 candidate reviews of randomized controlled trials, 8 reviews fulfilled the inclusion criteria. For these 8 reviews, the machine learning system significantly reduced the literature screening workload by at least 6-fold versus that of manual screening based on WSS@95%. When machine learning was initiated using 2 correct articles that were randomly selected by a researcher, a 10-fold reduction in workload was achieved versus that of manual screening based on the WSS@95% value, with high sensitivity for eligible studies. The area under the receiver operating characteristic curve increased dramatically every time the algorithm learned a correct article. Conclusions: Concept Encoder achieved a 10-fold reduction of the screening workload for systematic review after learning from 2 randomly selected studies on the target topic. However, few meta-analyses of randomized controlled trials were included. Concept Encoder could facilitate the acquisition of evidence for clinical guidelines. UR - https://www.jmir.org/2020/12/e22422 UR - http://dx.doi.org/10.2196/22422 UR - http://www.ncbi.nlm.nih.gov/pubmed/33262102 ID - info:doi/10.2196/22422 ER - TY - JOUR AU - Steeb, Theresa AU - Follmann, Markus AU - Hagen, Matthias Ralf AU - Berking, Carola AU - Heppt, Vincent Markus PY - 2020/12/29 TI - Implications of the COVID-19 Pandemic for the Development and Update of Clinical Practice Guidelines: Viewpoint JO - J Med Internet Res SP - e20064 VL - 22 IS - 12 KW - practice guideline KW - consensus development conference KW - guideline KW - videoconferencing KW - clinical practice KW - COVID-19 KW - pandemic KW - public health KW - policy KW - decision making KW - online conference UR - http://www.jmir.org/2020/12/e20064/ UR - http://dx.doi.org/10.2196/20064 UR - http://www.ncbi.nlm.nih.gov/pubmed/33347419 ID - info:doi/10.2196/20064 ER - TY - JOUR AU - Mallidou, Anastasia AU - Dordunoo, Dzifa AU - Borycki, Elizabeth AU - Kushniruk, Andre AU - Sadeghi-Yekta, Kirsten AU - Fraser, Julie AU - Asuri, Sirisha PY - 2020/12/17 TI - Perspectives and Experiences of Policy Makers, Researchers, Health Information Technology Professionals, and the Public on Evidence-Based Health Policies: Protocol for a Qualitative Study JO - JMIR Res Protoc SP - e16268 VL - 9 IS - 12 KW - evidence-based health policy KW - knowledge translation KW - transparency KW - policy makers KW - researchers KW - knowledge producers KW - health information technology N2 - Background: Evidence-based health policy (EBHP) development is critical to the judicious use of public funds. EBHPs increase transparency, accountability, effectiveness, and efficiency of policies. Encouraging collaboration between researchers or knowledge producers and policy makers is important because both communities have distinct professional cultures, resulting in them working separately without understanding each other. Knowledge sharing is a complex process that requires understanding of cultural aspects that may reduce cultural differences and increase the use of common language. Health information technology (HIT) is a useful tool to increase knowledge translation, which may result in the transparent use of evidence and networking in developing EBHPs. Our vision is to leverage HIT tools for a better health system that includes digitalized, open source, evidence-based, and transparent ways for collaboration and development of robust mechanisms and for sharing of synthesized evidence with knowledge user?friendly forms. Objective: The aim of this study is to develop a conceptual framework on Knowledge translation and health Information Technology for Transparency (KhITT) in policy making and EBHPs (ie, the KhITT framework). The framework will be informed by the views of four key stakeholder groups (ie, policy makers, knowledge producers, HIT professionals, and the public) toward EBHP. The informants may also describe practices that demonstrate the EBHP development process and suggest technology platforms to enable this process. Methods: We propose an exploratory, descriptive qualitative study to take place in British Columbia, Canada, using in-depth semistructured interviews. To ensure data saturation and trustworthiness, we will use a nonprobability, purposive snowball sample of up to 15 eligible participants in each of the four stakeholder groups. We will analyze the data using content analysis. Results: The KhITT framework focuses on various stakeholders? perspectives to better understand their perceived needs and priorities in identifying issues with EBHP, in order to make informed recommendations. Ethics approval has been obtained by the harmonized Behavioural Research Ethics Board at the University of British Columbia. We anticipate that we will complete data collection and analysis by December 2020. Preliminary results will be published in summer 2021. Conclusions: Our ultimate goal of this study is to develop a conceptual framework and describe the technology platforms that would enable the EBHP process. We anticipate that our rigorous content analysis will be able to produce insights and themes that are able to address our objectives, contribute to an in-depth understanding of the EBHP process within British Columbia, highlight all influential factors, explicitly disseminate and communicate the study results, identify issues with EBHP and provide informed recommendations to address them, and enhance efforts toward transparent EBHPs. International Registered Report Identifier (IRRID): PRR1-10.2196/16268 UR - http://www.researchprotocols.org/2020/12/e16268/ UR - http://dx.doi.org/10.2196/16268 UR - http://www.ncbi.nlm.nih.gov/pubmed/33331825 ID - info:doi/10.2196/16268 ER - TY - JOUR AU - Oska, Sandra AU - Lerma, Edgar AU - Topf, Joel PY - 2020/12/4 TI - A Picture Is Worth a Thousand Views: A Triple Crossover Trial of Visual Abstracts to Examine Their Impact on Research Dissemination JO - J Med Internet Res SP - e22327 VL - 22 IS - 12 KW - social media KW - science communication KW - visual abstract KW - Twitter KW - dissemination N2 - Background: A visual abstract is a graphic summary of a research article?s question, methods, and major findings. Although they have a number of uses, visual abstracts are chiefly used to promote research articles on social media. Objective: This study aimed to determine if the use of visual abstracts increases the visibility of nephrology research shared on Twitter. Methods: A prospective case-control crossover study was conducted using 40 research articles published in the American Journal of Nephrology (AJN). Each article was shared by the AJN Twitter account in 3 formats: (1) the article citation, (2) the citation with a key figure from the article, and (3) the citation with a visual abstract. Tweets were spaced 2 weeks apart to allow washout of the previous tweet, and the order of the tweets was randomized. Dissemination was measured via retweets, views, number of link clicks, and Altmetric scores. Results: Tweets that contained a visual abstract had more than twice as many views as citation-only tweets (1351, SD 1053 vs 639, SD 343) and nearly twice as many views as key figure tweets (1351, SD 1053 vs 732, SD 464). Visual abstract tweets had 5 times the engagements of citation-only tweets and more than 3.5 times the engagements of key figure tweets. Visual abstract tweets were also associated with greater increases in Altmetric scores as compared to citation-only tweets (2.20 vs 1.05). Conclusions: The use of visual abstracts increased visibility of research articles on Twitter, resulting in a greater number of views, engagements, and retweets. Visual abstracts were also associated with increased Altmetric scores as compared to citation-only tweets. These findings support the broader use of visual abstracts in the scientific community. Journals should consider visual abstracts as valuable tools for research dissemination. UR - https://www.jmir.org/2020/12/e22327 UR - http://dx.doi.org/10.2196/22327 UR - http://www.ncbi.nlm.nih.gov/pubmed/33275112 ID - info:doi/10.2196/22327 ER - TY - JOUR AU - Biran, Noa AU - Anthony Kouyaté, Robin AU - Yucel, Emre AU - McGovern, E. Gillian AU - Schoenthaler, M. Antoinette AU - Durling, G. Olivia AU - Unawane, Rashmi AU - Schutt, Andrew AU - Panjabi, Sumeet PY - 2020/11/17 TI - Adaptation and Evaluation of a Symptom-Monitoring Digital Health Intervention for Patients With Relapsed and Refractory Multiple Myeloma: Pilot Mixed-Methods Implementation Study JO - JMIR Form Res SP - e18982 VL - 4 IS - 11 KW - mHealth KW - digital health KW - electronic patient-reported outcome KW - ePRO KW - patient-reported outcome KW - PRO KW - mobile KW - app KW - implementation science KW - multiple myeloma KW - relapsed refractory multiple myeloma N2 - Background: Relapsed and refractory multiple myeloma (RRMM) is a bone marrow cancer that requires systemic treatment, which often results in severe symptom burden. Recent studies have found that electronic patient-reported outcome (ePRO) interventions implemented in the clinic setting have had positive outcomes for other oncology populations. Evidence of the efficacy of a similar approach is lacking for patients with RRMM. Objective: Recent recommendations for digital health interventions call for the publication of descriptions of iterative development processes in order to improve reproducibility and comparability. This study is an implementation pilot aiming to evaluate the acceptability and appropriateness of an ePRO intervention for patients with RRMM and to explore its impact on clinic workflow. Methods: A total of 11 patients with RRMM were recruited from the John Theurer Cancer Center in Hackensack, New Jersey. Patients used a mobile app to report on 17 symptoms at 4 sessions, each a week apart. Patients could also report symptoms ad hoc. When reports met predefined thresholds, the clinic was alerted and patients received automated guidance. Study end points were assessed using qualitative and quantitative methods. Results: A total of 9 patients (mean age 69.7 years) completed the study. Overall, 83% (30/36) of weekly sessions were completed. Patients found the frequency and time required to complete reporting acceptable. All patients agreed that the app was easy to use and understand. Providers felt the alerts they received required refinement. Patients and providers agreed it would be beneficial for patients to report for longer than 4 weeks. Patients felt that the training they received was adequate but contained too much information for a single session. All patients found the symptoms tracked to be appropriate; providers suggested shortening the list. All patients understood how to use the app for weekly reporting but had confusion about using it ad hoc. Providers felt the ad hoc feature could be removed. Neither patients nor providers viewed the in-app data reports but agreed on their potential value. Patients reported benefitting from symptom reporting through increased awareness of their symptoms. Clinic staff reported that app alerts were too numerous and redundant. They had difficulty responding to alerts within their existing workflow, partially because the data were not integrated into the electronic medical record system. Conclusions: Overall, the intervention was found to be acceptable and appropriate for patients with RRMM. Points of friction integrating the intervention into the clinic workflow were identified. Clinic staff provided recommendations for addressing these issues. Once such modifications are implemented, ePRO data from patients with RRMM could be used to inform and improve clinical research and care. This study underlines the importance of an iterative approach to implementation that includes all stakeholders in order to ensure successful adoption. UR - http://formative.jmir.org/2020/11/e18982/ UR - http://dx.doi.org/10.2196/18982 UR - http://www.ncbi.nlm.nih.gov/pubmed/33200997 ID - info:doi/10.2196/18982 ER - TY - JOUR AU - Cecchetti, A. Alfred AU - Bhardwaj, Niharika AU - Murughiyan, Usha AU - Kothakapu, Gouthami AU - Sundaram, Uma PY - 2020/10/14 TI - Fueling Clinical and Translational Research in Appalachia: Informatics Platform Approach JO - JMIR Med Inform SP - e17962 VL - 8 IS - 10 KW - Appalachian region KW - medical informatics KW - health care disparities KW - electronic health records KW - data warehousing KW - data mining KW - data visualization KW - machine learning KW - data science N2 - Background: The Appalachian population is distinct, not just culturally and geographically but also in its health care needs, facing the most health care disparities in the United States. To meet these unique demands, Appalachian medical centers need an arsenal of analytics and data science tools with the foundation of a centralized data warehouse to transform health care data into actionable clinical interventions. However, this is an especially challenging task given the fragmented state of medical data within Appalachia and the need for integration of other types of data such as environmental, social, and economic with medical data. Objective: This paper aims to present the structure and process of the development of an integrated platform at a midlevel Appalachian academic medical center along with its initial uses. Methods: The Appalachian Informatics Platform was developed by the Appalachian Clinical and Translational Science Institute?s Division of Clinical Informatics and consists of 4 major components: a centralized clinical data warehouse, modeling (statistical and machine learning), visualization, and model evaluation. Data from different clinical systems, billing systems, and state- or national-level data sets were integrated into a centralized data warehouse. The platform supports research efforts by enabling curation and analysis of data using the different components, as appropriate. Results: The Appalachian Informatics Platform is functional and has supported several research efforts since its implementation for a variety of purposes, such as increasing knowledge of the pathophysiology of diseases, risk identification, risk prediction, and health care resource utilization research and estimation of the economic impact of diseases. Conclusions: The platform provides an inexpensive yet seamless way to translate clinical and translational research ideas into clinical applications for regions similar to Appalachia that have limited resources and a largely rural population. UR - http://medinform.jmir.org/2020/10/e17962/ UR - http://dx.doi.org/10.2196/17962 UR - http://www.ncbi.nlm.nih.gov/pubmed/33052114 ID - info:doi/10.2196/17962 ER - TY - JOUR AU - van Lieshout, Florence AU - Yang, Rebecca AU - Stamenova, Vess AU - Agarwal, Payal AU - Cornejo Palma, Daniel AU - Sidhu, Aman AU - Engel, Katrina AU - Erwood, Adam AU - Bhatia, Sacha R. AU - Bhattacharyya, Onil AU - Shaw, James PY - 2020/10/9 TI - Evaluating the Implementation of a Remote-Monitoring Program for Chronic Obstructive Pulmonary Disease: Qualitative Methods from a Service Design Perspective JO - J Med Internet Res SP - e18148 VL - 22 IS - 10 KW - service design KW - digital health KW - innovation KW - implementation science KW - remote monitoring KW - telemedicine N2 - Background: Implementing digital health technologies is complex but can be facilitated by considering the features of the tool that is being implemented, the team that will use it, and the routines that will be affected. Objective: The goal of this study was to assess the implementation of a remote-monitoring initiative for patients with chronic obstructive pulmonary disease in Ontario, Canada using the Tool+Team+Routine framework and to refine this approach to conceptualize the adoption of technologies in health care. Methods: This study was a qualitative research project that took place alongside a randomized controlled trial comparing a technology-enabled self-monitoring program with a technology-enabled self- and remote-monitoring program in patients with chronic obstructive pulmonary disease and with standard care. This study included interviews with 5 remote-monitoring patients, 3 self-monitoring patients, 2 caregivers, 5 health care providers, and 3 hospital administrators. The interview questions were structured around the 3 main concepts of the Tool+Team+Routine framework. Results: Findings emphasized that (1) technologies can alter relationships between providers and patients, and that these relationships drove the development of a new service arising from the technology, in our case, and (2) technologies can create additional work that is not visible to management as a result of not being considered within the scope of the service. Conclusions: Literature on the implementation of digital health technologies has still not reconciled the importance of interpersonal relationships to conventional implementation strategies. By acknowledging the centrality of such relationships, implementation teams can better plan for the adaptations required in order to make new technologies work for patients and health care providers. Further work will need to address how specific individuals administering a remote-monitoring program work to build relationships, and how these relationships and other sources of activity might lead to technological scope creep?an unanticipated expanding scope of work activities in relation to the function of the tool. UR - https://www.jmir.org/2020/10/e18148 UR - http://dx.doi.org/10.2196/18148 UR - http://www.ncbi.nlm.nih.gov/pubmed/33034565 ID - info:doi/10.2196/18148 ER - TY - JOUR AU - Poss-Doering, Regina AU - Kuehn, Lukas AU - Kamradt, Martina AU - Glassen, Katharina AU - Wensing, Michel PY - 2020/10/7 TI - Applying Digital Information Delivery to Convert Habits of Antibiotic Use in Primary Care in Germany: Mixed-Methods Study JO - J Med Internet Res SP - e18200 VL - 22 IS - 10 KW - antimicrobial resistance KW - educative digital solutions KW - health literacy KW - diffusion of innovations N2 - Background: Antimicrobial resistance is an important global health issue. In Germany, the national agenda supports various interventions to convert habits of antibiotic use. In the CHANGE-3 (Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care) study, digital tools were applied for information delivery: tablet computers in primary care practices, e-learning platforms for medical professionals, and a public website to promote awareness and health literacy among primary care physicians, their teams, and their patients. Objective: This study is embedded in the process evaluation of the CHANGE-3 study. The aim of this study was to evaluate the acceptance and uptake of digital devices for the delivery of health-related information to enhance awareness and change habits of antibiotic use in primary care in Germany. Methods: This study used a convergent-parallel mixed-methods design. Audio-recorded semistructured telephone interviews were conducted with physicians, nonphysician health professionals, and patients in the CHANGE-3 program. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was performed based on the inductive category of information provision via digital information tools. Identified themes were related to the main postulates of Diffusion of Innovations theory (DIT) to provide an explanatory frame. In addition, data generated through a structured survey with physicians and nonphysician health professionals in the program were analyzed descriptively and integrated with the qualitative data to explore the complementarity of the findings. Results: Findings regarding the acceptance and uptake of digital devices were related to three postulates of DIT: innovation characteristics, communication channels, and unanticipated consequences. Participants considered the provided digital educative solutions to be supportive for promoting health literacy regarding conversion of habits of antibiotic use. However, health care professionals found it challenging to integrate these solutions into existing routines in primary care and to align them with their professional values. Low technology affinity was a major barrier to the use of digital information in primary care. Patients welcomed the general idea of introducing health-related information in digital formats; however, they expressed concerns about device-related hygiene and the appropriateness of the digital tools for older patients. Conclusions: Patients and medical professionals in German primary care are reluctant to use digital devices for information and education. Using a Diffusion of Innovations approach can support assessment of existing barriers and provide information about setting-specific preconditions that are necessary for future tailoring of implementation strategies. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 15061174; http://www.isrctn.com/ISRCTN15061174. UR - http://www.jmir.org/2020/10/e18200/ UR - http://dx.doi.org/10.2196/18200 UR - http://www.ncbi.nlm.nih.gov/pubmed/32960773 ID - info:doi/10.2196/18200 ER - TY - JOUR AU - Nan, Shan AU - Tang, Tianhua AU - Feng, Hongshuo AU - Wang, Yijie AU - Li, Mengyang AU - Lu, Xudong AU - Duan, Huilong PY - 2020/10/1 TI - A Computer-Interpretable Guideline for COVID-19: Rapid Development and Dissemination JO - JMIR Med Inform SP - e21628 VL - 8 IS - 10 KW - COVID-19 KW - guideline KW - CDSS KW - openEHR KW - Guideline Definition Language KW - development KW - dissemination KW - electronic health record KW - algorithm N2 - Background: COVID-19 is a global pandemic that is affecting more than 200 countries worldwide. Efficient diagnosis and treatment are crucial to combat the disease. Computer-interpretable guidelines (CIGs) can aid the broad global adoption of evidence-based diagnosis and treatment knowledge. However, currently, no internationally shareable CIG exists. Objective: The aim of this study was to establish a rapid CIG development and dissemination approach and apply it to develop a shareable CIG for COVID-19. Methods: A 6-step rapid CIG development and dissemination approach was designed and applied. Processes, roles, and deliverable artifacts were specified in this approach to eliminate ambiguities during development of the CIG. The Guideline Definition Language (GDL) was used to capture the clinical rules. A CIG for COVID-19 was developed by translating, interpreting, annotating, extracting, and formalizing the Chinese COVID-19 diagnosis and treatment guideline. A prototype application was implemented to validate the CIG. Results: We used 27 archetypes for the COVID-19 guideline. We developed 18 GDL rules to cover the diagnosis and treatment suggestion algorithms in the narrative guideline. The CIG was further translated to object data model and Drools rules to facilitate its use by people who do not employ the non-openEHR archetype. The prototype application validated the correctness of the CIG with a public data set. Both the GDL rules and Drools rules have been disseminated on GitHub. Conclusions: Our rapid CIG development and dissemination approach accelerated the pace of COVID-19 CIG development. A validated COVID-19 CIG is now available to the public. UR - https://medinform.jmir.org/2020/10/e21628 UR - http://dx.doi.org/10.2196/21628 UR - http://www.ncbi.nlm.nih.gov/pubmed/32931443 ID - info:doi/10.2196/21628 ER - TY - JOUR AU - Haddad, M. Samira AU - Souza, T. Renato AU - Cecatti, Guilherme Jose AU - Barreix, Maria AU - Tamrat, Tigest AU - Footitt, Carolyn AU - Mehl, L. Garrett AU - Syah, F. Inraini AU - Shankar, H. Anuraj AU - Tunçalp, Özge PY - 2020/10/1 TI - Building a Digital Tool for the Adoption of the World Health Organization?s Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology JO - J Med Internet Res SP - e16355 VL - 22 IS - 10 KW - clinical decision support KW - antenatal care KW - digital health KW - requirements gathering KW - implementation KW - WHO guidelines KW - evidence-based N2 - Background: One of the key mandates of the World Health Organization (WHO) is to develop guidelines, defined as ?a document containing recommendations for clinical practice or public health policy.? Guidelines represent the global standard for information sources shaping clinical practice and public health policies. Despite the rigorous development process and the value of guidelines for setting standards, implementing such standards within local contexts and at the point of care is a well-documented challenge. Digital technologies enable agile information management and may facilitate the adaptation of guidelines to diverse settings of health services delivery. Objective: The objective of this paper is to detail the systematic and iterative process involved in transforming the WHO Antenatal Care (ANC) guidelines into a digital decision-support and patient-record application for routine use in primary health care settings, known as the WHO digital ANC module. Methods: The WHO convened a team of clinical and digital health experts to develop the WHO digital ANC module as a tool to assist health care professionals in the implementation of WHO evidence-based recommendations for pregnant women. The WHO digital ANC module?s creation included the following steps: defining a minimum viable product (MVP), developing clinical workflows and algorithms, algorithm testing, developing a data dictionary, and the creation of a user interface or application development. The overall process of development took approximately 1 year to reach a stable prototype and to finalize the underlying content requirements of the data dictionary and decision support algorithms. Results: The first output is a reference software reflecting the generic WHO ANC guideline content, known as the WHO digital ANC module. Within it, all actionable ANC recommendations have related data fields and algorithms to confirm whether the associated task was performed. WHO recommendations that are not carried out by the health care worker are saved as pending tasks on a woman?s health record, and those that are adequately fulfilled trigger messages with positive reinforcement. The second output consists of the structured documentation of the different components which contributed to the development of the WHO digital ANC module, such as the data dictionary and clinical decision support workflows. Conclusions: This is a novel approach to facilitate the adoption and adaptation of recommendations through digital systems at the health service delivery level. It is expected that the WHO digital ANC module will support the implementation of evidence-based practices and provide information for monitoring and surveillance; however, further evidence is needed to understand how the WHO digital ANC module impacts the implementation of WHO recommendations. Further, the module?s implementation will inform the WHO?s ongoing efforts to create a pathway to adaptive and integrated (Smart) Guidelines in Digital Systems to improve health system quality, coverage, and accountability. UR - https://www.jmir.org/2020/10/e16355 UR - http://dx.doi.org/10.2196/16355 UR - http://www.ncbi.nlm.nih.gov/pubmed/33001032 ID - info:doi/10.2196/16355 ER - TY - JOUR AU - Cresswell, Kathrin AU - Williams, Robin AU - Carlile, Narath AU - Sheikh, Aziz PY - 2020/9/25 TI - Accelerating Innovation in Health Care: Insights From a Qualitative Inquiry Into United Kingdom and United States Innovation Centers JO - J Med Internet Res SP - e19644 VL - 22 IS - 9 KW - innovation KW - health information technology KW - health care N2 - Background: Digital health innovations are being prioritized on international policy agendas in the hope that they will help to address the existing health system challenges. Objective: The aim of this study was to explore the setup, design, facilities, and strategic priorities of leading United Kingdom and United States health care innovation centers to identify transferable lessons for accelerating their creation and maximizing their impact. Methods: We conducted qualitative case studies consisting of semistructured, audio-recorded interviews with decision makers and center staff in 6 innovation centers. We also conducted nonparticipant observations of meetings and center tours, where we took field notes. Qualitative data were analyzed initially within and then across cases facilitated by QSR International?s NVivo software. Results: The centers had different institutional arrangements, including university-associated institutes or innovation laboratories, business accelerators or incubators, and academic health science partnership models. We conducted interviews with 34 individuals, 1 group interview with 3 participants, and observations of 4 meetings. Although the centers differed significantly in relation to their mission, structure, and governance, we observed key common characteristics. These included high-level leadership support and incentives to engage in innovation activities, a clear mission to address identified gaps within their respective organizational and health system settings, physical spaces that facilitated networking through open-door policies, flat managerial structures characterized by new organizational roles for which boundary spanning was key, and a wider innovation ecosystem that was strategically and proactively engaged with the center facilitating external partnerships. Conclusions: Although innovation in health care settings is unpredictable, we offer insights that may help those establishing innovation centers. The key in this respect is the ability to support different kinds of innovations at different stages through adequate support structures, including the development of new career pathways. UR - http://www.jmir.org/2020/9/e19644/ UR - http://dx.doi.org/10.2196/19644 UR - http://www.ncbi.nlm.nih.gov/pubmed/32975524 ID - info:doi/10.2196/19644 ER - TY - JOUR AU - Sheth, N. Anandi AU - Hussen, A. Sophia AU - Escoffery, Cam AU - Haddad, B. Lisa AU - Powell, Leah AU - Brown, Nakita AU - Filipowicz, R. Teresa AU - McCumber, Micah AU - Sanchez, Maria AU - Renshaw, Laura AU - Psioda, A. Matthew AU - Sales, M. Jessica PY - 2020/9/25 TI - Pre-Exposure Prophylaxis Integration Into Family Planning Services at Title X Clinics in the Southeastern United States: Protocol for a Mixed Methods Hybrid Type I Effectiveness Implementation Study (Phase 2 ATN 155) JO - JMIR Res Protoc SP - e18784 VL - 9 IS - 9 KW - HIV KW - pre-exposure prophylaxis KW - implementation science KW - family planning services N2 - Background: Adolescent and young adult women (AYAW), particularly racial and ethnic minorities, in the Southern United States are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is an effective, scalable, individual-controlled HIV prevention strategy that is grossly underutilized among women of all ages and requires innovative delivery approaches to optimize its benefit. Anchoring PrEP delivery to family planning (FP) services that AYAW already trust, access routinely, and deem useful for their sexual health may offer an ideal opportunity to reach women at risk for HIV and to enhance their PrEP uptake and adherence. However, PrEP has not been widely integrated into FP services, including Title X?funded FP clinics that provide safety net sources of care for AYAW. To overcome potential implementation challenges for AYAW, Title X clinics in the Southern United States are uniquely positioned to be focal sites for conceptually informed and thoroughly evaluated PrEP implementation science studies. Objective: The objective of this study is two-fold: to evaluate multilevel factors associated with the level of PrEP adoption and implementation (eg, PrEP screening, counseling, and prescription) within and across 3 FP clinics and to evaluate PrEP uptake, persistence, and adherence among female patients in these clinics over a 6-month follow-up period. Methods: Phase 2 of Planning4PrEP (Adolescent Medicine Trials Network for HIV/AIDS Interventions 155) is a mixed methods hybrid type 1 effectiveness implementation study to be conducted in three clinics in Metro Atlanta, Georgia, United States. Guided by the Exploration, Preparation, Implementation, and Sustainment framework, this study will prepare clinics for PrEP integration via clinic-wide trainings and technical assistance and will develop clinic-specific PrEP implementation plans. We will monitor and evaluate PrEP implementation as well as female patient PrEP uptake, persistence, and adherence over a 6-month follow-up period. Results: Phase 2 of Planning4PrEP research activities began in February 2018 and are ongoing. Qualitative data analysis is scheduled to begin in Fall 2020. Conclusions: This study seeks to evaluate factors associated with the level of PrEP adoption and implementation (eg, PrEP screening, counseling, and prescription) within and across 3 FP clinics following training and implementation planning and to evaluate PrEP uptake, persistence, and adherence among female patients over a 6-month follow-up period. This will guide future strategies to support PrEP integration in Title X?funded clinics across the Southern United States. Trial Registration: ClinicalTrials.gov NCT04097834; https://clinicaltrials.gov/ct2/show/NCT04097834 International Registered Report Identifier (IRRID): DERR1-10.2196/18784 UR - http://www.researchprotocols.org/2020/9/e18784/ UR - http://dx.doi.org/10.2196/18784 UR - http://www.ncbi.nlm.nih.gov/pubmed/32975528 ID - info:doi/10.2196/18784 ER - TY - JOUR AU - Dang, Huyen AU - Dao, Sang AU - Carnahan, Emily AU - Kawakyu, Nami AU - Duong, Hong AU - Nguyen, Trung AU - Nguyen, Doan AU - Nguyen, Linh AU - Rivera, Maya AU - Ngo, Tuan AU - Werner, Laurie AU - Nguyen, Nga PY - 2020/9/22 TI - Determinants of Scale-up From a Small Pilot to a National Electronic Immunization Registry in Vietnam: Qualitative Evaluation JO - J Med Internet Res SP - e19923 VL - 22 IS - 9 KW - immunization KW - immunization information system KW - electronic immunization registry KW - scale-up KW - digital health intervention KW - mHealth KW - eHealth N2 - Background: Digital health innovations can improve health system performance, yet previous experience has shown that many innovations do not advance beyond the pilot stage to achieve scale. Vietnam?s National Immunization Information System (NIIS) began as a series of digital health pilots, first initiated in 2010, and was officially launched nationwide in 2017. The NIIS is one of the few examples of an electronic immunization registry (EIR) at national scale in low- and middle-income countries. Objective: The aim of this study was to understand the determinants of scale-up of the national EIR in Vietnam. Methods: This qualitative study explored the facilitators and barriers to national scale-up of the EIR in Vietnam. Qualitative data were collected from October to December 2019 through in-depth key informant interviews and desk review. The mHealth Assessment and Planning for Scale (MAPS) Toolkit guided the development of the study design, interview guides, and analytic framework. MAPS defines the key determinants of success, or the ?axes of scale,? to be groundwork, partnerships, financial health, technology and architecture, operations, and monitoring and evaluation. Results: The partnership and operations axes were critical to the successful scale-up of the EIR in Vietnam, while the groundwork and monitoring and the evaluation axes were considered to be strong contributors in the success of all the other axes. The partnership model leveraged complementary strengths of the technical working group partners: the Ministry of Health General Department of Preventive Medicine, the National Expanded Program on Immunization, Viettel (the mobile network operator), and PATH. The operational approach to introducing the NIIS with lean, iterative, and integrated training and supervision was also a key facilitator to successful scale-up. The financial health, technology and architecture, and operations axes were identified as barriers to successful deployment and scale-up. Key barriers to scale-up included insufficient estimates of operational costs, unanticipated volume of data storage and transmission, lack of a national ID to support interoperability, and operational challenges among end users. Overall, the multiple phases of EIR deployment and scale-up from 2010 to 2017 allowed for continuous learning and improvement that strengthened all the axes and contributed to successful scale-up. Conclusions: The results highlight the importance of the measured, iterative approach that was taken to gradually expand a series of small pilots to nationwide scale. The findings from this study can be used to inform other countries considering, introducing, or in the process of scaling an EIR or other digital health innovations. UR - http://www.jmir.org/2020/9/e19923/ UR - http://dx.doi.org/10.2196/19923 UR - http://www.ncbi.nlm.nih.gov/pubmed/32960184 ID - info:doi/10.2196/19923 ER - TY - JOUR AU - Windisch, Olivier AU - Zamberg, Ido AU - Zanella, Marie-Céline AU - Gayet-Ageron, Angčle AU - Blondon, Katherine AU - Schiffer, Eduardo AU - Agoritsas, Thomas PY - 2020/8/19 TI - Using mHealth to Increase the Reach of Local Guidance to Health Professionals as Part of an Institutional Response Plan to the COVID-19 Outbreak: Usage Analysis Study JO - JMIR Mhealth Uhealth SP - e20025 VL - 8 IS - 8 KW - COVID-19 KW - smartphone KW - mHealth KW - information dissemination KW - health professionals KW - health administration KW - health apps N2 - Background: The ongoing coronavirus disease (COVID-19) pandemic forced health jurisdictions worldwide to significantly restructure and reorganize their medical activities. In response to the rapidly evolving body of evidence, a solid communication strategy is needed to increase the reach of and adherence to locally drafted and validated guidance to aide medical staff with COVID-19?related clinical decisions. Objective: We present a usage analysis of a dedicated mobile health (mHealth) platform as part of an institutional knowledge dissemination strategy of COVID-19?related guidance to all health care workers (HCWs) in a large academic hospital. Methods: A multidisciplinary team of experts drafted local guidance related to COVID-19. In total, 60 documents and 17 external links were made available through the platform. Documents were disseminated using a recently deployed mHealth platform for HCWs. Targeted dissemination of COVID-19?related content began on March 22, 2020. Using a third-party statistics tool, data concerning user activity and content use was anonymously collected. A quantitative analysis of user activity was performed over a 4-month period, separated into 3 periods: 2 months before (Period A), 2 weeks after (Period B), and 6 weeks following (Period C) targeted dissemination. Regional epidemiological data (daily new COVID-19 cases and total COVID-19?related hospitalizations) was extracted from an official registry. Results: During the study period, the platform was downloaded by 1233 new users. Consequently, the total number of users increased from 1766 users before Period A to a total of 2999 users at the end of Period C. We observed 27,046 document views, of which 12,728 (47.1%) were COVID-19?related. The highest increase in activity occurred in Period B, rapidly following targeted dissemination, with 7740 COVID-19?related content views, representing 71.2% of total content views within the abovementioned period and 550 daily views of COVID-19?related documents. Total documents consulted per day increased from 117 (IQR 74-160) to 657 (IQR 481-1051), P<.001. This increase in activity followed the epidemiological curbing of newly diagnosed COVID-19 cases, which peaked during Period B. Total active devices doubled from 684 to 1400, daily user activity increased fourfold, and the number of active devices rose from 53 (IQR 40-70) to 210 (IQR 167-297), P<.001. In addition, the number of sessions per day rose from 166 (IQR 110-246) to 704 (IQR 517-1028), P<.001. A persistent but reduced increase in total documents consulted per day (172 [IQR 131-251] versus 117 [IQR 74-160], P<.001) and active devices (71 [IQR 64-89] versus 53 [IQR 40-70]) was observed in Period C compared to Period A, while only 29.8% of the content accessed was COVID-19?related. After targeted dissemination, an immediate increase in activity was observed after push notifications were sent to users. Conclusions: The use of an mHealth solution to disseminate time-sensitive medical knowledge seemed to be an effective solution to increase the reach of validated content to a targeted audience. UR - http://mhealth.jmir.org/2020/8/e20025/ UR - http://dx.doi.org/10.2196/20025 UR - http://www.ncbi.nlm.nih.gov/pubmed/32749996 ID - info:doi/10.2196/20025 ER - TY - JOUR AU - Kujala, Sari AU - Ammenwerth, Elske AU - Kolanen, Heta AU - Ervast, Minna PY - 2020/8/12 TI - Applying and Extending the FITT Framework to Identify the Challenges and Opportunities of Successful eHealth Services for Patient Self-Management: Qualitative Interview Study JO - J Med Internet Res SP - e17696 VL - 22 IS - 8 KW - interview KW - implementation KW - adoption KW - patient self-management KW - organization N2 - Background: The number of public eHealth services that support patient self-management is rapidly increasing. However, the implementation of these eHealth services for self-management has encountered challenges. Objective: The purpose of this paper was to analyze the challenges and opportunities of implementing eHealth services for self-management by focusing on the fit between the technical solution and clinical use. Methods: We performed in-depth interviews with 10 clinical project coordinators and managers who were responsible for developing and implementing various eHealth services for self-management interventions in five university hospitals in Finland. The results were analyzed using content analysis and open coding. The Fit between Individuals, Task, and Technology (FITT) framework was used to interpret the findings. Results: The implementation of self-management services involved many challenges related to technical problems, health professional acceptance, patient motivation, and health organization and management. The implementers identified practices to manage the identified challenges, including improving the design of the technology, supporting health professionals in the adoption of the eHealth services, changing the work processes and tasks, involving patients, and collectively planning the implementation inside an organization. The findings could be mostly attributed to the dimensions of the FITT framework. Conclusions: The FITT framework helped to analyze the challenges related to the implementation, and most of them were related to poor fit. The importance of patients as stakeholders in eHealth services for patient self-management needs to be highlighted. Thus, we propose that patients should be added as a different type of individual dimension to the FITT framework. In addition, the framework could be extended to include organization and management in a new context dimension. UR - https://www.jmir.org/2020/8/e17696 UR - http://dx.doi.org/10.2196/17696 UR - http://www.ncbi.nlm.nih.gov/pubmed/32784175 ID - info:doi/10.2196/17696 ER - TY - JOUR AU - Mustanski, Brian AU - Moskowitz, A. David AU - Moran, O. Kevin AU - Newcomb, E. Michael AU - Macapagal, Kathryn AU - Rodriguez-Díaz, Carlos AU - Rendina, Jonathon H. AU - Laber, B. Eric AU - Li, H. Dennis AU - Matson, Margaret AU - Talan, J. Ali AU - Cabral, Cynthia PY - 2020/8/11 TI - Evaluation of a Stepped-Care eHealth HIV Prevention Program for Diverse Adolescent Men Who Have Sex With Men: Protocol for a Hybrid Type 1 Effectiveness Implementation Trial of SMART JO - JMIR Res Protoc SP - e19701 VL - 9 IS - 8 KW - HIV prevention KW - eHealth KW - adolescents KW - men who have sex with men KW - implementation science KW - mobile phone N2 - Background: Adolescent men who have sex with men (AMSM), aged 13 to 18 years, account for more than 80% of teen HIV occurrences. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs. Implementation issues are critical as traditional HIV prevention delivery channels (eg, community-based organizations, schools) have significant access limitations for AMSM. As such, eHealth interventions, such as our proposed SMART program, represent an excellent modality for delivering AMSM-specific intervention material where youth are. Objective: This randomized trial aimed to test the effectiveness of the SMART program in reducing condom-less anal sex and increasing condom self-efficacy, condom use intentions, and HIV testing for AMSM. We also plan to test whether SMART has differential effectiveness across important subgroups of AMSM based on race and ethnicity, urban versus rural residence, age, socioeconomic status, and participation in an English versus a Spanish version of SMART. Methods: Using a sequential multiple assignment randomized trial design, we will evaluate the impact of a stepped-care package of increasingly intensive eHealth interventions (ie, the universal, information-based SMART Sex Ed; the more intensive, selective SMART Squad; and a higher cost, indicated SMART Sessions). All intervention content is available in English and Spanish. Participants are recruited primarily from social media sources using paid and unpaid advertisements. Results: The trial has enrolled 1285 AMSM aged 13 to 18 years, with a target enrollment of 1878. Recruitment concluded in June 2020. Participants were recruited from 49 US states as well as Puerto Rico and the District of Columbia. Assessments of intervention outcomes at 3, 6, 9, and 12 months are ongoing. Conclusions: SMART is the first web-based program for AMSM to take a stepped-care approach to sexual education and HIV prevention. This design indicates that SMART delivers resources to all adolescents, but more costly treatments (eg, video chat counseling in SMART Sessions) are conserved for individuals who need them the most. SMART has the potential to reach AMSM to provide them with a sex-positive curriculum that empowers them with the information, motivation, and skills to make better health choices. Trial Registration: ClinicalTrials.gov Identifier NCT03511131; https://clinicaltrials.gov/ct2/show/NCT03511131 International Registered Report Identifier (IRRID): DERR1-10.2196/19701 UR - http://www.researchprotocols.org/2020/8/e19701/ UR - http://dx.doi.org/10.2196/19701 UR - http://www.ncbi.nlm.nih.gov/pubmed/32779573 ID - info:doi/10.2196/19701 ER - TY - JOUR AU - Camacho, Jhon AU - Zanoletti-Mannello, Manuela AU - Landis-Lewis, Zach AU - Kane-Gill, L. Sandra AU - Boyce, D. Richard PY - 2020/8/6 TI - A Conceptual Framework to Study the Implementation of Clinical Decision Support Systems (BEAR): Literature Review and Concept Mapping JO - J Med Internet Res SP - e18388 VL - 22 IS - 8 KW - clinical decision support system KW - computerized decision support system KW - implementation science KW - technology acceptance KW - barriers KW - facilitators KW - determinants KW - decision support system N2 - Background: The implementation of clinical decision support systems (CDSSs) as an intervention to foster clinical practice change is affected by many factors. Key factors include those associated with behavioral change and those associated with technology acceptance. However, the literature regarding these subjects is fragmented and originates from two traditionally separate disciplines: implementation science and technology acceptance. Objective: Our objective is to propose an integrated framework that bridges the gap between the behavioral change and technology acceptance aspects of the implementation of CDSSs. Methods: We employed an iterative process to map constructs from four contributing frameworks?the Theoretical Domains Framework (TDF); the Consolidated Framework for Implementation Research (CFIR); the Human, Organization, and Technology-fit framework (HOT-fit); and the Unified Theory of Acceptance and Use of Technology (UTAUT)?and the findings of 10 literature reviews, identified through a systematic review of reviews approach. Results: The resulting framework comprises 22 domains: agreement with the decision algorithm; attitudes; behavioral regulation; beliefs about capabilities; beliefs about consequences; contingencies; demographic characteristics; effort expectancy; emotions; environmental context and resources; goals; intentions; intervention characteristics; knowledge; memory, attention, and decision processes; patient?health professional relationship; patient?s preferences; performance expectancy; role and identity; skills, ability, and competence; social influences; and system quality. We demonstrate the use of the framework providing examples from two research projects. Conclusions: We proposed BEAR (BEhavior and Acceptance fRamework), an integrated framework that bridges the gap between behavioral change and technology acceptance, thereby widening the view established by current models. UR - https://www.jmir.org/2020/8/e18388 UR - http://dx.doi.org/10.2196/18388 UR - http://www.ncbi.nlm.nih.gov/pubmed/32759098 ID - info:doi/10.2196/18388 ER - TY - JOUR AU - Archambault, Michel Patrick AU - Rivard, Josée AU - Smith, Y. Pascal AU - Sinha, Samir AU - Morin, Michčle AU - LeBlanc, Annie AU - Couturier, Yves AU - Pelletier, Isabelle AU - Ghandour, Kebir El AU - Légaré, France AU - Denis, Jean-Louis AU - Melady, Don AU - Paré, Daniel AU - Chouinard, Josée AU - Kroon, Chantal AU - Huot-Lavoie, Maxime AU - Bert, Laetitia AU - Witteman, O. Holly AU - Brousseau, Audrey-Anne AU - Dallaire, Clémence AU - Sirois, Marie-Josée AU - Émond, Marcel AU - Fleet, Richard AU - Chandavong, Sam AU - PY - 2020/8/5 TI - Learning Integrated Health System to Mobilize Context-Adapted Knowledge With a Wiki Platform to Improve the Transitions of Frail Seniors From Hospitals and Emergency Departments to the Community (LEARNING WISDOM): Protocol for a Mixed-Methods Implementation Study JO - JMIR Res Protoc SP - e17363 VL - 9 IS - 8 KW - implementation science KW - knowledge translation KW - context adaptation KW - interrupted time series KW - care transitions KW - elderly KW - older persons KW - health care utilization KW - frailty KW - learning health systems KW - Wiki KW - collaborative writing applications N2 - Background: Elderly patients discharged from hospital experience fragmented care, repeated and lengthy emergency department (ED) visits, relapse into their earlier condition, and rapid cognitive and functional decline. The Acute Care for Elders (ACE) program at Mount Sinai Hospital in Toronto, Canada uses innovative strategies, such as transition coaches, to improve the care transition experiences of frail elderly patients. The ACE program reduced the lengths of hospital stay and readmission for elderly patients, increased patient satisfaction, and saved the health care system over Can $4.2 million (US $2.6 million) in 2014. In 2016, a context-adapted ACE program was implemented at one hospital in the Centre intégré de santé et de services sociaux de Chaudičre-Appalaches (CISSS-CA) with a focus on improving transitions between hospitals and the community. The quality improvement project used an intervention strategy based on iterative user-centered design prototyping and a ?Wiki-suite? (free web-based database containing evidence-based knowledge tools) to engage multiple stakeholders. Objective: The objectives of this study are to (1) implement a context-adapted CISSS-CA ACE program in four hospitals in the CISSS-CA and measure its impact on patient-, caregiver-, clinical-, and hospital-level outcomes; (2) identify underlying mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly; and (3) identify underlying mechanisms by which the Wiki-suite contributes to context-adaptation and local uptake of knowledge tools. Methods: Objective 1 will involve staggered implementation of the context-adapted CISSS-CA ACE program across the four CISSS-CA sites and interrupted time series to measure the impact on hospital-, patient-, and caregiver-level outcomes. Objectives 2 and 3 will involve a parallel mixed-methods process evaluation study to understand the mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly and by which our Wiki-suite contributes to adaptation, implementation, and scaling up of geriatric knowledge tools. Results: Data collection started in January 2019. As of January 2020, we enrolled 1635 patients and 529 caregivers from the four participating hospitals. Data collection is projected to be completed in January 2022. Data analysis has not yet begun. Results are expected to be published in 2022. Expected results will be presented to different key internal stakeholders to better support the effort and resources deployed in the transition of seniors. Through key interventions focused on seniors, we are expecting to increase patient satisfaction and quality of care and reduce readmission and ED revisit. Conclusions: This study will provide evidence on effective knowledge translation strategies to adapt best practices to the local context in the transition of care for elderly people. The knowledge generated through this project will support future scale-up of the ACE program and our wiki methodology in other settings in Canada. Trial Registration: ClinicalTrials.gov NCT04093245; https://clinicaltrials.gov/ct2/show/NCT04093245. International Registered Report Identifier (IRRID): DERR1-10.2196/17363 UR - https://www.researchprotocols.org/2020/8/e17363 UR - http://dx.doi.org/10.2196/17363 UR - http://www.ncbi.nlm.nih.gov/pubmed/32755891 ID - info:doi/10.2196/17363 ER - TY - JOUR AU - Thompson, P. Alison AU - MacDonald, E. Shannon AU - Wine, Eytan AU - Scott, D. Shannon PY - 2020/8/4 TI - An Evaluation of Parents? Experiences of Patient Engagement in Research to Develop a Digital Knowledge Translation Tool: Protocol for a Multi-Method Study JO - JMIR Res Protoc SP - e19108 VL - 9 IS - 8 KW - patient engagement in research KW - knowledge translation KW - functional constipation KW - digital health resources KW - patient-oriented research KW - formative evaluation N2 - Background: The last decade has seen increasing calls for patient and public involvement in health-related research due to an ideological shift toward more equitable methods of knowledge development and an effort to increase the usability and relevance of knowledge by improving outcomes in clinical practice. Patient engagement includes simply informing patients to offering complete decision-making autonomy to individuals, groups, communities, caregivers, friends, and families who have personal experience and knowledge of a health issue. Despite the use of patient engagement methods in research, evaluation has lagged, resulting in a knowledge gap that makes it difficult to foster capacity and sustainability for patients and researchers alike since little is known about how effective patient collaborations in research are built, maintained, or improved. This study centers on pediatric functional constipation, a common condition that affects children and families. Since parents play a pivotal role in treatment, they are an optimal group to engage in improving the resources and support available to them. Objective: This study aims to use patient-engagement methods to establish a research collaboration with parents to cocreate a digital knowledge translation tool for parents caring for a child with functional constipation and formally evaluate the patient engagement processes within this project to build the science of patient engagement in research. Methods: Members of the parent collaborator group will be recruited from previous participants who expressed interest in the development of a digital knowledge translation tool. The group will collaborate with the research team to create a tool to address patients? support and information needs when caring for a child with functional constipation. The parent collaborator group will then be evaluated in a multimethod study design. Data will be digitally and anonymously collected from all members of the parent collaborator group, using the validated Public and Patient Engagement Evaluation Tool (PPEET) patient questionnaire. Descriptive statistics will be used to report group characteristics and question responses. Qualitative analysis will be used to understand open-ended question responses. Specifically, directed content analysis will be used to assess themes of the Patient Engagement in Research (PEIR) Framework with a combination of deductive and inductive analyses. Findings will be integrated into the discussion if there are sufficient commonalities and inter-relationships. The final manuscript will include reporting of each element as described by the Good Reporting of a Mixed Methods Study criteria. Results: Recruitment is planned for June 2020. Data collection for the evaluation of patient engagement processes will occur upon completion of the digital knowledge translation tool. The results of this study are expected to be published by the end of 2020. Conclusions: This study will provide valuable information about parents? experiences participating in child-health research and is a fundamental step in building the science of patient engagement in research. International Registered Report Identifier (IRRID): PRR1-10.2196/19108 UR - https://www.researchprotocols.org/2020/8/e19108 UR - http://dx.doi.org/10.2196/19108 UR - http://www.ncbi.nlm.nih.gov/pubmed/32663147 ID - info:doi/10.2196/19108 ER - TY - JOUR AU - Brown, Alison AU - Barnes, Courtney AU - Byaruhanga, Judith AU - McLaughlin, Matthew AU - Hodder, K. Rebecca AU - Booth, Debbie AU - Nathan, Nicole AU - Sutherland, Rachel AU - Wolfenden, Luke PY - 2020/7/31 TI - Effectiveness of Technology-Enabled Knowledge Translation Strategies in Improving the Use of Research in Public Health: Systematic Review JO - J Med Internet Res SP - e17274 VL - 22 IS - 7 KW - knowledge translation KW - public health N2 - Background: Knowledge translation (KT) aims to facilitate the use of research evidence in decision making. Changes in technology have provided considerable opportunities for KT strategies to improve access and use of evidence in decision making by public health policy makers and practitioners. Despite this opportunity, there have been no reviews that have assessed the effects of digital technology-enabled KT (TEKT) in the field of public health. Objective: This study aims to examine the effectiveness of digital TEKT strategies in (1) improving the capacity for evidence-based decision making by public health policy makers and practitioners, (2) changing public health policy or practice, and (3) changes in individual or population health outcomes. Methods: A search strategy was developed to identify randomized trials assessing the effectiveness of digital TEKT strategies in public health. Any primary research study with a randomized trial design was eligible. Searches for eligible studies were undertaken in multiple electronic bibliographic databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulative Index to Nursing and Allied Health Literature [CINAHL], and Scopus) and the reference lists of included studies. A hand search of 2 journals (Implementation Science and Journal of Medical Internet Research) and a gray literature search were also conducted. Pairs of independent review authors screened studies, assessed the risk of bias, and extracted data from relevant studies. Results: Of the 6819 citations screened, 8 eligible randomized trials were included in the review. The studies examined the impact of digital TEKT strategies on health professionals, including nurses, child care health consultants, physiotherapists, primary health care workers, and public health practitioners. Overall, 5 of the interventions were web-training programs. The remaining 3 interventions included simulation games, access to digital resource materials and the use of tailored messaging, and a web-based registry. The findings suggest that digital TEKT interventions may be effective in improving the knowledge of public health professionals, relative to control, and may be as effective as a face-to-face KT approach. The effectiveness of digital TEKT strategies relative to a control or other digital KT interventions on measures of health professional self-efficacy to use evidence to enhance practice behavior or behavioral intention outcomes was mixed. The evidence regarding the effects on changes to health policy or practice following exposure to digital TEKT was mixed. No trials assessed the effects on individual or population-level health outcomes. Conclusions: This review is the first to synthesize the effectiveness of digital TEKT interventions in a public health setting. Despite its potential, relatively few trials have been undertaken to investigate the impacts of digital TEKT interventions. The findings suggest that although a digital TEKT intervention may improve knowledge, the effects of such interventions on other outcomes are equivocal. UR - http://www.jmir.org/2020/7/e17274/ UR - http://dx.doi.org/10.2196/17274 UR - http://www.ncbi.nlm.nih.gov/pubmed/32735231 ID - info:doi/10.2196/17274 ER - TY - JOUR AU - Sbaffi, Laura AU - Walton, James AU - Blenkinsopp, John AU - Walton, Graham PY - 2020/7/27 TI - Information Overload in Emergency Medicine Physicians: A Multisite Case Study Exploring the Causes, Impact, and Solutions in Four North England National Health Service Trusts JO - J Med Internet Res SP - e19126 VL - 22 IS - 7 KW - emergency medicine KW - information overload KW - physicians KW - national health care system N2 - Background: Information overload is affecting modern society now more than ever because of the wide and increasing distribution of digital technologies. Social media, emails, and online communications among others infuse a sense of urgency as information must be read, produced, and exchanged almost instantaneously. Emergency medicine is a medical specialty that is particularly affected by information overload with consequences on patient care that are difficult to quantify and address. Understanding the current causes of medical information overload, their impact on patient care, and strategies to handle the inflow of constant information is crucial to alleviating stress and anxiety that is already crippling the profession. Objective: This study aims to identify and evaluate the main causes and sources of medical information overload, as experienced by emergency medicine physicians in selected National Health Service (NHS) trusts in the United Kingdom. Methods: This study used a quantitative, survey-based data collection approach including close- and open-ended questions. A web-based survey was distributed to emergency physicians to assess the impact of medical information overload on their jobs. In total, 101 valid responses were collected from 4 NHS trusts in north England. Descriptive statistics, principal component analysis, independent sample two-tailed t tests, and one-way between-group analysis of variance with post hoc tests were performed on the data. Open-ended questions were analyzed using thematic analysis to identify key topics. Results: The vast majority of respondents agreed that information overload is a serious issue in emergency medicine, and it increases with time. The always available culture (mean 5.40, SD 1.56), email handling (mean 4.86, SD 1.80), and multidisciplinary communications (mean 4.51, SD 1.61) are the 3 main reasons leading to information overload. Due to this, emergency physicians experience guideline fatigue, stress and tension, longer working hours, and impaired decision making, among other issues. Aspects of information overload are also reported to have different impacts on physicians depending on demographic factors such as age, years spent in emergency medicine, and level of employment. Conclusions: There is a serious concern regarding information overload in emergency medicine. Participants identified a considerable number of daily causes affecting their job, particularly the traditional culture of emergency departments being always available on the ward, exacerbated by email and other forms of communication necessary to maintain optimal, evidence-based practice standards. However, not all information is unwelcome, as physicians also need to stay updated with the latest guidelines on conditions and treatment, and communicate with larger medical teams to provide quality care. UR - http://www.jmir.org/2020/7/e19126/ UR - http://dx.doi.org/10.2196/19126 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716313 ID - info:doi/10.2196/19126 ER - TY - JOUR AU - Mangin, Dee AU - Lawson, Jennifer AU - Adamczyk, Krzysztof AU - Guenter, Dale PY - 2020/7/27 TI - Embedding ?Smart? Disease Coding Within Routine Electronic Medical Record Workflow: Prospective Single-Arm Trial JO - JMIR Med Inform SP - e16764 VL - 8 IS - 7 KW - chronic disease management KW - comorbidity KW - problem list KW - disease coding KW - disease registry KW - data improvement KW - electronic medical record KW - electronic health record KW - practice-based research network KW - population health KW - primary care KW - family medicine N2 - Background: Electronic medical record (EMR) chronic disease measurement can help direct primary care prevention and treatment strategies and plan health services resource management. Incomplete data and poor consistency of coded disease values within EMR problem lists are widespread issues that limit primary and secondary uses of these data. These issues were shared by the McMaster University Sentinel and Information Collaboration (MUSIC), a primary care practice-based research network (PBRN) located in Hamilton, Ontario, Canada. Objective: We sought to develop and evaluate the effectiveness of new EMR interface tools aimed at improving the quantity and the consistency of disease codes recorded within the disease registry across the MUSIC PBRN. Methods: We used a single-arm prospective trial design with preintervention and postintervention data analysis to assess the effect of the intervention on disease recording volume and quality. The MUSIC network holds data on over 75,080 patients, 37,212 currently rostered. There were 4 MUSIC network clinician champions involved in gap analysis of the disease coding process and in the iterative design of new interface tools. We leveraged terminology standards and factored EMR workflow and usability into a new interface solution that aimed to optimize code selection volume and quality while minimizing physician time burden. The intervention was integrated as part of usual clinical workflow during routine billing activities. Results: After implementation of the new interface (June 25, 2017), we assessed the disease registry codes at 3 and 6 months (intervention period) to compare their volume and quality to preintervention levels (baseline period). A total of 17,496 International Classification of Diseases, 9th Revision (ICD9) code values were recorded in the disease registry during the 11.5-year (2006 to mid-2017) baseline period. A large gain in disease recording occurred in the intervention period (8516/17,496, 48.67% over baseline), resulting in a total of 26,774 codes. The coding rate increased by a factor of 11.2, averaging 1419 codes per month over the baseline average rate of 127 codes per month. The proportion of preferred ICD9 codes increased by 17.03% in the intervention period (11,007/17,496, 62.91% vs 7417/9278, 79.94%; ?21=819.4; P<.001). A total of 45.03% (4178/9278) of disease codes were entered by way of the new screen prompt tools, with significant increases between quarters (Jul-Sep: 2507/6140, 40.83% vs Oct-Dec: 1671/3148, 53.08%; ?21=126.2; P<.001). Conclusions: The introduction of clinician co-designed, workflow-embedded disease coding tools is a very effective solution to the issues of poor disease coding and quality in EMRs. The substantial effectiveness in a routine care environment demonstrates usability, and the intervention detail described here should be generalizable to any setting. Significant improvements in problem list coding within primary care EMRs can be realized with minimal disruption to routine clinical workflow. UR - http://medinform.jmir.org/2020/7/e16764/ UR - http://dx.doi.org/10.2196/16764 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716304 ID - info:doi/10.2196/16764 ER - TY - JOUR AU - Elliott, A. Sarah AU - Dyson, P. Michele AU - Wilkes, V. Gilbert AU - Zimmermann, L. Gabrielle AU - Chambers, T. Christine AU - Wittmeier, DM Kristy AU - Russell, J. Dianne AU - Scott, D. Shannon AU - Thomson, Denise AU - Hartling, Lisa PY - 2020/7/23 TI - Considerations for Health Researchers Using Social Media for Knowledge Translation: Multiple Case Study JO - J Med Internet Res SP - e15121 VL - 22 IS - 7 KW - social media KW - knowledge translation KW - health research KW - engagement KW - dissemination KW - exchange KW - evaluation N2 - Background: Despite extensive literature describing the use of social media in health research, a gap exists around best practices in establishing, implementing, and evaluating an effective social media knowledge translation (KT) and exchange strategies. Objective: This study aims to examine successes, challenges, and lessons learned from using social media within health research and to create practical considerations to guide other researchers. Methods: The Knowledge Translation Platform of the Alberta Strategy for Patient-Oriented Research SUPPORT Unit formed a national working group involving platform staff, academics, and a parent representative with experience using social media for health research. We collected and analyzed 4 case studies that used a variety of social media platforms and evaluation methods. The case studies covered a spectrum of initiatives from participant recruitment and data collection to dissemination, engagement, and evaluation. Methods and findings from each case study as well as barriers and facilitators encountered were summarized. Through iterative discussions, we converged on recommendations and considerations for health researchers planning to use social media for KT. Results: We provide recommendations for elements to consider when developing a social media KT strategy: (1) set a clear goal and identify a theory, framework, or model that aligns with the project goals and objectives; (2) understand the intended audience (use social network mapping to learn what platforms and social influences are available); (3) choose a platform or platforms that meet the needs of the intended audience and align well with the research team?s capabilities (can you tap into an existing network, and what mode of communication does it support?); (4) tailor messages to meet user needs and platform requirements (eg, plain language and word restrictions); (5) consider timing, frequency, and duration of messaging as well as the nature of interactions (ie, social filtering and negotiated awareness); (6) ensure adequate resources and personnel are available (eg, content creators, project coordinators, communications experts, and audience stakeholder or patient advocate); (7) develop an evaluation plan a priori driven by goals and types of data available (ie, quantitative and qualitative); and (8) consider ethical approvals needed (driven by evaluation and type of data collection). Conclusions: In the absence of a comprehensive framework to guide health researchers using social media for KT, we provide several key considerations. Future research will help validate the proposed components and create a body of evidence around best practices for using and evaluating social media as part of a KT strategy UR - http://www.jmir.org/2020/7/e15121/ UR - http://dx.doi.org/10.2196/15121 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706653 ID - info:doi/10.2196/15121 ER - TY - JOUR AU - Bubolz, Stefan AU - Mayer, Gwendolyn AU - Gronewold, Nadine AU - Hilbel, Thomas AU - Schultz, Jobst-Hendrik PY - 2020/7/13 TI - Adherence to Established Treatment Guidelines Among Unguided Digital Interventions for Depression: Quality Evaluation of 28 Web-Based Programs and Mobile Apps JO - J Med Internet Res SP - e16136 VL - 22 IS - 7 KW - web-based interventions KW - depression KW - mHealth KW - mental health KW - telemedicine KW - mobile phone KW - eHealth KW - electronic mental health KW - online therapy N2 - Background: Web-based interventions for depression have been widely tested for usability and functioning. However, the few studies that have addressed the therapeutic quality of these interventions have mainly focused on general aspects without consideration of specific quality factors related to particular treatment components. Clinicians and scientists are calling for standardized assessment criteria for web-based interventions to enable effective and trustworthy patient care. Therefore, an extensive evaluation of web-based interventions at the level of individual treatment components based on therapeutic guidelines and manuals is needed. Objective: The objective of this study was to evaluate the quality of unguided web-based interventions for depression at the level of individual treatment components based on their adherence to current gold-standard treatment guidelines and manuals. Methods: A comprehensive online search of popular app stores and search engines in January 2018 revealed 11 desktop programs and 17 smartphone apps that met the inclusion criteria. Programs and apps were included if they were available for German users, interactive, unguided, and targeted toward depression. All programs and apps were tested by three independent researchers following a standardized procedure with a predefined symptom trajectory. During the testing, all web-based interventions were rated with a standardized list of criteria based on treatment guidelines and manuals for depression. Results: Overall interrater reliability for all raters was substantial with an intraclass correlation coefficient of 0.73 and Gwet AC1 value of 0.80. The main features of web-based interventions included mood tracking (24/28, 86%), psychoeducation (21/28, 75%), cognitive restructuring (21/28, 75%), crisis management (20/28, 71%), behavioral activation (19/29, 68%), and relaxation training (18/28, 64%). Overall, therapeutic meaningfulness was rated higher for desktop programs (mean 4.13, SD 1.17) than for smartphone apps (mean 2.92, SD 1.46). Conclusions: Although many exercises from manuals are included in web-based interventions, the necessary therapeutic depth of the interventions is often not reached, and risk management is frequently lacking. There is a need for further research targeting general principles for the development and evaluation of therapeutically sound web-based interventions for depression. UR - https://www.jmir.org/2020/7/e16136 UR - http://dx.doi.org/10.2196/16136 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673221 ID - info:doi/10.2196/16136 ER - TY - JOUR AU - Hempstead, E. Sarah AU - Fredkin, Kelsey AU - Hovater, Cade AU - Naureckas, T. Edward PY - 2020/7/13 TI - Patient and Family Participation in Clinical Guidelines Development: The Cystic Fibrosis Foundation Experience JO - J Participat Med SP - e17875 VL - 12 IS - 3 KW - cystic fibrosis KW - guidelines KW - patient participation KW - patient engagement UR - https://jopm.jmir.org/2020/3/e17875 UR - http://dx.doi.org/10.2196/17875 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/17875 ER - TY - JOUR AU - Eysenbach, Gunther PY - 2020/6/29 TI - How to Fight an Infodemic: The Four Pillars of Infodemic Management JO - J Med Internet Res SP - e21820 VL - 22 IS - 6 KW - infodemiology KW - infodemic KW - COVID-19 KW - infoveillance KW - pandemic KW - epidemics KW - emergency management KW - public health UR - http://www.jmir.org/2020/6/e21820/ UR - http://dx.doi.org/10.2196/21820 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589589 ID - info:doi/10.2196/21820 ER - TY - JOUR AU - Tangcharoensathien, Viroj AU - Calleja, Neville AU - Nguyen, Tim AU - Purnat, Tina AU - D?Agostino, Marcelo AU - Garcia-Saiso, Sebastian AU - Landry, Mark AU - Rashidian, Arash AU - Hamilton, Clayton AU - AbdAllah, Abdelhalim AU - Ghiga, Ioana AU - Hill, Alexandra AU - Hougendobler, Daniel AU - van Andel, Judith AU - Nunn, Mark AU - Brooks, Ian AU - Sacco, Luigi Pier AU - De Domenico, Manlio AU - Mai, Philip AU - Gruzd, Anatoliy AU - Alaphilippe, Alexandre AU - Briand, Sylvie PY - 2020/6/26 TI - Framework for Managing the COVID-19 Infodemic: Methods and Results of an Online, Crowdsourced WHO Technical Consultation JO - J Med Internet Res SP - e19659 VL - 22 IS - 6 KW - COVID-19 KW - infodemic KW - knowledge translation KW - message amplification KW - misinformation KW - information-seeking behavior KW - access to information KW - information literacy KW - communications media KW - internet KW - risk communication KW - evidence synthesis N2 - Background: An infodemic is an overabundance of information?some accurate and some not?that occurs during an epidemic. In a similar manner to an epidemic, it spreads between humans via digital and physical information systems. It makes it hard for people to find trustworthy sources and reliable guidance when they need it. Objective: A World Health Organization (WHO) technical consultation on responding to the infodemic related to the coronavirus disease (COVID-19) pandemic was held, entirely online, to crowdsource suggested actions for a framework for infodemic management. Methods: A group of policy makers, public health professionals, researchers, students, and other concerned stakeholders was joined by representatives of the media, social media platforms, various private sector organizations, and civil society to suggest and discuss actions for all parts of society, and multiple related professional and scientific disciplines, methods, and technologies. A total of 594 ideas for actions were crowdsourced online during the discussions and consolidated into suggestions for an infodemic management framework. Results: The analysis team distilled the suggestions into a set of 50 proposed actions for a framework for managing infodemics in health emergencies. The consultation revealed six policy implications to consider. First, interventions and messages must be based on science and evidence, and must reach citizens and enable them to make informed decisions on how to protect themselves and their communities in a health emergency. Second, knowledge should be translated into actionable behavior-change messages, presented in ways that are understood by and accessible to all individuals in all parts of all societies. Third, governments should reach out to key communities to ensure their concerns and information needs are understood, tailoring advice and messages to address the audiences they represent. Fourth, to strengthen the analysis and amplification of information impact, strategic partnerships should be formed across all sectors, including but not limited to the social media and technology sectors, academia, and civil society. Fifth, health authorities should ensure that these actions are informed by reliable information that helps them understand the circulating narratives and changes in the flow of information, questions, and misinformation in communities. Sixth, following experiences to date in responding to the COVID-19 infodemic and the lessons from other disease outbreaks, infodemic management approaches should be further developed to support preparedness and response, and to inform risk mitigation, and be enhanced through data science and sociobehavioral and other research. Conclusions: The first version of this framework proposes five action areas in which WHO Member States and actors within society can apply, according to their mandate, an infodemic management approach adapted to national contexts and practices. Responses to the COVID-19 pandemic and the related infodemic require swift, regular, systematic, and coordinated action from multiple sectors of society and government. It remains crucial that we promote trusted information and fight misinformation, thereby helping save lives. UR - http://www.jmir.org/2020/6/e19659/ UR - http://dx.doi.org/10.2196/19659 UR - http://www.ncbi.nlm.nih.gov/pubmed/32558655 ID - info:doi/10.2196/19659 ER - TY - JOUR AU - Li, Xin AU - Rousseau, F. Justin AU - Ding, Ying AU - Song, Min AU - Lu, Wei PY - 2020/6/16 TI - Understanding Drug Repurposing From the Perspective of Biomedical Entities and Their Evolution: Bibliographic Research Using Aspirin JO - JMIR Med Inform SP - e16739 VL - 8 IS - 6 KW - drug repurposing KW - biomedical entities KW - entitymetrics KW - bibliometrics KW - aspirin KW - acetylsalicylic acid N2 - Background: Drug development is still a costly and time-consuming process with a low rate of success. Drug repurposing (DR) has attracted significant attention because of its significant advantages over traditional approaches in terms of development time, cost, and safety. Entitymetrics, defined as bibliometric indicators based on biomedical entities (eg, diseases, drugs, and genes) studied in the biomedical literature, make it possible for researchers to measure knowledge evolution and the transfer of drug research. Objective: The purpose of this study was to understand DR from the perspective of biomedical entities (diseases, drugs, and genes) and their evolution. Methods: In the work reported in this paper, we extended the bibliometric indicators of biomedical entities mentioned in PubMed to detect potential patterns of biomedical entities in various phases of drug research and investigate the factors driving DR. We used aspirin (acetylsalicylic acid) as the subject of the study since it can be repurposed for many applications. We propose 4 easy, transparent measures based on entitymetrics to investigate DR for aspirin: Popularity Index (P1), Promising Index (P2), Prestige Index (P3), and Collaboration Index (CI). Results: We found that the maxima of P1, P3, and CI are closely associated with the different repurposing phases of aspirin. These metrics enabled us to observe the way in which biomedical entities interacted with the drug during the various phases of DR and to analyze the potential driving factors for DR at the entity level. P1 and CI were indicative of the dynamic trends of a specific biomedical entity over a long time period, while P2 was more sensitive to immediate changes. P3 reflected the early signs of the practical value of biomedical entities and could be valuable for tracking the research frontiers of a drug. Conclusions: In-depth studies of side effects and mechanisms, fierce market competition, and advanced life science technologies are driving factors for DR. This study showcases the way in which researchers can examine the evolution of DR using entitymetrics, an approach that can be valuable for enhancing decision making in the field of drug discovery and development. UR - https://medinform.jmir.org/2020/6/e16739 UR - http://dx.doi.org/10.2196/16739 UR - http://www.ncbi.nlm.nih.gov/pubmed/32543442 ID - info:doi/10.2196/16739 ER - TY - JOUR AU - Sibley, M. Kathryn AU - Khan, Masood AU - Roche, L. Patricia AU - Faucher, Patrick AU - Leggett, Carly PY - 2020/6/15 TI - Disseminating the Foundations of Knowledge Translation and Patient Engagement Science Through the KnowledgeNudge Blog and Twitter Profile: Quantitative Descriptive Evaluation JO - J Med Internet Res SP - e15351 VL - 22 IS - 6 KW - knowledge translation KW - dissemination KW - blog KW - Twitter N2 - Background: There is a documented need to build capacity for theory- and evidence-informed knowledge translation (KT) and patient engagement (PE) practice in health research. Dissemination of foundational content online coupled with social media promotion may build capacity by increasing awareness, knowledge, and positive attitudes. Objective: This retrospective study sought to (1) describe exposure and engagement of the KnowledgeNudge KT and PE dissemination strategy (online blog and Twitter profile) over 2 years and (2) identify and compare characteristics of individual posts with the most and least exposure and reach. Methods: Exposure was assessed by blog site views per month and Twitter profile impressions per month. Engagement was assessed by Twitter profile interactions per month. Descriptive statistics were calculated for 6-month blocks and compared using one-way analysis of variance or Student t test. Individual post exposure was assessed by average post views per week. Individual post reach was assessed by average post reads per week. High- and low-profile blog posts with the highest and lowest 10th percentile for exposure and reach were identified. Results: A total of 99 posts and 755 tweets were published during the study period. There was a significant increase in exposure (P=.004) and reach (P<.001) during the final 6 months. Seven high-profile and 6 low-profile posts were identified. High-profile posts had a significantly greater average word count than low-profile posts (P=.003). There were no other significant differences between posts. Conclusions: The increases in KnowledgeNudge exposure and engagement offer preliminary evidence in support of this dissemination strategy for the practice of KT and PE. Variation in individual post exposure and reach warrants further exploration to tailor content to user needs. Future work will include a prospective evaluation strategy to explore the effect of KnowledgeNudge on awareness, knowledge, attitudes, and behavior. UR - http://www.jmir.org/2020/6/e15351/ UR - http://dx.doi.org/10.2196/15351 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442133 ID - info:doi/10.2196/15351 ER - TY - JOUR AU - Cresswell, Kathrin AU - Williams, Robin AU - Sheikh, Aziz PY - 2020/6/10 TI - Developing and Applying a Formative Evaluation Framework for Health Information Technology Implementations: Qualitative Investigation JO - J Med Internet Res SP - e15068 VL - 22 IS - 6 KW - health information technology KW - evaluation KW - sociotechnical N2 - Background: There is currently a lack of comprehensive, intuitive, and usable formative evaluation frameworks for health information technology (HIT) implementations. We therefore sought to develop and apply such a framework. This study describes the Technology, People, Organizations, and Macroenvironmental factors (TPOM) framework we developed. Objective: The aim was to develop and apply a formative evaluation framework for HIT implementations, highlighting interrelationships between identified dimensions and offering guidance for implementers. Methods: We drew on an initial prototype framework developed as part of a literature review exploring factors for the effective implementation of HIT. In addition, we used qualitative data from three national formative evaluations of different HIT interventions (electronic health record, electronic prescribing, and clinical decision support functionality). The combined data set comprised 19 case studies of primarily hospital settings, and included 703 semistructured interviews, 663 hours of observations, and 864 documents gathered from a range of care settings across National Health Service (NHS) England and NHS Scotland. Data analysis took place over a period of 10 years and was guided by a framework informed by the existing evidence base. Results: TPOM dimensions are intimately related and each include a number of subthemes that evaluators need to consider. Although technological functionalities are crucial in getting an initiative off the ground, system design needs to be cognizant of the accompanying social and organizational transformations required to ensure that technologies deliver the desired value for a variety of stakeholders. Wider structural changes, characterized by shifting policy landscapes and markets, influence technologies and the ways they are used by organizations and staff. Conclusions: The TPOM framework supports formative evaluations of HIT implementation and digitally enabled transformation efforts. There is now a need for prospective application of the TPOM framework to determine its value. UR - http://www.jmir.org/2020/6/e15068/ UR - http://dx.doi.org/10.2196/15068 UR - http://www.ncbi.nlm.nih.gov/pubmed/32519968 ID - info:doi/10.2196/15068 ER - TY - JOUR AU - Hulter, Pauline AU - Pluut, Bettine AU - Leenen-Brinkhuis, Christine AU - de Mul, Marleen AU - Ahaus, Kees AU - Weggelaar-Jansen, Marie Anne PY - 2020/5/19 TI - Adopting Patient Portals in Hospitals: Qualitative Study JO - J Med Internet Res SP - e16921 VL - 22 IS - 5 KW - patient portal KW - adoption KW - adoption processes KW - eHealth N2 - Background: Theoretical models help to explain or predict the adoption of electronic health (eHealth) technology and illustrate the complexity of the adoption process. These models provide insights into general factors that influence the use of eHealth technology. However, they do not give hospitals much actionable knowledge on how to facilitate the adoption process. Objective: Our study aims to provide insights into patient portal adoption processes among patients and hospital staff, including health care professionals (HCPs), managers, and administrative clerks. Studying the experiences and views of stakeholders answers the following question: How can hospitals encourage patients and HCPs to adopt a patient portal? Methods: We conducted 22 semistructured individual and group interviews (n=69) in 12 hospitals and four focus groups with members of national and seminational organizations and patient portal suppliers (n=53). Results: The effort hospitals put into adopting patient portals can be split into three themes. First, inform patients and HCPs about the portal. This communication strategy has four objectives: users should (1) know about the portal, (2) know how the portal works, (3) know that action on the portal is required, and (4) know where to find help with the portal. Second, embed the patient portal in the daily routine of HCPs and management. This involves three forms of support: (1) hospital policy, (2) management by monitoring the numbers, and (3) a structured implementation strategy that includes all staff of one department. Third, try to adjust the portal to meet patients? needs to optimize user-friendliness in two ways: (1) use patients? feedback and (2) focus on optimizing for patients with special needs (eg, low literacy and low digital skills). Conclusions: Asking stakeholders what they have learned from their efforts to stimulate patient portal use in hospitals elicited rich insights into the adoption process. These insights are missing in the theoretical models. Therefore, our findings help to translate the relatively abstract factors one finds in theoretical models to the everyday pragmatics of eHealth projects in hospitals. UR - http://www.jmir.org/2020/5/e16921/ UR - http://dx.doi.org/10.2196/16921 UR - http://www.ncbi.nlm.nih.gov/pubmed/32427110 ID - info:doi/10.2196/16921 ER - TY - JOUR AU - Linzey, R. Joseph AU - Robertson, Faith AU - Haider, S. Ali AU - Graffeo, Salvatore Christopher AU - Wang, Z. Justin AU - Shasby, Gillian AU - Alotaibi, M. Naif AU - Cohen-Gadol, A. Aaron AU - Rutka, T. James PY - 2020/5/19 TI - Online Impact and Presence of a Specialized Social Media Team for the Journal of Neurosurgery: Descriptive Analysis JO - J Med Internet Res SP - e17741 VL - 22 IS - 5 KW - social media KW - Twitter KW - Facebook KW - research dissemination N2 - Background: Social media use continues to gain momentum in academic neurosurgery. To increase journal impact and broaden engagement, many scholarly publications have turned to social media to disseminate research. The Journal of Neurosurgery Publishing Group (JNSPG) established a dedicated, specialized social media team (SMT) in November 2016 to provide targeted improvement in digital outreach. Objective: The goal of this study was to examine the impact of the JNSPG SMT as measured by increased engagement. Methods: We analyzed various metrics, including impressions, engagements, retweets, likes, profile clicks, and URL clicks, from consecutive social media posts from the JNSPG?s Twitter and Facebook platforms between February 1, 2015 and February 28, 2019. Standard descriptive statistics were utilized. Results: Between February 2015 and October 2016, when a specialized SMT was created, 170 tweets (8.1 tweets/month) were posted compared to 3220 tweets (115.0 tweets/month) between November 2016 and February 2019. All metrics significantly increased, including the impressions per tweet (mean 1646.3, SD 934.9 vs mean 4605.6, SD 65,546.5; P=.01), engagements per tweet (mean 35.2, SD 40.6 vs mean 198.2, SD 1037.2; P<.001), retweets (mean 2.5, SD 2.8 vs mean 10.5, SD 15.3; P<.001), likes (mean 2.5, SD 4.0 vs mean 18.0, SD 37.9; P<.001), profile clicks (mean 1.5, SD 2.0 vs mean 5.2, SD 43.3; P<.001), and URL clicks (mean 13.1, SD 14.9 vs mean 38.3, SD 67.9; P<.001). Tweets that were posted on the weekend compared to weekdays had significantly more retweets (mean 9.2, SD 9.8 vs mean 13.4, SD 25.6; P<.001), likes (mean 15.3, SD 17.9 vs mean 23.7, SD 70.4; P=.001), and URL clicks (mean 33.4, SD 40.5 vs mean 49.5, SD 117.3; P<.001). Between November 2015 and October 2016, 49 Facebook posts (2.3 posts/month) were sent compared to 2282 posts (81.5 posts/month) sent between November 2016 and February 2019. All Facebook metrics significantly increased, including impressions (mean 5475.9, SD 5483.0 vs mean 8506.1, SD 13,113.9; P<.001), engagements (mean 119.3, SD 194.8 vs mean 283.8, SD 733.8; P<.001), and reach (mean 2266.6, SD 2388.3 vs mean 5344.1, SD 8399.2; P<.001). Weekend Facebook posts had significantly more impressions per post (mean 7967.9, SD 9901.0 vs mean 9737.8, SD 19,013.4; P=.03) and a higher total reach (mean 4975.8, SD 6309.8 vs mean 6108.2, SD 12,219.7; P=.03) than weekday posts. Conclusions: Social media has been established as a crucial tool for the propagation of neurosurgical research and education. Implementation of the JNSPG specialized SMT had a demonstrable impact on increasing the online visibility of social media content. UR - http://www.jmir.org/2020/5/e17741/ UR - http://dx.doi.org/10.2196/17741 UR - http://www.ncbi.nlm.nih.gov/pubmed/32163371 ID - info:doi/10.2196/17741 ER - TY - JOUR AU - Utunen, Heini AU - Ndiaye, Ngouille AU - Piroux, Corentin AU - George, Richelle AU - Attias, Melissa AU - Gamhewage, Gaya PY - 2020/4/27 TI - Global Reach of an Online COVID-19 Course in Multiple Languages on OpenWHO in the First Quarter of 2020: Analysis of Platform Use Data JO - J Med Internet Res SP - e19076 VL - 22 IS - 4 KW - online learning KW - OpenWHO KW - novel coronavirus KW - COVID-19 KW - coronavirus KW - pandemic KW - WHO KW - e-learning KW - MOOC KW - public health N2 - Background: At the onset of the coronavirus outbreak, the World Health Organization?s (WHO) Health Emergencies Learning and Capacity Development Unit, together with the WHO?s health technical lead on coronaviruses, developed a massive open online course within 3 weeks as part of the global response to the emergency. The introductory coronavirus disease (COVID?19) course was launched on January 26, 2020, on the health emergencies learning platform OpenWHO.org. Objective: The aim of this paper is to investigate the geographic reach of different language courses accessed by a worldwide audience seeking information on COVID-19. Users? professional identities and backgrounds were explored to inform course owners on the use case. The course was developed and delivered via the open-access learning platform OpenWHO.org. The self-paced resources are available in a total of 13 languages and were produced between January 26 and March 25, 2020. Methods: Data were collected from the online courses? statistical data and metrics reporting system on the OpenWHO platform. User patterns and locations were analyzed based on Google Analytics and the platform?s own statistics capabilities, and data sets were overlaid. This analysis was conducted based on user location, with the data disaggregated according to the six WHO regions, the top 10 countries, and the proportion of use for each language version. Data included affiliation, gender, age, and other parameters for 32.43% (52,214/161,007) of the users who indicated their background. Results: As of March 25, 2020, the introductory COVID-19 course totaled 232,890 enrollments across all languages. The Spanish language course was comprised of more than half (n=118,754, 50.99%) of all course enrollments, and the English language course was comprised of 38.21% (n=88,988) of enrollments. The WHO?s Region of the Americas accounted for most of the course enrollments, with more than 72.47% (138,503/191,130) enrollment across all languages. Other regions were more evenly distributed with less than 10% enrollment for each. A total of 32.43% (52,214/161,007) of users specified a professional affiliation by choosing from the 12 most common backgrounds in the OpenWHO user profiles. Before the COVID-19 pandemic, users were spread over the 11 distinct affiliations, with a small fraction of users identifying themselves as ?Other.? With the COVID-19 introductory course, the largest number of users selected ?Other? (16,527/52,214, 31.65%), suggesting a large number of users who were not health professionals or academics. The top 10 countries with the most users across all languages were Argentina, Chile, Colombia, Ecuador, India, Mexico, Peru, Spain, the United Kingdom, and the United States. Conclusions: The online course has addressed a worldwide learning need by providing WHO?s technical guidance packaged in simple formats for access and use. The learning material development was expedited to meet the onset of the epidemic. Initial data suggest that the various language versions of the course, in particular Spanish, have reached new user groups, fulfilling the platform?s aim of providing learning everywhere to anyone that is interested. User surveys will be carried out to measure the real impact. UR - https://www.jmir.org/2020/4/e19076 UR - http://dx.doi.org/10.2196/19076 UR - http://www.ncbi.nlm.nih.gov/pubmed/32293580 ID - info:doi/10.2196/19076 ER - TY - JOUR AU - Seguin, Aurélie AU - Haynes, Brian Robert AU - Carballo, Sebastian AU - Iorio, Alfonso AU - Perrier, Arnaud AU - Agoritsas, Thomas PY - 2020/4/20 TI - Translating Clinical Questions by Physicians Into Searchable Queries: Analytical Survey Study JO - JMIR Med Educ SP - e16777 VL - 6 IS - 1 KW - evidence-based medicine KW - evidence retrieval KW - Web-based resources KW - search engines KW - search taxonomy KW - clinical information science N2 - Background: Staying up to date and answering clinical questions with current best evidence from health research is challenging. Evidence-based clinical texts, databases, and tools can help, but clinicians first need to translate their clinical questions into searchable queries. MacPLUS FS (McMaster Premium LiteratUre Service Federated Search) is an online search engine that allows clinicians to explore multiple resources simultaneously and retrieves one single output that includes the following: (1) evidence from summaries (eg, UpToDate and DynaMed), (2) preappraised research (eg, EvidenceAlerts), and (3) non-preappraised research (eg, PubMed), with and without validated bibliographic search filters. MacPLUS FS can also be used as a laboratory to explore clinical questions and evidence retrieval. Objective: Our primary objective was to examine how clinicians formulate their queries on a federated search engine, according to the population, intervention, comparison, and outcome (PICO) framework. Our secondary objective was to assess which resources were accessed by clinicians to answer their questions. Methods: We performed an analytical survey among 908 clinicians who used MacPLUS FS in the context of a randomized controlled trial on search retrieval. Recording account log-ins and usage, we extracted all 1085 queries performed during a 6-month period and classified each search term according to the PICO framework. We further categorized queries into background (eg, ?What is porphyria??) and foreground questions (eg, ?Does treatment A work better than B??). We then analyzed the type of resources that clinicians accessed. Results: There were 695 structured queries, after exclusion of meaningless queries and iterations of similar searches. We classified 56.5% (393/695) of these queries as background questions and 43.5% (302/695) as foreground questions, the majority of which were related to questions about therapy (213/695, 30.6%), followed by diagnosis (48/695, 6.9%), etiology (24/695, 3.5%), and prognosis (17/695, 2.5%). This distribution did not significantly differ between postgraduate residents and medical faculty physicians (P=.51). Queries included a median of 3 search terms (IQR 2-4), most often related to the population and intervention or test, rarely related to the outcome, and never related to the comparator. About half of the resources accessed (314/610, 51.5%) were summaries, 24.4% (149/610) were preappraised research, and 24.1% were (147/610) non-preappraised research. Conclusions: Our results, from a large sample of real-life queries, could guide the development of educational interventions to improve clinicians? retrieval skills, as well as inform the design of more useful evidence-based resources for clinical practice. Trial Registration: ClinicalTrials.gov NCT02038439; https://www.clinicaltrials.gov/ct2/show/NCT02038439 UR - http://mededu.jmir.org/2020/1/e16777/ UR - http://dx.doi.org/10.2196/16777 UR - http://www.ncbi.nlm.nih.gov/pubmed/32310137 ID - info:doi/10.2196/16777 ER - TY - JOUR AU - Gaiser, Meike AU - Kirsch, Joachim AU - Mutzbauer, Sebastian Till PY - 2020/4/17 TI - Using Nonexpert Online Reports to Enhance Expert Knowledge About Causes of Death in Dental Offices Reported in Scientific Publications: Qualitative and Quantitative Content Analysis and Search Engine Analysis JO - J Med Internet Res SP - e15304 VL - 22 IS - 4 KW - dental death KW - dental practice KW - dental sedation KW - risk KW - internet search engine N2 - Background: Fatalities rarely occur in dental offices. Implications for clinicians may be deduced from scientific publications and internet reports about deaths in dental offices. Objective: Data involving deaths in dental facilities were analyzed using Google as well as the PubMed database. By comparing both sources, we examined how internet data may enhance knowledge about deaths in dental offices obtained from scientific medical publications, which causes of death are published online, and how associated life-threatening emergencies may be prevented. Methods: To retrieve relevant information, we searched Google for country-specific incidents of death in dental practices using the following keywords: ?death at the dentist,? ?death in dental practice,? and ?dying at the dentist.? For PubMed searches, the following keywords were used: ?dentistry and mortality,? ?death and dental treatment,? ?dentistry and fatal outcome,? and ?death and dentistry.? Deaths associated with dental treatment in a dental facility, attributable causes of death, and documented ages of the deceased were included in our analysis. Deaths occurring in maxillofacial surgery or pre-existing diseases involved in the death (eg, cancer and abscesses) were excluded. A total of 128 cases from online publications and 71 cases from PubMed publications that met the inclusion criteria were analyzed using chi-square statistics after exclusion of duplicates. Results: The comparison between the fatalities from internet (n=117) and PubMed (n=71) publications revealed that more casualties affecting minors appeared online than in PubMed literature (online 68/117, 58.1%; PubMed 20/71, 28%; P<.001). In PubMed articles, 10 fatalities in patients older than 70 years of age were described, while online sources published 5 fatalities (P=.02). Most deaths, both from internet publications and PubMed literature, could be assigned to the category anesthesia, medication, or sedation (online 80/117, 68.4%; PubMed 25/71, 35%; P<.001). Deaths assigned to the categories infection and cardiovascular system appeared more often in the PubMed literature (infection: online 10/117, 8.5%; PubMed 15/71, 21%; P=.01; cardiovascular system: online 5/117, 4.3%; PubMed 15/71, 21%; P<.001). Furthermore, sedative drugs were involved in a larger proportion of fatal incidents listed online compared to in PubMed (online 41/117, 35.0%; PubMed: 14/71, 20%, P=.03). In the United States, more deaths occurred under sedation (44/96, 46%) compared to those in the other countries (Germany and Austria 1/17, 6%, P=.002; United Kingdom 1/14, 7%, P=.006). Conclusions: Online and PubMed databases may increase awareness of life-threatening risks for patients during dental treatment. Negative aspects of anesthesia and sedation, as well as the number of deaths of young patients, were underestimated when reviewing PubMed literature only. Medical history of patients, medication dosages, and vital function monitoring are significant issues for practitioners. A high-impact finding from online reports was the underestimation of risks when performing sedation and even general anesthesia. Detailed knowledge of the definition and understanding of deep sedation and general anesthesia by dentists is of major concern. By avoiding potentially hazardous procedures, such as sedation-aided treatments performed solely by dentists, the risk of treatment-induced life-threatening emergencies may be reduced. UR - http://www.jmir.org/2020/4/e15304/ UR - http://dx.doi.org/10.2196/15304 UR - http://www.ncbi.nlm.nih.gov/pubmed/32038029 ID - info:doi/10.2196/15304 ER - TY - JOUR AU - Groenhof, J. T. Katrien AU - Kofink, Daniel AU - Bots, L. Michiel AU - Nathoe, M. Hendrik AU - Hoefer, E. Imo AU - Van Solinge, W. Wouter AU - Lely, Titia A. AU - Asselbergs, W. Folkert AU - Haitjema, Saskia PY - 2020/4/2 TI - Low-Density Lipoprotein Cholesterol Target Attainment in Patients With Established Cardiovascular Disease: Analysis of Routine Care Data JO - JMIR Med Inform SP - e16400 VL - 8 IS - 4 KW - learning health care system KW - routine clinical data KW - cardiovascular risk management KW - LDL-c N2 - Background: Direct feedback on quality of care is one of the key features of a learning health care system (LHS), enabling health care professionals to improve upon the routine clinical care of their patients during practice. Objective: This study aimed to evaluate the potential of routine care data extracted from electronic health records (EHRs) in order to obtain reliable information on low-density lipoprotein cholesterol (LDL-c) management in cardiovascular disease (CVD) patients referred to a tertiary care center. Methods: We extracted all LDL-c measurements from the EHRs of patients with a history of CVD referred to the University Medical Center Utrecht. We assessed LDL-c target attainment at the time of referral and per year. In patients with multiple measurements, we analyzed LDL-c trajectories, truncated at 6 follow-up measurements. Lastly, we performed a logistic regression analysis to investigate factors associated with improvement of LDL-c at the next measurement. Results: Between February 2003 and December 2017, 250,749 LDL-c measurements were taken from 95,795 patients, of whom 23,932 had a history of CVD. At the time of referral, 51% of patients had not reached their LDL-c target. A large proportion of patients (55%) had no follow-up LDL-c measurements. Most of the patients with repeated measurements showed no change in LDL-c levels over time: the transition probability to remain in the same category was up to 0.84. Sequence clustering analysis showed more women (odds ratio 1.18, 95% CI 1.07-1.10) in the cluster with both most measurements off target and the most LDL-c measurements furthest from the target. Timing of drug prescription was difficult to determine from our data, limiting the interpretation of results regarding medication management. Conclusions: Routine care data can be used to provide feedback on quality of care, such as LDL-c target attainment. These routine care data show high off-target prevalence and little change in LDL-c over time. Registrations of diagnosis; follow-up trajectory, including primary and secondary care; and medication use need to be improved in order to enhance usability of the EHR system for adequate feedback. UR - https://medinform.jmir.org/2020/4/e16400 UR - http://dx.doi.org/10.2196/16400 UR - http://www.ncbi.nlm.nih.gov/pubmed/32238333 ID - info:doi/10.2196/16400 ER - TY - JOUR AU - Ottwell, Ryan AU - Rogers, C. Taylor AU - Anderson, Michael J. AU - Johnson, Austin AU - Vassar, Matt PY - 2020/3/20 TI - Evaluation of Spin in the Abstracts of Systematic Reviews and Meta-Analyses Focused on the Treatment of Acne Vulgaris: Cross-Sectional Analysis JO - JMIR Dermatol SP - e16978 VL - 3 IS - 1 KW - acne vulgaris KW - systematic review KW - abstracts KW - dermatology N2 - Background: Spin is the misrepresentation of study findings, which may positively or negatively influence the reader?s interpretation of the results. Little is known regarding the prevalence of spin in abstracts of systematic reviews, specifically systematic reviews pertaining to the management and treatment of acne vulgaris. Objective: The primary objective of this study was to characterize and determine the frequency of the most severe forms of spin in systematic review abstracts and to evaluate whether various study characteristics were associated with spin. Methods: Using a cross-sectional study design, we searched PubMed and EMBASE for systematic reviews focusing on the management and treatment of acne vulgaris. Our search returned 316 studies, of which 36 were included in our final sample. To be included, each systematic review must have addressed either pharmacologic or nonpharmacologic treatment of acne vulgaris. These studies were screened, and data were extracted in duplicate by two blinded investigators. We analyzed systematic review abstracts for the nine most severe types of spin. Results: Spin was present in 31% (11/36) of abstracts. A total of 12 examples of spin were identified in the 11 abstracts containing spin, with one abstract containing two instances of spin. The most common type of spin, selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention, was identified five times (5/12, 42%). A total of 44% (16/36) of studies did not report a risk of bias assessment. Of the 11 abstracts containing spin, six abstracts (55%) had not reported a risk of bias assessment or performed a risk of bias assessment but did not discuss it. Spin in abstracts was not significantly associated with a specific intervention type, funding source, or journal impact factor. Conclusions: Spin is present in the abstracts of systematic reviews and meta-analyses covering the treatment of acne vulgaris. This paper raises awareness of spin in abstracts and emphasizes the importance of its recognition, which may lead to fewer incidences of spin in future studies. UR - http://derma.jmir.org/2020/1/e16978/ UR - http://dx.doi.org/10.2196/16978 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/16978 ER - TY - JOUR AU - Anzinger, Harrison AU - Elliott, Alexandra Sarah AU - Hartling, Lisa PY - 2020/3/13 TI - Comparative Usability Analysis and Parental Preferences of Three Web-Based Knowledge Translation Tools: Multimethod Study JO - J Med Internet Res SP - e14562 VL - 22 IS - 3 KW - child health KW - knowledge translation KW - parents KW - internet KW - comparative study KW - health information,consumer N2 - Background: Connecting parents to research evidence is known to improve health decision making. However, guidance on how to develop effective knowledge translation (KT) tools that synthesize child-health evidence into a form understandable by parents is lacking. Objective: The aim of this study was to conduct a comparative usability analysis of three Web-based KT tools to identify differences in tool effectiveness, identify which format parents prefer, and better understand what factors affect usability for parents. Methods: We evaluated a Cochrane plain language summary (PLS), Blogshot, and a Wikipedia page on a specific child-health topic (acute otitis media). A mixed method approach was used involving a knowledge test, written usability questionnaire, and a semistructured interview. Differences in knowledge and usability questionnaire scores for each of the KT tools were analyzed using Kruskal-Wallis tests, considering a critical significance value of P=.05. Thematic analysis was used to synthesize and identify common parent preferences among the semistructured interviews. Key elements parents wanted in a KT tool were derived through author consensus using questionnaire data and parent interviews. Results: In total, 16 parents (9 female) with a mean age of 39.6 (SD 11.9) years completed the study. Parents preferred the Blogshot over the PLS and Wikipedia page (P=.002) and found the Blogshot to be the most aesthetic (P=.001) and easiest to use (P=.001). Knowledge questions and usability survey data also indicated that the Blogshot was the most preferred and effective KT tool at relaying information about the topic. Four key themes were derived from thematic analysis, describing elements parents valued in KT tools. Parents wanted tools that were (1) simple, (2) quick to access and use, and (3) trustworthy, and which (4) informed how to manage the condition. Out of the three KT tools assessed, Blogshots were the most preferred tool by parents and encompassed these four key elements. Conclusions: It is important that child health evidence be available in formats accessible and understandable by parents to improve decision making, use of health care resources, and health outcomes. Further usability testing of different KT tools should be conducted involving broader populations and other conditions (eg, acute vs chronic) to generate guidelines to improve KT tools for parents. UR - http://www.jmir.org/2020/3/e14562/ UR - http://dx.doi.org/10.2196/14562 UR - http://www.ncbi.nlm.nih.gov/pubmed/32167478 ID - info:doi/10.2196/14562 ER - TY - JOUR AU - Gu, Dongxiao AU - Yang, Xuejie AU - Deng, Shuyuan AU - Liang, Changyong AU - Wang, Xiaoyu AU - Wu, Jiao AU - Guo, Jingjing PY - 2020/2/25 TI - Tracking Knowledge Evolution in Cloud Health Care Research: Knowledge Map and Common Word Analysis JO - J Med Internet Res SP - e15142 VL - 22 IS - 2 KW - cloud health care KW - cloud computing KW - health care informatics KW - cybermetrics KW - co-word analysis N2 - Background: With the continuous development of the internet and the explosive growth in data, big data technology has emerged. With its ongoing development and application, cloud computing technology provides better data storage and analysis. The development of cloud health care provides a more convenient and effective solution for health. Studying the evolution of knowledge and research hotspots in the field of cloud health care is increasingly important for medical informatics. Scholars in the medical informatics community need to understand the extent of the evolution of and possible trends in cloud health care research to inform their future research. Objective: Drawing on the cloud health care literature, this study aimed to describe the development and evolution of research themes in cloud health care through a knowledge map and common word analysis. Methods: A total of 2878 articles about cloud health care was retrieved from the Web of Science database. We used cybermetrics to analyze and visualize the keywords in these articles. We created a knowledge map to show the evolution of cloud health care research. We used co-word analysis to identify the hotspots and their evolution in cloud health care research. Results: The evolution and development of cloud health care services are described. In 2007-2009 (Phase I), most scholars used cloud computing in the medical field mainly to reduce costs, and grid computing and cloud computing were the primary technologies. In 2010-2012 (Phase II), the security of cloud systems became of interest to scholars. In 2013-2015 (Phase III), medical informatization enabled big data for health services. In 2016-2017 (Phase IV), machine learning and mobile technologies were introduced to the medical field. Conclusions: Cloud health care research has been rapidly developing worldwide, and technologies used in cloud health research are simultaneously diverging and becoming smarter. Cloud?based mobile health, cloud?based smart health, and the security of cloud health data and systems are three possible trends in the future development of the cloud health care field. UR - http://www.jmir.org/2020/2/e15142/ UR - http://dx.doi.org/10.2196/15142 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130115 ID - info:doi/10.2196/15142 ER - TY - JOUR AU - Neil-Sztramko, Sarah AU - Smith-Turchyn, Jenna AU - Richardson, Julie AU - Dobbins, Maureen PY - 2020/2/11 TI - Impact of a Knowledge Translation Intervention on Physical Activity and Mobility in Older Adults (the Move4Age Study): Randomized Controlled Trial JO - J Med Internet Res SP - e15125 VL - 22 IS - 2 KW - physical activity KW - mobility limitation KW - aging KW - knowledge translation KW - randomized controlled trial N2 - Background: The McMaster Optimal Aging Portal (the Portal) was launched in 2014 as a knowledge translation (KT) tool to increase access to evidence-based health information. Objective: The purpose of this study was to understand if and how dissemination of mobility information through the Portal impacts physical activity (PA) in older adults. Methods: In this randomized controlled trial, participants (n=510) were assigned to a 12-week mobility-focused KT intervention or self-serve control group. The intervention included weekly email alerts and a study-specific social media hashtag linking to mobility-focused Portal materials. The control group was able to access the Portal on their own but did not receive targeted KT strategies. Participants completed questionnaires (including the Rapid Assessment of Physical Activity to quantify PA) at baseline, end of the study, and 3-month follow-up. Results: Participants were predominantly female (430/510, 84.3%), mean age 64.7 years, with no baseline differences between groups. Over half (277/510, 54.3%) of the participants were classified as ?active? at baseline. There was no significant between-group difference in the PA category. Overall, both groups increased their PA with improvements maintained at 3-month follow-up (P<.001). In planned subgroup analyses, the KT intervention had a significant effect for those with poor or fair baseline self-rated health (P=.03). Conclusions: No differences were found between those who received the targeted intervention and a control group with self-serve access to the Portal, except in subgroups with low self-rated health. Both groups did report increases in PA that were sustained beyond participation in a research study. Findings suggest that different KT strategies may be needed for different types of users, with more intense interventions being most impactful for certain groups (ie, those with lower self-rated health). Trial Registration: ClinicalTrials.gov NCT02947230; https://clinicaltrials.gov/ct2/show/NCT02947230 UR - https://www.jmir.org/2020/2/e15125 UR - http://dx.doi.org/10.2196/15125 UR - http://www.ncbi.nlm.nih.gov/pubmed/32044750 ID - info:doi/10.2196/15125 ER - TY - JOUR AU - Lenaerts, Gerlinde AU - Bekkering, E. Geertruida AU - Goossens, Martine AU - De Coninck, Leen AU - Delvaux, Nicolas AU - Cordyn, Sam AU - Adriaenssens, Jef AU - Vankrunkelsven, Patrick PY - 2020/1/17 TI - Tools to Assess the Trustworthiness of Evidence-Based Point-of-Care Information for Health Care Professionals: Systematic Review JO - J Med Internet Res SP - e15415 VL - 22 IS - 1 KW - evidence-based medicine KW - evidence-based practice KW - point-of-care systems KW - health care quality KW - internet information KW - information science KW - systematic review N2 - Background: User-friendly information at the point of care should be well structured, rapidly accessible, and comprehensive. Also, this information should be trustworthy, as it will be used by health care practitioners to practice evidence-based medicine. Therefore, a standard, validated tool to evaluate the trustworthiness of such point-of-care information resources is needed. Objective: This systematic review sought to search for tools to assess the trustworthiness of point-of-care resources and to describe and analyze the content of these tools. Methods: A systematic search was performed on three sources: (1) we searched online for initiatives that worked off of the trustworthiness of medical information; (2) we searched Medline (PubMed) until June 2019 for relevant literature; and (3) we scanned reference lists and lists of citing papers via Web of Science for each retrieved paper. We included all studies, reports, websites, or methodologies that reported on tools that assessed the trustworthiness of medical information for professionals. From the selected studies, we extracted information on the general characteristics of the tools. As no standard, risk-of-bias assessment instruments are available for these types of studies, we described how each tool was developed, including any assessments on reliability and validity. We analyzed the criteria used in the different tools and divided them into five categories: (1) author-related information; (2) evidence-based methodology; (3) website quality; (4) website design and usability; and (5) website interactivity. The percentage of tools in compliance with these categories and the different criteria were calculated. Results: Included in this review was a total of 17 tools, all published between 1997 and 2018. The tools were developed for different purposes, from a general quality assessment of medical information to very detailed analyses, all specifically for point-of-care resources. However, the development process of the tools was poorly described. Overall, seven tools had a scoring system implemented, two were assessed for reliability only, and two other tools were assessed for both validity and reliability. The content analysis showed that all the tools assessed criteria related to an evidence-based methodology: 82% of the tools assessed author-related information, 71% assessed criteria related to website quality, 71% assessed criteria related to website design and usability, and 47% of the tools assessed criteria related to website interactivity. There was significant variability in criteria used, as some were very detailed while others were more broadly defined. Conclusions: The 17 included tools encompass a variety of items important for the assessment of the trustworthiness of point-of-care information. Overall, two tools were assessed for both reliability and validity, but they lacked some essential criteria for the assessment of the trustworthiness of medical information for use at the point-of-care. Currently, a standard, validated tool does not exist. The results of this review may contribute to the development of such an instrument, which may enhance the quality of point-of-care information in the long term. Trial Registration: PROSPERO CRD42019122565; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=122565 UR - https://www.jmir.org/2020/1/e15415 UR - http://dx.doi.org/10.2196/15415 UR - http://www.ncbi.nlm.nih.gov/pubmed/31951213 ID - info:doi/10.2196/15415 ER - TY - JOUR AU - Eysenbach, Gunther PY - 2019/12/23 TI - Celebrating 20 Years of Open Access and Innovation at JMIR Publications JO - J Med Internet Res SP - e17578 VL - 21 IS - 12 KW - JMIR KW - internet KW - medical informatics KW - ehealth KW - digital health KW - participatory medicine KW - open access KW - electronic publishing KW - scholarly publishing KW - science communication KW - journalogy KW - history of science KW - overlay journal KW - preprints KW - open science UR - http://www.jmir.org/2019/12/e17578/ UR - http://dx.doi.org/10.2196/17578 UR - http://www.ncbi.nlm.nih.gov/pubmed/31868653 ID - info:doi/10.2196/17578 ER - TY - JOUR AU - Wyatt, C. Jeremy PY - 2019/12/23 TI - Preserving the Open Access Benefits Pioneered by the Journal of Medical Internet Research and Discouraging Fraudulent Journals JO - J Med Internet Res SP - e16532 VL - 21 IS - 12 KW - open access KW - predatory journals KW - knowledge management KW - scientific journals KW - mobilizing computable knowledge KW - fraudulent journals UR - http://www.jmir.org/2019/12/e16532/ UR - http://dx.doi.org/10.2196/16532 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/16532 ER - TY - JOUR AU - Afzal, Muhammad AU - Hussain, Maqbool AU - Malik, Mahmood Khalid AU - Lee, Sungyoung PY - 2019/12/9 TI - Impact of Automatic Query Generation and Quality Recognition Using Deep Learning to Curate Evidence From Biomedical Literature: Empirical Study JO - JMIR Med Inform SP - e13430 VL - 7 IS - 4 KW - data curation KW - evidence-based medicine KW - clinical decision support systems KW - precision medicine KW - biomedical research KW - machine learning KW - deep learning N2 - Background: The quality of health care is continuously improving and is expected to improve further because of the advancement of machine learning and knowledge-based techniques along with innovation and availability of wearable sensors. With these advancements, health care professionals are now becoming more interested and involved in seeking scientific research evidence from external sources for decision making relevant to medical diagnosis, treatments, and prognosis. Not much work has been done to develop methods for unobtrusive and seamless curation of data from the biomedical literature. Objective: This study aimed to design a framework that can enable bringing quality publications intelligently to the users? desk to assist medical practitioners in answering clinical questions and fulfilling their informational needs. Methods: The proposed framework consists of methods for efficient biomedical literature curation, including the automatic construction of a well-built question, the recognition of evidence quality by proposing extended quality recognition model (E-QRM), and the ranking and summarization of the extracted evidence. Results: Unlike previous works, the proposed framework systematically integrates the echelons of biomedical literature curation by including methods for searching queries, content quality assessments, and ranking and summarization. Using an ensemble approach, our high-impact classifier E-QRM obtained significantly improved accuracy than the existing quality recognition model (1723/1894, 90.97% vs 1462/1894, 77.21%). Conclusions: Our proposed methods and evaluation demonstrate the validity and rigorousness of the results, which can be used in different applications, including evidence-based medicine, precision medicine, and medical education. UR - http://medinform.jmir.org/2019/4/e13430/ UR - http://dx.doi.org/10.2196/13430 UR - http://www.ncbi.nlm.nih.gov/pubmed/31815673 ID - info:doi/10.2196/13430 ER - TY - JOUR AU - Yada, Nicole AU - Head, Milena PY - 2019/12/4 TI - Attitudes Toward Health Care Virtual Communities of Practice: Survey Among Health Care Workers JO - J Med Internet Res SP - e15176 VL - 21 IS - 12 KW - virtual community of practice KW - eHealth KW - digital health KW - knowledge translation KW - implementation science KW - elaboration likelihood model KW - technology adoption N2 - Background: Virtual communities of practice (VCoPs) have been shown to be an effective means for knowledge and research uptake, but little is known about why health care workers choose to use them. The elaboration likelihood model (ELM) is a theoretical model of persuasion that distinguishes between different routes of information processing that influence attitude formation and change. To date, no research has investigated the antecedents to these processing routes for VCoPs within a health care setting. In understanding these determinants, VCoPs can be appropriately designed to increase their chances of use and value among health care professionals. Objective: Our aim is to explore how motivation and ability affect attitudes toward using VCoPs for those working in health care. Methods: Data were collected from 86 health care workers using an online survey at two Canadian health care conferences. Participants were shown a mock VCoP and asked about their perceptions of the online platform and related technologies. The survey instrument was developed based on previously validated scales to measure participants? ability and motivation toward using a VCoP. Attitudes were assessed both at the beginning and end of the study; intention to use the platform was assessed at the end. Results: Ability (expertise with CoPs and VCoPs) was found to directly affect intention to use the system (P<.001 and P=.009, respectively) as was motivation (P<.001). Argument quality had the greatest effect on formed attitudes toward VCoPs, regardless of the user?s level of experience (lower expertise: P=.04; higher expertise: P=.003). Those with higher levels of CoPs expertise were also influenced by peripheral cues of source credibility (P=.005 for attitude formation and intention to use the system) and connectedness (P=.04 for attitude formation; P=.008 for intention to use the system), whereas those with lower levels of CoP expertise were not (P>.05). A significant correlation between formed attitude and intention to use the VCoPs system was found for those with higher levels of expertise (P<.001). Conclusions: This research found that both user ability and motivation play an important and positive role in the attitude toward and adoption of health care VCoPs. Unlike previous ELM research, evidence-based arguments were found to be an effective messaging tactic for improving attitudes toward VCoPs for health care professionals with both high and low levels of expertise. Understanding these factors that influence the attitudes of VCoPs can provide insight into how to best design and position such systems to encourage their effective use among health care professionals. UR - https://www.jmir.org/2019/12/e15176 UR - http://dx.doi.org/10.2196/15176 UR - http://www.ncbi.nlm.nih.gov/pubmed/31799934 ID - info:doi/10.2196/15176 ER - TY - JOUR AU - Murad, Abdulaziz AU - Hyde, Natalie AU - Chang, Shanton AU - Lederman, Reeva AU - Bosua, Rachelle AU - Pirotta, Marie AU - Audehm, Ralph AU - Yates, J. Christopher AU - Briggs, M. Andrew AU - Gorelik, Alexandra AU - Chiang, Cherie AU - Wark, D. John PY - 2019/11/27 TI - Quantifying Use of a Health Virtual Community of Practice for General Practitioners? Continuing Professional Development: A Novel Methodology and Pilot Evaluation JO - J Med Internet Res SP - e14545 VL - 21 IS - 11 KW - online systems KW - online social networking KW - general practitioners KW - online learning KW - continuing education KW - professional education KW - evaluation methodology KW - use-effectiveness KW - quantitative evaluation KW - knowledgebases KW - information sharing N2 - Background: Health care practitioners (HPs), in particular general practitioners (GPs), are increasingly adopting Web-based social media platforms for continuing professional development (CPD). As GPs are restricted by time, distance, and demanding workloads, a health virtual community of practice (HVCoP) is an ideal solution to replace face-to-face CPD with Web-based CPD. However, barriers such as time and work schedules may limit participation in an HVCoP. Furthermore, it is difficult to gauge whether GPs engage actively or passively in HVCoP knowledge-acquisition for Web-based CPD, as GPs? competencies are usually measured with pre- and posttests. Objective: This study investigated a method for measuring the engagement features needed for an HVCoP (the Community Fracture Capture [CFC] Learning Hub) for learning and knowledge sharing among GPs for their CPD activity. Methods: A prototype CFC Learning Hub was developed using an Igloo Web-based social media software platform and involved a convenience sample of GPs interested in bone health topics. This Hub, a secure Web-based community site, included 2 key components: an online discussion forum and a knowledge repository (the Knowledge Hub). The discussion forum contained anonymized case studies (contributed by GP participants) and topical discussions (topics that were not case studies). Using 2 complementary tools (Google Analytics and Igloo Statistical Tool), we characterized individual participating GPs? engagement with the Hub. We measured the GP participants? behavior by quantifying the number of online sessions of the participants, activities undertaken within these online sessions, written posts made per learning topic, and their time spent per topic. We calculated time spent in both active and passive engagement for each topic. Results: Seven GPs participated in the CFC Learning Hub HVCoP from September to November 2017. The complementary tools successfully captured the GP participants? engagement in the Hub. GPs were more active in topics in the discussion forum that had direct clinical application as opposed to didactic, evidence-based discussion topics (ie, topical discussions). From our knowledge hub, About Osteoporosis and Prevention were the most engaging topics, whereas shared decision making was the least active topic. Conclusions: We showcased a novel complementary analysis method that allowed us to quantify the CFC Learning Hub?s usage data into (1) sessions, (2) activities, (3) active or passive time spent, and (4) posts made to evaluate the potential engagement features needed for an HVCoP focused on GP participants? CPD process. Our design and evaluation methods for ongoing use and engagement in this Hub may be useful to evaluate future learning and knowledge-sharing projects for GPs and may allow for extension to other HPs? environments. However, owing to the limited number of GP participants in this study, we suggest that further research with a larger cohort should be performed to validate and extend these findings. UR - http://www.jmir.org/2019/11/e14545/ UR - http://dx.doi.org/10.2196/14545 UR - http://www.ncbi.nlm.nih.gov/pubmed/31774401 ID - info:doi/10.2196/14545 ER - TY - JOUR AU - Roberts, Anne Natasha AU - Alexander, Kimberly AU - Wyld, David AU - Janda, Monika PY - 2019/11/26 TI - Factors in Randomized Controlled Trials Reported to Impact the Implementation of Patient-Reported Outcome Measures Into Routine Care: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e14579 VL - 8 IS - 11 KW - patient reported outcomes KW - PROs KW - PROMs KW - clinical practice KW - implementation KW - implementation science KW - iPARIHS N2 - Background: Patient-reported outcome measures (PROMs) are tools that enable patients to directly report their own assessments of well-being, or symptoms, in a structured and consistent way. Despite the usefulness of PROMs in optimizing health outcomes, their use in clinical practice is not routine. PROMs are complex to integrate into the clinical setting, with many elements potentially impacting on the success of implementation. For this reason, a protocol has been developed to guide a systematic review to collate information on implementation as presented in the randomized controlled trials (RCTs) to date. Objective: The primary objective of this systematic review is to identify and synthesize factors available from RCT data about the fidelity of PROM interventions in clinical practice. The secondary objective will be an assessment of how implementation factors impact fidelity outcomes. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards will be followed. MEDLINE, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature via OvidSP will be accessed using a defined search strategy. Grey literature and ClinicalTrials.gov will be reviewed for unpublished studies. Data extraction will be done to identify fidelity and factors impacting implementation, summarized using a narrative synthesis. An evidence-based implementation science framework will assist in identifying potential elements of importance and their effect on the process and outcomes of implementation. A meta-analysis to assess the impact of implementation factors will be attempted. A Cochrane risk of bias tool will be used. Results: This protocol has received funding, and searches of databases will commence at the end of May 2019. It is planned that this systematic review will be finalized for publication in (December) 2019. Conclusions: Applying an implementation science evidence-based framework to the published literature may identify factors present in the data that impact on the implementation of PROMs into routine clinical care. This systematic review aims to improve understanding of how these factors impact the fidelity of this intervention, so that PROMs can be more effectively used in the care of patients. This systematic review can also offer more detailed information about the process and outcomes of successful implementation of PROMs. International Registered Report Identifier (IRRID): PRR1-10.2196/14579 UR - http://www.researchprotocols.org/2019/11/e14579/ UR - http://dx.doi.org/10.2196/14579 UR - http://www.ncbi.nlm.nih.gov/pubmed/31769763 ID - info:doi/10.2196/14579 ER - TY - JOUR AU - Schreiweis, Björn AU - Pobiruchin, Monika AU - Strotbaum, Veronika AU - Suleder, Julian AU - Wiesner, Martin AU - Bergh, Björn PY - 2019/11/22 TI - Barriers and Facilitators to the Implementation of eHealth Services: Systematic Literature Analysis JO - J Med Internet Res SP - e14197 VL - 21 IS - 11 KW - eHealth KW - health information interoperability KW - policy KW - software design N2 - Background: The field of eHealth has a history of more than 20 years. During that time, many different eHealth services were developed. However, factors influencing the adoption of such services were seldom the main focus of analyses. For this reason, organizations adopting and implementing eHealth services seem not to be fully aware of the barriers and facilitators influencing the integration of eHealth services into routine care. Objective: The objective of this work is to provide (1) a comprehensive list of relevant barriers to be considered and (2) a list of facilitators or success factors to help in planning and implementing successful eHealth services. Methods: For this study, a twofold approach was applied. First, we gathered experts? current opinions on facilitators and barriers in implementing eHealth services via expert discussions at two health informatics conferences held in Europe. Second, we conducted a systematic literature analysis concerning the barriers and facilitators for the implementation of eHealth services. Finally, we merged the results of the expert discussions with those of the systematic literature analysis. Results: Both expert discussions (23 and 10 experts, respectively) identified 15 barriers and 31 facilitators, whereas 76 barriers and 268 facilitators were found in 38 of the initial 56 articles published from 12 different countries. For the analyzed publications, the count of distinct barriers reported ranged from 0 to 40 (mean 10.24, SD 8.87, median 8). Likewise, between 0 and 48 facilitators were mentioned in the literature (mean 9.18, SD 9.33, median 6). The combination of both sources resulted in 77 barriers and 292 facilitators for the adoption and implementation of eHealth services. Conclusions: This work contributes a comprehensive list of barriers and facilitators for the implementation and adoption of eHealth services. Addressing barriers early, and leveraging facilitators during the implementation, can help create eHealth services that better meet the needs of users and provide higher benefits for patients and caregivers. UR - http://www.jmir.org/2019/11/e14197/ UR - http://dx.doi.org/10.2196/14197 UR - http://www.ncbi.nlm.nih.gov/pubmed/31755869 ID - info:doi/10.2196/14197 ER - TY - JOUR AU - Buis, Lorraine PY - 2019/11/20 TI - Implementation: The Next Giant Hurdle to Clinical Transformation With Digital Health JO - J Med Internet Res SP - e16259 VL - 21 IS - 11 KW - digital health KW - digital medicine KW - ehealth KW - mhealth KW - implementation KW - knowledge translation KW - publishing KW - open access KW - journalogy UR - http://www.jmir.org/2019/11/e16259/ UR - http://dx.doi.org/10.2196/16259 UR - http://www.ncbi.nlm.nih.gov/pubmed/31746763 ID - info:doi/10.2196/16259 ER - TY - JOUR AU - Allan, Stephanie AU - Bradstreet, Simon AU - Mcleod, Hamish AU - Farhall, John AU - Lambrou, Maria AU - Gleeson, John AU - Clark, Andrea AU - AU - Gumley, Andrew PY - 2019/10/24 TI - Developing a Hypothetical Implementation Framework of Expectations for Monitoring Early Signs of Psychosis Relapse Using a Mobile App: Qualitative Study JO - J Med Internet Res SP - e14366 VL - 21 IS - 10 KW - psychosis KW - self-management KW - implementation science N2 - Background: Relapse is a common experience for people diagnosed with psychosis, which is associated with increased service costs and profound personal and familial distress. EMPOWER (Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery) is a peer worker?supported digital intervention that aims to enable service users to self-monitor their mental health with the aim of encouraging self-management and the shared use of personal data to promote relapse prevention. Digital interventions have not been widely used in relapse prevention and, therefore, little is currently known about their likely implementation?both within trials and beyond. Objective: Seeking the perspectives of all relevant stakeholder groups is recommended in developing theories about implementation because this can reveal important group differences in understandings and assumptions about whether and for whom the intervention is expected to work. However, the majority of intervention implementation research has been retrospective. This study aimed to discover and theoretically frame implementation expectations in advance of testing and synthesize these data into a framework. Methods: To develop a hypothetical implementation framework, 149 mental health professionals, carers, and people diagnosed with psychosis participated in 25 focus groups in both Australia and the United Kingdom. An interview schedule informed by the normalization process theory was used to explore stakeholders? expectations about the implementation of the EMPOWER intervention. Data were analyzed using thematic analysis and then theoretically framed using the Medical Research Council guidelines for understanding the implementation of complex interventions. Results: All groups expected that EMPOWER could be successfully implemented if the intervention generated data that were meaningful to mental health staff, carers, and service users within their unique roles. However, there were key differences between staff, carers, and service users about what facilitators and barriers that stakeholders believe exist for intervention implementation in both the cluster randomized controlled trial stage and beyond. For example, service user expectations mostly clustered around subjective user experiences, whereas staff and carers spoke more about the impact upon staff interactions with service users. Conclusions: A hypothetical implementation framework synthesized from stakeholder implementation expectations provides an opportunity to compare actual implementation data gathered during an ongoing clinical trial, giving valuable insights into the accuracy of these stakeholders? previous expectations. This is among the first studies to assess and record implementation expectations for a newly developed digital intervention for psychosis in advance of testing in a clinical trial. Trial Registration: ISRCTN Registry ISRCTN99559262; http://www.isrctn.com/ISRCTN99559262 UR - https://www.jmir.org/2019/10/e14366 UR - http://dx.doi.org/10.2196/14366 UR - http://www.ncbi.nlm.nih.gov/pubmed/31651400 ID - info:doi/10.2196/14366 ER - TY - JOUR AU - Varsi, Cecilie AU - Solberg Nes, Lise AU - Kristjansdottir, Birna Olöf AU - Kelders, M. Saskia AU - Stenberg, Una AU - Zangi, Andersen Heidi AU - Břrřsund, Elin AU - Weiss, Elizabeth Karen AU - Stubhaug, Audun AU - Asbjřrnsen, Aune Rikke AU - Westeng, Marianne AU - Řdegaard, Marte AU - Eide, Hilde PY - 2019/9/27 TI - Implementation Strategies to Enhance the Implementation of eHealth Programs for Patients With Chronic Illnesses: Realist Systematic Review JO - J Med Internet Res SP - e14255 VL - 21 IS - 9 KW - chronic illness KW - eHealth KW - implementation KW - implementation strategies KW - implementation outcomes KW - realist review N2 - Background: There is growing evidence of the positive effects of electronic health (eHealth) interventions for patients with chronic illness, but implementation of such interventions into practice is challenging. Implementation strategies that potentially impact implementation outcomes and implementation success have been identified. Which strategies are actually used in the implementation of eHealth interventions for patients with chronic illness and which ones are the most effective is unclear. Objective: This systematic realist review aimed to summarize evidence from empirical studies regarding (1) which implementation strategies are used when implementing eHealth interventions for patients with chronic illnesses living at home, (2) implementation outcomes, and (3) the relationship between implementation strategies, implementation outcomes, and degree of implementation success. Methods: A systematic literature search was performed in the electronic databases MEDLINE, Embase, PsycINFO, Scopus, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Studies were included if they described implementation strategies used to support the integration of eHealth interventions into practice. Implementation strategies were categorized according to 9 categories defined by the Expert Recommendations for Implementing Change project: (1) engage consumers, (2) use evaluative and iterative strategies, (3) change infrastructure, (4) adapt and tailor to the context, (5) develop stakeholder interrelationships, (6) use financial strategies, (7) support clinicians, (8) provide interactive assistance, and (9) train and educate stakeholders. Implementation outcomes were extracted according to the implementation outcome framework by Proctor and colleagues: (1) acceptability, (2) adoption, (3) appropriateness, (4) cost, (5) feasibility, (6) fidelity, (7) penetration, and (8) sustainability. Implementation success was extracted according to the study authors? own evaluation of implementation success in relation to the used implementation strategies. Results: The implementation strategies management support and engagement, internal and external facilitation, training, and audit and feedback were directly related to implementation success in several studies. No clear relationship was found between the number of implementation strategies used and implementation success. Conclusions: This is the first review examining implementation strategies, implementation outcomes, and implementation success of studies reporting the implementation of eHealth programs for patients with chronic illnesses living at home. The review indicates that internal and external facilitation, audit and feedback, management support, and training of clinicians are of importance for eHealth implementation. The review also points to the lack of eHealth studies that report implementation strategies in a comprehensive way and highlights the need to design robust studies focusing on implementation strategies in the future. Trial Registration: PROSPERO CRD42018085539; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=85539 UR - https://www.jmir.org/2019/9/e14255 UR - http://dx.doi.org/10.2196/14255 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573934 ID - info:doi/10.2196/14255 ER - TY - JOUR AU - LaMonica, M. Haley AU - Davenport, A. Tracey AU - Braunstein, Katharine AU - Ottavio, Antonia AU - Piper, Sarah AU - Martin, Craig AU - Hickie, B. Ian AU - Cross, Shane PY - 2019/09/19 TI - Technology-Enabled Person-Centered Mental Health Services Reform: Strategy for Implementation Science JO - JMIR Ment Health SP - e14719 VL - 6 IS - 9 KW - implementation science KW - mental health KW - health care reform KW - technology KW - community-based participatory research N2 - Background: Health information technologies are being rapidly developed to improve the delivery of mental health care; however, a range of facilitators, barriers, and contextual conditions can impact the adoption and sustainment of these solutions. An implementation science protocol supports researchers to achieve primary effectiveness goals in relation to mental health services reform and aids in the optimization of implementation processes to promote quality health care, prolonging sustainability. Objective: The aim of this paper is to describe our implementation science protocol, which serves as a foundation by which to systematically guide the implementation of technology-enabled solutions in traditional face-to-face and Web-based mental health services, allowing for revisions over time on the basis of retrospective review and constructive feedback from the services in which the technology-enabled solutions are implemented. Methods: Our implementation science protocol comprises four phases. The primary objective of the scoping and feasibility phase (Phase 1) is to determine the alignment between the service partner and the quality improvement goals supported by the technology-enabled solution. This is followed by Phase 2, the local co-design and preimplementation phase, which aims to utilize co-design methodologies, including service pathway modelling, participatory design, and user (acceptance) testing, to determine how the solutions could be used to enhance the service. In Phase 3, implementation, the accepted solution is embedded in the mental health service to achieve better outcomes for consumers and their families as well as health professionals and service managers. Using iterative evaluative processes throughout Phase 3, the solution is continuously developed, designed, and refined during implementation to adapt to the changing needs of the stakeholders, including consumers with lived experience and their families as well as the service. Thus, the primary outcome of Phase 3 is the optimized technology-enabled solution that can be maintained in a service during the sustainment and scalability phase (Phase 4) for the purposes of mental health services reform. Results: Funding for the protocol was provided by the Australian Government Department of Health in June of 2017 for a period of 3 years. At the time of this publication, the protocol had been initiated in 11 services, serving three populations, all of which are currently operating in Phase 3. The first results are expected to be submitted for publication in 2020. Conclusions: With the aim of improving mental health service quality, our implementation science protocol aids in the identification of factors that predict the likelihood of implementation success, as well as the development of strategies to proactively mitigate potential barriers to achieve better implementation outcomes. Putting in place a theoretically sound implementation science protocol is essential to facilitate the uptake of novel technology-enabled solutions and evidence-based practices into routine clinical practice for the purposes of improved outcomes. UR - https://mental.jmir.org/2019/9/e14719 UR - http://dx.doi.org/10.2196/14719 UR - http://www.ncbi.nlm.nih.gov/pubmed/31538938 ID - info:doi/10.2196/14719 ER - TY - JOUR AU - Fontaine, Guillaume AU - Maheu-Cadotte, Marc-André AU - Lavallée, Andréane AU - Mailhot, Tanya AU - Rouleau, Genevičve AU - Bouix-Picasso, Julien AU - Bourbonnais, Anne PY - 2019/09/03 TI - Communicating Science in the Digital and Social Media Ecosystem: Scoping Review and Typology of Strategies Used by Health Scientists JO - JMIR Public Health Surveill SP - e14447 VL - 5 IS - 3 KW - health communication KW - public health KW - social media KW - internet KW - patient participation N2 - Background: The public?s understanding of science can be influential in a wide range of areas related to public health, including policy making and self-care. Through the digital and social media ecosystem, health scientists play a growing role in public science communication (SC). Objective: This review aimed to (1) synthesize the literature on SC initiated by health scientists targeting the public in the digital and social media ecosystem and (2) describe the SC strategies and communication channels used. Methods: This scoping review was based on the Joanna Briggs Institute Methodological Framework. A systematic search was performed in 6 databases (January 2000 to April 2018). Title and abstract screening, full-text review, data charting, and critical appraisal were performed independently by two review authors. Data regarding included studies and communication channels were synthesized descriptively. A typology of SC strategies was developed using a qualitative and inductive method of data synthesis. Results: Among 960 unique publications identified, 18 met inclusion criteria. A third of publications scored good quality (6/18, 33%), half scored moderate quality (9/18, 50%), and less than a fifth scored low quality (3/18, 16%). Overall, 75 SC strategies used by health scientists were identified. These were grouped into 9 types: content, credibility, engagement, intention, linguistics, planification, presentation, social exchange, and statistics. A total of 5 types of communication channels were identified: social networking platforms (eg, Twitter), content-sharing platforms (eg, YouTube), digital research communities (eg, ResearchGate), personal blogs and websites (eg, WordPress), and social news aggregation and discussion platforms (eg, Reddit). Conclusions: Evidence suggests that multiple types of SC strategies and communication channels are used by health scientists concurrently. Few empirical studies have been conducted on SC by health scientists in the digital and social media ecosystem. Future studies should examine the appropriateness and effectiveness of SC strategies for improving public health?related outcomes and identify the barriers, facilitators, and ethical considerations inherent to the involvement of health scientists in the digital and social media ecosystem. UR - http://publichealth.jmir.org/2019/3/e14447/ UR - http://dx.doi.org/10.2196/14447 UR - http://www.ncbi.nlm.nih.gov/pubmed/31482854 ID - info:doi/10.2196/14447 ER - TY - JOUR AU - Mechael, Patricia AU - Kaonga, Nina Nadi AU - Chandrasekharan, Subhashini AU - Prakash, Perumal Muthu AU - Peter, Joanne AU - Ganju, Aakash AU - Murthy, Nirmala PY - 2019/08/21 TI - The Elusive Path Toward Measuring Health Outcomes: Lessons Learned From a Pseudo-Randomized Controlled Trial of a Large-Scale Mobile Health Initiative JO - JMIR Mhealth Uhealth SP - e14668 VL - 7 IS - 8 KW - India KW - mHealth KW - maternal health KW - child health KW - research UR - http://mhealth.jmir.org/2019/8/e14668/ UR - http://dx.doi.org/10.2196/14668 UR - http://www.ncbi.nlm.nih.gov/pubmed/31436165 ID - info:doi/10.2196/14668 ER - TY - JOUR AU - Miranda, Alvet AU - Miah, Jahan Shah PY - 2019/08/21 TI - Design and Evaluation of a Contextual Model for Information Retrieval From Web-Scale Discovery Services to Improve Evidence-Based Practice by Health Care Practitioners: Mixed Methods Study JO - J Med Internet Res SP - e12621 VL - 21 IS - 8 KW - information retrieval KW - design science research KW - Web-scale discovery KW - evidence-based practice KW - libraries, digital KW - artefacts N2 - Background: Practicing evidence-based health care is challenging because of overwhelming results presented to practitioners by Google-like Web-scale discovery (WSD) services that index millions of resources while retrieving information based on relevancy algorithms with limited consideration for user information need. Objective: On the basis of the user-oriented theory of information need and following design science principles, this study aimed to develop and evaluate an innovative contextual model for information retrieval from WSD services to improve evidence-based practice (EBP) by health care practitioners. Methods: We identified problems from literature to support real-world requirements for this study. We used design science research methodology to guide artefact design. We iteratively improved prototype of the context model using artificial formative evaluation. We performed naturalistic summative evaluation using convergent interviewing of health care practitioners and content analysis from a confirmatory focus group consisting of health researchers to evaluate the model?s validity and utility. Results: The study iteratively designed and applied the context model to a WSD service to meet 5 identified requirements. All 5 health care practitioners interviewed found the artefact satisfied the 5 requirements to successfully evaluate the model as having validity and utility. Content analysis results from the confirmatory focus group mapped top 5 descriptors per requirement to support a true hypothesis that there is significant discussion among participants to justify concluding that the artefact had validity and utility. Conclusions: The context model for WSD satisfied all requirements and was evaluated successfully for information retrieval to improve EBP. Outcomes from this study justify further research into the model. UR - http://www.jmir.org/2019/8/e12621/ UR - http://dx.doi.org/10.2196/12621 UR - http://www.ncbi.nlm.nih.gov/pubmed/31436167 ID - info:doi/10.2196/12621 ER - TY - JOUR AU - Bachmann, F. Kaspar AU - Vetter, Christian AU - Wenzel, Lars AU - Konrad, Christoph AU - Vogt, P. Andreas PY - 2019/08/15 TI - Implementation and Evaluation of a Web-Based Distribution System For Anesthesia Department Guidelines and Standard Operating Procedures: Qualitative Study and Content Analysis JO - J Med Internet Res SP - e14482 VL - 21 IS - 8 KW - standards KW - computer communication networks KW - anesthesiology KW - decision making, computer-assisted N2 - Background: Digitization is spreading exponentially in medical care, with improved availability of electronic devices. Guidelines and standard operating procedures (SOPs) form an important part of daily clinical routine, and adherence is associated with improved outcomes. Objective: This study aimed to evaluate a digital solution for the maintenance and distribution of SOPs and guidelines in 2 different anesthesiology departments in Switzerland. Methods: A content management system (CMS), WordPress, was set up in 2 tertiary-level hospitals within 1 year: the Department of Anesthesiology and Pain Medicine at the Kantonsspital Lucerne in Lucerne, Switzerland, as an open-access system, followed by a similar system for internal usage in the Department of Anaesthesiology and Pain Medicine of the Inselspital, Bern University Hospital, in Bern, Switzerland. We analyzed the requirements and implementation processes needed to successfully set up these systems, and we evaluated the systems? impact by analyzing content and usage. Results: The systems? generated exportable metadata, such as traffic and content. Analysis of the exported metadata showed that the Lucerne website had 269 pages managed by 44 users, with 88,124 visits per month (worldwide access possible), and the Bern website had 341 pages managed by 35 users, with 1765 visits per month (access only possible from within the institution). Creation of an open-access system resulted in third-party interest in the published guidelines and SOPs. The implementation process can be performed over the course of 1 year and setup and maintenance costs are low. Conclusions: A CMS, such as WordPress, is a suitable solution for distributing and managing guidelines and SOPs. Content is easily accessible and is accessed frequently. Metadata from the system allow live monitoring of usage and suggest that the system be accepted and appreciated by the users. In the future, Web-based solutions could be an important tool to handle guidelines and SOPs, but further studies are needed to assess the effect of these systems. UR - https://www.jmir.org/2019/8/e14482/ UR - http://dx.doi.org/10.2196/14482 UR - http://www.ncbi.nlm.nih.gov/pubmed/31418427 ID - info:doi/10.2196/14482 ER - TY - JOUR AU - IJzerman, H. Renée V. AU - van der Vaart, Rosalie AU - Evers, M. Andrea W. PY - 2019/08/09 TI - Internet-Based Cognitive Behavioral Therapy Among Psychologists in a Medical Setting: A Survey on Implementation JO - J Med Internet Res SP - e13432 VL - 21 IS - 8 KW - eHealth KW - chronic care KW - self-management KW - implementation KW - psychologists KW - UTAUT N2 - Background: Internet-based cognitive behavioral therapy (iCBT) is an effective treatment for patients with a chronic somatic illness to improve self-management skills and to learn to adjust to their chronic disease and its impact on daily life. However, the implementation of iCBT in clinical practice is challenging. Objective: This study aimed to examine the current degree of implementation of iCBT among psychologists in a medical setting and discover determinants influencing the implementation of iCBT among nonusers. Methods: A Web-based survey, based on the Unified Theory of Acceptance and Use of Technology (UTAUT), was distributed among psychologists in a medical setting. The survey included questions regarding the current use of iCBT, intention to use iCBT in the future, and operationalized concepts of the UTAUT constructs, that is, performance expectancy (PE), effort expectancy (EE), social influence (SI), and facilitating conditions (FC). Results: In total, 107 (24.8%) psychologists completed the survey. Of them, 16.8% have access to iCBT, 15.9% currently use iCBT, and 21.5% are expected to use iCBT within the next year. The constructs PE, EE, and SI together significantly influenced behavioral intention (BI; mean 3.9 [SD=0.8]) among nonusers (R2=0.490; F4.85=20.405; P<.001). Conclusions: In spite of an average to high BI, the current implementation of iCBT is rather low among psychologists in a medical setting. Further research should focus on reducing the gap between intention to use and actual use by focusing on influencing the predictive UTAUT constructs. UR - https://www.jmir.org/2019/8/e13432/ UR - http://dx.doi.org/10.2196/13432 UR - http://www.ncbi.nlm.nih.gov/pubmed/31400101 ID - info:doi/10.2196/13432 ER - TY - JOUR AU - Shaw, James AU - Rudzicz, Frank AU - Jamieson, Trevor AU - Goldfarb, Avi PY - 2019/07/10 TI - Artificial Intelligence and the Implementation Challenge JO - J Med Internet Res SP - e13659 VL - 21 IS - 7 KW - artificial intelligence KW - machine learning KW - implementation science KW - ethics N2 - Background: Applications of artificial intelligence (AI) in health care have garnered much attention in recent years, but the implementation issues posed by AI have not been substantially addressed. Objective: In this paper, we have focused on machine learning (ML) as a form of AI and have provided a framework for thinking about use cases of ML in health care. We have structured our discussion of challenges in the implementation of ML in comparison with other technologies using the framework of Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies (NASSS). Methods: After providing an overview of AI technology, we describe use cases of ML as falling into the categories of decision support and automation. We suggest these use cases apply to clinical, operational, and epidemiological tasks and that the primary function of ML in health care in the near term will be decision support. We then outline unique implementation issues posed by ML initiatives in the categories addressed by the NASSS framework, specifically including meaningful decision support, explainability, privacy, consent, algorithmic bias, security, scalability, the role of corporations, and the changing nature of health care work. Results: Ultimately, we suggest that the future of ML in health care remains positive but uncertain, as support from patients, the public, and a wide range of health care stakeholders is necessary to enable its meaningful implementation. Conclusions: If the implementation science community is to facilitate the adoption of ML in ways that stand to generate widespread benefits, the issues raised in this paper will require substantial attention in the coming years. UR - https://www.jmir.org/2019/7/e13659/ UR - http://dx.doi.org/10.2196/13659 UR - http://www.ncbi.nlm.nih.gov/pubmed/31293245 ID - info:doi/10.2196/13659 ER - TY - JOUR AU - Neil-Sztramko, E. Sarah AU - Smith-Turchyn, Jenna AU - Richardson, Julie AU - Dobbins, Maureen PY - 2019/06/20 TI - A Mobility-Focused Knowledge Translation Randomized Controlled Trial to Improve Physical Activity: Process Evaluation of the Move4Age Study JO - J Med Internet Res SP - e13965 VL - 21 IS - 6 KW - process evaluation KW - physical activity KW - health information KW - mobility KW - older adults KW - knowledge translation N2 - Background: Maintaining physical activity and physical function is important for healthy aging. We recently completed a randomized controlled trial of a targeted knowledge translation (KT) intervention delivered through the McMaster Optimal Aging Portal with the goal to increase physical activity and physical mobility in middle-aged and older adults, with results reported elsewhere. Objective: The purpose of this process evaluation study is to explore which KT strategies were used by both intervention and control group participants, as well as the intervention groups? engagement, satisfaction, and perceived usefulness of the targeted KT intervention. Methods: Data on engagement with the intervention materials were gathered quantitatively through Google Analytics and Hootsuite throughout the intervention. Qualitative data were collected through a combination of open-ended surveys and qualitative interviews with a subset of participants at the end of the study to further understand engagement, satisfaction, and usefulness of the KT strategies. Results: Throughout the intervention period, engagement with content delivered through weekly emails was highest, and participants rated email content most favorably in both surveys and interviews. Participants were generally satisfied with the intervention, noting the ease of participating and the distillation of information in an easy-to-access format being beneficial features. Participants who did not find the intervention useful were those with already high levels of baseline physical activity or physical function and those who were looking for more specific or individualized content. Conclusions: This process evaluation provides insight into our randomized controlled trial findings and provides information that can be used to improve future online KT interventions. Trial Registration: ClinicalTrials.gov NCT02947230; https://clinicaltrials.gov/ct2/show/nct02947230 (Archived by WebCite at http://www.webcitation.org/78t4tR8tM) UR - http://www.jmir.org/2019/6/e13965/ UR - http://dx.doi.org/10.2196/13965 UR - http://www.ncbi.nlm.nih.gov/pubmed/31223121 ID - info:doi/10.2196/13965 ER - TY - JOUR AU - Quanbeck, Andrew PY - 2019/06/07 TI - Using Stakeholder Values to Promote Implementation of an Evidence-Based Mobile Health Intervention for Addiction Treatment in Primary Care Settings JO - JMIR Mhealth Uhealth SP - e13301 VL - 7 IS - 6 KW - implementation models KW - implementation strategies KW - mHealth KW - behavioral economics KW - game theory KW - decision-framing KW - primary care KW - stakeholder engagement N2 - Background: Most evidence-based practices (EBPs) do not find their way into clinical use, including evidence-based mobile health (mHealth) technologies. The literature offers implementers little practical guidance for successfully integrating mHealth into health care systems. Objective: The goal of this research was to describe a novel decision-framing model that gives implementers a method of eliciting the considerations of different stakeholder groups when they decide whether to implement an EBP. Methods: The decision-framing model can be generally applied to EBPs, but was applied in this case to an mHealth system (Seva) for patients with addiction. The model builds from key insights in behavioral economics and game theory. The model systematically identifies, using an inductive process, the perceived gains and losses of different stakeholder groups when they consider adopting a new intervention. The model was constructed retrospectively in a parent implementation research trial that introduced Seva to 268 patients in 3 US primary care clinics. Individual and group interviews were conducted to elicit stakeholder considerations from 6 clinic managers, 17 clinicians, and 6 patients who were involved in implementing Seva. Considerations were used to construct decision frames that trade off the perceived value of adopting Seva versus maintaining the status quo from each stakeholder group?s perspective. The face validity of the decision-framing model was assessed by soliciting feedback from the stakeholders whose input was used to build it. Results: Primary considerations related to implementing Seva were identified for each stakeholder group. Clinic managers perceived the greatest potential gain to be better care for patients and the greatest potential loss to be cost (ie, staff time, sustainability, and opportunity cost to implement Seva). All clinical staff considered time their foremost consideration?primarily in negative terms (eg, cognitive burden associated with learning a new system) but potentially in positive terms (eg, if Seva could automate functions done manually). Patients considered safety (anonymity, privacy, and coming from a trusted source) to be paramount. Though payers were not interviewed directly, clinic managers judged cost to be most important to payers?whether Seva could reduce total care costs or had reimbursement mechanisms available. This model will be tested prospectively in a forthcoming mHealth implementation trial for its ability to predict mHealth adoption. Overall, the results suggest that implementers proactively address the cost and burden of implementation and seek to promote long-term sustainability. Conclusions: This paper presents a model implementers may use to elicit stakeholders? considerations when deciding to adopt a new technology, considerations that may then be used to adapt the intervention and tailor implementation, potentially increasing the likelihood of implementation success. Trial Registration: ClinicalTrials.gov NCT01963234; https://clinicaltrials.gov/ct2/show/NCT01963234 (Archived by WebCite at http://www.webcitation.org/78qXQJvVI) UR - http://mhealth.jmir.org/2019/6/e13301/ UR - http://dx.doi.org/10.2196/13301 UR - http://www.ncbi.nlm.nih.gov/pubmed/31237841 ID - info:doi/10.2196/13301 ER - TY - JOUR AU - Gulliver, Amelia AU - Banfield, Michelle AU - Morse, R. Alyssa AU - Reynolds, Julia AU - Miller, Sarah AU - Galati, Connie PY - 2019/06/04 TI - A Peer-Led Electronic Mental Health Recovery App in a Community-Based Public Mental Health Service: Pilot Trial JO - JMIR Form Res SP - e12550 VL - 3 IS - 2 KW - peer work KW - computers, handheld KW - pilot study KW - mental health recovery KW - mental health services, community KW - mental disorders N2 - Background: There is an increasing need for peer workers (people with lived experience of mental health problems who support others) to work alongside consumers to improve recovery and outcomes. In addition, new forms of technology (tablet or mobile apps) can deliver services in an engaging and innovative way. However, there is a need to evaluate interventions in real-world settings. Objective: This exploratory proof-of-concept study aimed to determine if a peer worker?led electronic mental health (e-mental health) recovery program is a feasible, acceptable, and effective adjunct to usual care for people with moderate-to-severe mental illness. Methods: Overall, 6 consumers and 5 health service staff participated in the evaluation of a peer-led recovery app delivered at a community-based public mental health service. The peer worker and other health professional staff invited attendees at the drop-in medication clinics to participate in the trial during June to August 2017. Following the intervention period, participants were also invited by the peer worker to complete the evaluation in a separate room with the researcher. Consumers were explicitly informed that participation in the research evaluation was entirely voluntary. Consumer evaluation measures at postintervention included recovery and views on the acceptability of the program and its delivery. Interviews with staff focused on the acceptability and feasibility of the app itself and integrating a peer worker into the health care service. Results: Consumer recruitment in the research component of the study (n=6) fell substantially short of the target number of participants (n=30). However, from those who participated, both staff and consumers were highly satisfied with the peer worker and somewhat satisfied with the app. Health care staff overall believed that the addition of the peer worker was highly beneficial to both the consumers and staff. Conclusions: The preliminary findings from this proof-of-concept pilot study suggest that a peer-led program may be a feasible and acceptable method of working on recovery in this population. However, the e-mental health program did not appear feasible in this setting. In addition, recruitment was challenging in this particular group, and it is important to note that these study findings may not be generalizable. Despite this, ensuring familiarity of technology in the target population before implementing e-mental health interventions is likely to be of benefit. UR - http://formative.jmir.org/2019/2/e12550/ UR - http://dx.doi.org/10.2196/12550 UR - http://www.ncbi.nlm.nih.gov/pubmed/31165708 ID - info:doi/10.2196/12550 ER - TY - JOUR AU - Sanders, Ilea AU - Short, E. Camille AU - Bogomolova, Svetlana AU - Stanford, Tyman AU - Plotnikoff, Ronald AU - Vandelanotte, Corneel AU - Olds, Tim AU - Edney, Sarah AU - Ryan, Jillian AU - Curtis, G. Rachel AU - Maher, Carol PY - 2019/06/03 TI - Characteristics of Adopters of an Online Social Networking Physical Activity Mobile Phone App: Cluster Analysis JO - JMIR Mhealth Uhealth SP - e12484 VL - 7 IS - 6 KW - k-medoid cluster analysis KW - social marketing KW - mobile phone app KW - physical activity KW - online social networking N2 - Background: To date, many online health behavior programs developed by researchers have not been translated at scale. To inform translational efforts, health researchers must work with marketing experts to design cost-effective marketing campaigns. It is important to understand the characteristics of end users of a given health promotion program and identify key market segments. Objective: This study aimed to describe the characteristics of the adopters of Active Team, a gamified online social networking physical activity app, and identify potential market segments to inform future research translation efforts. Methods: Participants (N=545) were Australian adults aged 18 to 65 years who responded to general advertisements to join a randomized controlled trial (RCT) evaluating the Active Team app. At baseline they provided demographic (age, sex, education, marital status, body mass index, location of residence, and country of birth), behavioral (sleep, assessed by the Pittsburgh Quality Sleep Index) and physical activity (assessed by the Active Australia Survey), psychographic information (health and well-being, assessed by the PERMA [Positive Emotion, Engagement, Relationships, Meaning, Achievement] Profile; depression, anxiety and stress, assessed by the Depression, Anxiety, and Stress Scale [DASS-21]; and quality of life, assessed by the 12-Item Short Form Health Survey [SF-12]). Descriptive analyses and a k-medoids cluster analysis were performed using the software R 3.3.0 (The R Foundation) to identify key characteristics of the sample. Results: Cluster analyses revealed four clusters: (1) younger inactive women with poor well-being (218/545), characterized by a higher score on the DASS-21, low mental component summary score on the SF-12, and relatively young age; (2) older, active women (153/545), characterized by a lower score on DASS-21, a higher overall score on the SF-12, and relatively older age; (3) young, active but stressed men (58/545) with a higher score on DASS-21 and higher activity levels; and (4) older, low active and obese men (30/545), characterized by a high body mass index and lower activity levels. Conclusions: Understanding the characteristics of population segments attracted to a health promotion program will guide the development of cost-effective research translation campaigns. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12617000113358; https://www.anzctr.org .au/Trial/Registration/TrialReview.aspx?id=371463 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-017-4882-7 UR - https://mhealth.jmir.org/2019/6/e12484/ UR - http://dx.doi.org/10.2196/12484 UR - http://www.ncbi.nlm.nih.gov/pubmed/31162130 ID - info:doi/10.2196/12484 ER - TY - JOUR AU - Feng, Xiaoyue AU - Zhang, Hao AU - Ren, Yijie AU - Shang, Penghui AU - Zhu, Yi AU - Liang, Yanchun AU - Guan, Renchu AU - Xu, Dong PY - 2019/05/24 TI - The Deep Learning?Based Recommender System ?Pubmender? for Choosing a Biomedical Publication Venue: Development and Validation Study JO - J Med Internet Res SP - e12957 VL - 21 IS - 5 KW - recommender system KW - deep learning KW - convolutional neural network KW - biomedical literature KW - PubMed N2 - Background: It is of great importance for researchers to publish research results in high-quality journals. However, it is often challenging to choose the most suitable publication venue, given the exponential growth of journals and conferences. Although recommender systems have achieved success in promoting movies, music, and products, very few studies have explored recommendation of publication venues, especially for biomedical research. No recommender system exists that can specifically recommend journals in PubMed, the largest collection of biomedical literature. Objective: We aimed to propose a publication recommender system, named Pubmender, to suggest suitable PubMed journals based on a paper?s abstract. Methods: In Pubmender, pretrained word2vec was first used to construct the start-up feature space. Subsequently, a deep convolutional neural network was constructed to achieve a high-level representation of abstracts, and a fully connected softmax model was adopted to recommend the best journals. Results: We collected 880,165 papers from 1130 journals in PubMed Central and extracted abstracts from these papers as an empirical dataset. We compared different recommendation models such as Cavnar-Trenkle on the Microsoft Academic Search (MAS) engine, a collaborative filtering?based recommender system for the digital library of the Association for Computing Machinery (ACM) and CiteSeer. We found the accuracy of our system for the top 10 recommendations to be 87.0%, 22.9%, and 196.0% higher than that of MAS, ACM, and CiteSeer, respectively. In addition, we compared our system with Journal Finder and Journal Suggester, which are tools of Elsevier and Springer, respectively, that help authors find suitable journals in their series. The results revealed that the accuracy of our system was 329% higher than that of Journal Finder and 406% higher than that of Journal Suggester for the top 10 recommendations. Our web service is freely available at https://www.keaml.cn:8081/. Conclusions: Our deep learning?based recommender system can suggest an appropriate journal list to help biomedical scientists and clinicians choose suitable venues for their papers. UR - http://www.jmir.org/2019/5/e12957/ UR - http://dx.doi.org/10.2196/12957 UR - http://www.ncbi.nlm.nih.gov/pubmed/31127715 ID - info:doi/10.2196/12957 ER - TY - JOUR AU - Kang-Yi, D. Christina PY - 2019/05/24 TI - Optimizing the Impact of Public-Academic Partnerships in Fostering Policymakers? Use of Research Evidence: Proposal to Test a Conceptual Framework JO - JMIR Res Protoc SP - e14382 VL - 8 IS - 5 KW - public-academic partnership KW - use of research evidence KW - youth KW - mental health KW - well-being N2 - Background: Previous research has reported that public-academic partnerships (PAPs) can effectively promote PAP leaders? use of research evidence in improving youth outcomes. However, the existing literature has not yet clarified whether and how PAP leaders? use of research evidence evolves along the PAP life cycle and whether PAP partners? concordant perceptions of usefulness of their PAP has an impact on PAP leaders? use of research evidence. Developing a conceptual framework that recognizes the PAP life cycle and empirically identifying contexts and mechanisms of PAPs that promote PAP leaders? use of research evidence from the PAP life cycle perspective are imperative to guide researchers and policymakers to successfully lead PAPs and foster policymakers? use of research evidence for improving youth outcomes. Objective: Utilizing an integrated framework of organizational life cycle perspective, a social partnership perspective, and a realist evaluation, this study examines the extent to which PAP development and PAP leaders? use of research evidence can be characterized into life cycle stages and identifies PAP contexts and mechanisms that explain the progress of PAPs and PAP leaders? use of research evidence through life cycle stages. Methods: Recruiting PAPs across the United States that aim to improve mental health and promote well-being of youth aged 12-25 years, the study conducts a document analysis and an online survey of PAPs to inform policymakers and academic researchers on the contexts and mechanisms to increase PAP sustainability and promote policymakers? use of research evidence in improving youth outcomes. Results: Fifty-three PAPs that meet the recruitment criteria have been identified, and document review of PAPs and participant recruitment for the online survey of PAP experience have been conducted. Conclusions: This paper will help policymakers and researchers gain a deeper knowledge of the contexts and mechanisms for each PAP life cycle stage in order to optimize PAP leaders? use of research evidence in achieving positive youth outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/14382 UR - http://www.researchprotocols.org/2019/5/e14382/ UR - http://dx.doi.org/10.2196/14382 UR - http://www.ncbi.nlm.nih.gov/pubmed/31127725 ID - info:doi/10.2196/14382 ER - TY - JOUR AU - Opoku, Daniel AU - Busse, Reinhard AU - Quentin, Wilm PY - 2019/05/03 TI - Achieving Sustainability and Scale-Up of Mobile Health Noncommunicable Disease Interventions in Sub-Saharan Africa: Views of Policy Makers in Ghana JO - JMIR Mhealth Uhealth SP - e11497 VL - 7 IS - 5 KW - implementation science KW - mHealth KW - eHealth KW - noncommunicable diseases KW - disease management KW - sub-Saharan Africa KW - qualitative research KW - health policy N2 - Background: A growing body of evidence shows that mobile health (mHealth) interventions may improve treatment and care for the rapidly rising number of patients with noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA). A recent realist review developed a framework highlighting the influence of context factors, including predisposing characteristics, needs, and enabling resources (PNE), for the long-term success of mHealth interventions. The views of policy makers will ultimately determine implementation and scale-up of mHealth interventions in SSA. However, their views about necessary conditions for sustainability and scale-up remain unexplored. Objective: This study aimed to understand the views of policy makers in Ghana with regard to the most important factors for successful implementation, sustainability, and scale-up of mHealth NCD interventions. Methods: Members of the technical working group responsible for Ghana?s national NCD policy were interviewed about their knowledge of and attitude toward mHealth and about the most important factors contributing to long-term intervention success. Using qualitative methods and applying a qualitative content analysis approach, answers were categorized according to the PNE framework. Results: A total of 19 policy makers were contacted and 13 were interviewed. Interviewees had long-standing work experience of an average of 26 years and were actively involved in health policy making in Ghana. They were well-informed about the potential of mHealth, and they strongly supported mHealth expansion in the country. Guided by the PNE framework?s categories, the policy makers ascertained which critical factors would support the successful implementation of mHealth interventions in Ghana. The policy makers mentioned many factors described in the literature as important for mHealth implementation, sustainability, and scale-up, but they focused more on enabling resources than on predisposing characteristics and need. Furthermore, they mentioned several factors that have been rather unexplored in the literature. Conclusions: The study shows that the PNE framework is useful to guide policy makers toward a more systematic assessment of context factors that support intervention implementation, sustainability, and scale-up. Furthermore, the framework was refined by adding additional factors. Policy makers may benefit from using the PNE framework at the various stages of mHealth implementation. Researchers may (and should) use the framework when investigating reasons for success (or failure) of interventions. UR - https://mhealth.jmir.org/2019/5/e11497/ UR - http://dx.doi.org/10.2196/11497 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066706 ID - info:doi/10.2196/11497 ER - TY - JOUR AU - Huenefeld, Daisy AU - Rodde, Sibyll AU - Bureick, Gertrud AU - Elkeles, Barbara AU - Hasebrook, Joachim PY - 2019/05/03 TI - Improving Treatment of Elderly Patients by Interprofessional Education in a Quality Network of Geriatric Medicine: Protocol for Evaluating an Educational Initiative JO - JMIR Res Protoc SP - e11067 VL - 8 IS - 5 KW - geriatrics KW - education, medical, continuing KW - education, nursing, continuing KW - staff development KW - clinical competence KW - interdisciplinary placement N2 - Background: All statistics on the development of demand for care for multimorbid elderly patients highlight the acute pressure to act to adequately respond to the expected increase in geriatric patient population in the next 15 years. Against this background, great importance must be attached to the improvement of cross-occupational group and cross-sector treatment of these patients. In addition, many professionals in the health care sector often have little knowledge about the special treatment and care needs of the elderly. Objective: The Quality Network of Geriatric Medicine in north-west Germany is the body responsible for the project; with its member organizations, it provides care for over 400,000 inpatients and is thus one of the largest associations for geriatrics in Germany. The Quality Network conducts binding evaluated qualification measures for staff involved in the treatment and care of multimorbid elderly patients. The training offers are especially intended for staff who have not yet been trained in working with elderly patients. This approach is intended to improve the expertise of various occupational groups on different hierarchy levels, to include patients and their family members in the evaluation process, and to initiate changes within the organizations. Methods: Various instruments are used in the evaluation of qualification measures: besides written surveys and questionnaires, structured work groups (consensus groups) and interviews are conducted. The evaluation starts before the qualification measures to determine the starting point and then continues during the measure and after its completion. This allows major findings to be integrated directly into the ongoing qualification program. At least 100 trainings on geriatric topics, 80 consensus groups, and 120 patients (and family members) are going to be included in the study. Results: The evaluation of the educational initiative is funded by the State of Northrhine-Westfalia (Germany; LZG TG 71 001 / 2015 and LZG TG 71 002 / 2015). The results of the study will be published after review and approval by the state authorities ? presumably by the end of 2019. The before and after comparison of the treatment-related outcomes at the beginning and near the completion of the educational initiative gives insights into how transfer-oriented education can improve the treatment of elderly patients across sector lines for inpatients as well as outpatients. The evaluation of the implementation of educational content in day-to-day work and occupational groups is to facilitate recommendations about economically sensible use of educational resources and about further adjustments to the training content. Conclusions: The evaluation develops the foundation for targeted and needs-oriented qualification measures as well as transfer in cross-sector, multiprofessional networks. Instruments and results will be published and provided to other health care networks and institutions. The Quality Network will implement the results of the evaluation process in its member institutions. International Registered Report Identifier (IRRID): DERR1-10.2196/11067 UR - http://www.researchprotocols.org/2019/5/e11067/ UR - http://dx.doi.org/10.2196/11067 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066716 ID - info:doi/10.2196/11067 ER - TY - JOUR AU - Michalak, E. Erin AU - Morton, Emma AU - Barnes, J. Steven AU - Hole, Rachelle AU - AU - Murray, Greg PY - 2019/04/15 TI - Supporting Self-Management in Bipolar Disorder: Mixed-Methods Knowledge Translation Study JO - JMIR Ment Health SP - e13493 VL - 6 IS - 4 KW - bipolar disorder KW - eHealth KW - self-management KW - knowledge translation KW - community-based participatory research KW - mHealth N2 - Background: Self-management is increasingly recognized as an important method through which individuals with bipolar disorder (BD) may cope with symptoms and improve quality of life. Digital health technologies have strong potential as a method to support the application of evidence-informed self-management strategies in BD. Little is known, however, about how to most effectively maximize user engagement with digital platforms. Objective: The aims of this study were (1) to create an innovative Web-based Bipolar Wellness Centre, (2) to conduct a mixed-methods (ie, quantitative and qualitative) evaluation to assess the impact of different sorts of engagement (ie, knowledge translation [KT]), and (3) to support engagement with the self-management information in the Bipolar Wellness Centre. Methods: The project was implemented in 2 phases. In phase 1, community-based participatory research and user-centered design methods were used to develop a website (Bipolar Wellness Centre) housing evidence-informed tools and strategies for self-management of BD. In phase 2, a mixed-methods evaluation was conducted to explore the potential impact of 4 KT strategies (Web-based webinars, Web-based videos, Web-based one-to-one Living Library peer support, and in-person workshops). Quantitative assessments occurred at 2 time points?preintervention and 3 weeks postintervention. Purposive sampling was used to recruit a subsample of participants for the qualitative interviews, ensuring each KT modality was represented, and interviews occurred approximately 3 weeks postintervention. Results: A total of 94 participants were included in the quantitative analysis. Responses to evaluative questions about engagement were broadly positive. When averaged across the 4 KT strategies, significant improvements were observed on the Bipolar Recovery Questionnaire (F1,77=5.887; P=.02) and Quality of Life in Bipolar Disorder (F1,77=8.212; P=.005). Nonsignificant improvements in positive affect and negative affect were also observed. The sole difference that emerged between KT strategies related to the Chronic Disease Self-Efficacy measure, which decreased after participation in the webinar and video arms but increased after the Living Library and workshop arms. A subsample of 43 participants was included in the qualitative analyses, with the majority of participants describing positive experiences with the 4 KT strategies; peer contact was emphasized as a benefit across all strategies. Infrequent negative experiences were reported in relation to the webinar and video strategies, and included technical difficulties, the academic tone of webinars, and feeling unable to relate to the actor in the videos. Conclusions: This study adds incremental evidence to a growing literature that suggests digital health technologies can provide effective support for self-management for people with BD. The finding that KT strategies could differentially impact chronic disease self-efficacy (hypothesized as being a product of differences in degree of peer contact) warrants further exploration. Implications of the findings for the development of evidence-informed apps for BD are discussed in this paper. UR - http://mental.jmir.org/2019/4/e13493/ UR - http://dx.doi.org/10.2196/13493 UR - http://www.ncbi.nlm.nih.gov/pubmed/30985287 ID - info:doi/10.2196/13493 ER - TY - JOUR AU - Giuliani, Elana Meredith AU - Liu, Geoffrey AU - Xu, Wei AU - Dirlea, Mihaela AU - Selby, Peter AU - Papadakos, Janet AU - Abdelmutti, Nazek AU - Yang, Dongyang AU - Eng, Lawson AU - Goldstein, Paul David AU - Jones, Michelle Jennifer PY - 2019/04/09 TI - Implementation of a Novel Electronic Patient-Directed Smoking Cessation Platform for Cancer Patients: Interrupted Time Series Analysis JO - J Med Internet Res SP - e11735 VL - 21 IS - 4 KW - neoplasms KW - smoking cessation KW - implementation science KW - quality improvement N2 - Background: Continued smoking in cancer patients undergoing treatment results in significantly higher rates of treatment toxicities and persistent effects, increased risk of recurrence and second malignancy, and increased all-cause mortality. Despite this, routine tobacco use screening and the provision of smoking cessation treatment has yet to be implemented widely in the cancer setting. Objective: The objective of this study was to implement and evaluate the adoption and impact of an innovative Smoking Cessation e-referral System (CEASE) to promote referrals to smoking cessation programs in cancer patients. Methods: A patient-directed electronic smoking cessation platform (CEASE) was developed to promote smoking screening and referral and implemented at 1 of Canada?s largest cancer centers. The implementation and evaluation were guided by the Ottawa Model of Research Use. An interrupted time series design was used to examine the impact of CEASE on screening rates, referrals offered, and referrals accepted compared with a previous paper-based screening program. A subsample of smokers or recent quitters was also assessed and compared pre- and postimplementation to examine the effect of CEASE on subsequent contact with smoking cessation programs and quit attempts. Results: A total of 17,842 new patients attended clinics over the 20-month study period. The CEASE platform was successfully implemented across all disease sites. Screening rates increased from 44.28% (2366/5343) using the paper-based approach to 65.72% (3538/5383) using CEASE (P<.01), and referrals offered to smokers who indicated interest in quitting increased from 18.6% (58/311) to 98.8% (421/426; P<.01). Accepted referrals decreased from 41% (24/58) to 20.4% (86/421), though the overall proportion of referrals generated from total current/recent tobacco users willing to quit increased from 5.8% (24/414) to 20.2% (86/426) due to the increase in referrals offered. At 1-month postscreening, there was no significant difference in the proportion that was currently using tobacco and had not changed use in the past 4 weeks (pre: 28.9% [24/83] and post: 28.8% [83/288]). However, contact with the referral program increased from 0% to 78% in the postCEASE cohort (P<.001). Conclusions: CEASE is an innovative tool to improve smoking screening and can be implemented in both a time- and cost-effective manner which promotes sustainability. CEASE was successfully implemented across all clinics and resulted in improvements in overall screening and referral rates and engagement with referral services. UR - https://www.jmir.org/2019/4/e11735/ UR - http://dx.doi.org/10.2196/11735 UR - http://www.ncbi.nlm.nih.gov/pubmed/30964445 ID - info:doi/10.2196/11735 ER - TY - JOUR AU - Lord, E. Sarah AU - Seavey, M. Katherine AU - Oren, D. Sonia AU - Budney, J. Alan AU - Marsch, A. Lisa PY - 2019/04/05 TI - Digital Presence of a Research Center as a Research Dissemination Platform: Reach and Resources JO - JMIR Ment Health SP - e11686 VL - 6 IS - 4 KW - telemedicine KW - internet KW - social media KW - behavioral sciences KW - implementation science KW - information dissemination N2 - Background: Web-based platforms can be powerful tools for research dissemination. By leveraging the advantages of mass media and interpersonal channels of communication, Web-based dissemination platforms may improve awareness about, and subsequent adoption of, evidence-based practices (EBPs). Digital dissemination strategies can augment traditional dissemination models, improving stakeholder access to digestible and actionable information and promoting translation of EBPs. Objective: This study aimed to describe the reach and content of the Web presence of a National Institute on Drug Abuse Center of Excellence and how it is used to disseminate research related to digital behavioral health approaches. Methods: The Center for Technology and Behavioral Health (CTBH) has a website and regularly updated Facebook and Twitter accounts. The website features include summaries of digital behavioral health approaches and related empirical literature, a blog feed focused on the state of the science and technology concerning digital health care approaches, and a newsletter about Center activities. We extracted website usage metrics from Google Analytics and follower counts from social media accounts for the period from March 1, 2013, to July 17, 2018. Results: Since the implementation of analytic tracking, 70,331 users have initiated 96,995 sessions on the CTBH website. The website includes summaries of 86 digital therapeutic programs, encompassing 447 empirical articles. There are 1160 posts in the CTBH blog feed, including 180 summaries of scholarly articles. The Twitter and Facebook accounts have 577 and 1500 followers, respectively. The newsletter has reached a growing subscriber network and has a high open rate relative to industry standards. Conclusions: The CTBH Web presence serves as a model for how to leverage accessible and easily updatable digital platforms as research dissemination channels. Digital dissemination tools can augment traditional dissemination strategies to promote awareness about evidence-based digital therapeutic approaches for behavioral health and health care more broadly. UR - https://mental.jmir.org/2019/4/e11686/ UR - http://dx.doi.org/10.2196/11686 UR - http://www.ncbi.nlm.nih.gov/pubmed/30950800 ID - info:doi/10.2196/11686 ER - TY - JOUR AU - Powell, Lauren AU - Parker, Jack AU - Harpin, Val AU - Mawson, Susan PY - 2019/04/03 TI - Guideline Development for Technological Interventions for Children and Young People to Self-Manage Attention Deficit Hyperactivity Disorder: Realist Evaluation JO - J Med Internet Res SP - e12831 VL - 21 IS - 4 KW - attention deficit disorder with hyperactivity KW - technology N2 - Background: Attention deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. ADHD can affect the individual, the individual?s family, and the community. ADHD is managed using pharmacological and nonpharmacological treatments, which principally involves others helping children and young people (CAYP) manage their ADHD rather than learning self-management strategies themselves. Over recent years, technological developments have meant that technology has been harnessed to create interventions to facilitate the self-management of ADHD in CAYP. Despite a clear potential to improve the effectiveness and personalization of interventions, there are currently no guidelines based on existing evidence or theories to underpin the development of technologies that aim to help CAYP self-manage their ADHD. Objective: The aim of this study was to create evidence-based guidelines with key stakeholders who will provide recommendations for the future development of technological interventions, which aim to specifically facilitate the self-management of ADHD. Methods: A realist evaluation (RE) approach was adopted over 5 phases. Phase 1 involved identifying propositions (or hypotheses) outlining what could work for such an intervention. Phase 2 involved the identification of existing middle-range theories of behavior change to underpin the propositions. Phase 3 involved the identification and development of context mechanism outcome configurations (CMOCs), which essentially state which elements of the intervention could be affected by which contexts and what the outcome of these could be. Phase 4 involved the validation and refinement of the propositions from phase 1 via interviews with key stakeholders (CAYP with ADHD, their parents and specialist clinicians). Phase 5 involved using information gathered during phases 1 to 4 to develop the guidelines. Results: A total of 6 specialist clinicians, 8 parents, and 7 CAYP were recruited to this study. Overall, 7 key themes were identified: (1) positive rewarding feedback, (2) downloadable gaming resources, (3) personalizable and adaptable components, (4) psychoeducation component, (5) integration of self-management strategies, (6) goal setting, and (7) context (environmental and personal). The identified mechanisms interacted with the variable contexts in which a complex technological intervention of this nature could be delivered. Conclusions: Complex intervention development for complex populations such as CAYP with ADHD should adopt methods such as RE, to account for the context it is delivered in, and co-design, which involves developing the intervention in partnership with key stakeholders to increase the likelihood that the intervention will succeed. The development of the guidelines outlined in this paper could be used for the future development of technologies that aim to facilitate self-management in CAYP with ADHD. UR - https://www.jmir.org/2019/4/e12831/ UR - http://dx.doi.org/10.2196/12831 UR - http://www.ncbi.nlm.nih.gov/pubmed/30942692 ID - info:doi/10.2196/12831 ER - TY - JOUR AU - Dijkstra, Alie AU - Heida, Anke AU - van Rheenen, Ferry Patrick PY - 2019/03/29 TI - Exploring the Challenges of Implementing a Web-Based Telemonitoring Strategy for Teenagers With Inflammatory Bowel Disease: Empirical Case Study JO - J Med Internet Res SP - e11761 VL - 21 IS - 3 KW - eHealth KW - inflammatory bowel disease KW - health care improvement KW - implementation science KW - quality of care N2 - Background: We designed a telemonitoring strategy for teenagers with inflammatory bowel disease to prevent an anticipated disease flare and avert unplanned office visits and day care procedures. The strategy was evaluated in a randomized controlled trial that involved 11 Dutch pediatric gastroenterology centers, each using repeated symptom scores and stool calprotectin measurements. In the telemonitoring arm of the trial, teenagers (n=84) as well as their health providers were alerted to out-of-range results, and suggestions for change in therapy were offered. We demonstrated that the technology was a safe and cost saving alternative to health checks by the specialist at fixed intervals. Objective: The aim of this study was to evaluate whether we could move our telemonitoring strategy from a demonstration project to one that is sustained within existing sites. Methods: In this empirical case study, we used the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework to explore the challenges to implementing our strategy. The framework distinguishes 7 domains: (1) the illness, (2) the technology, (3) the value proposition, (4) the adopter system, (5) the organization, (6) the societal system, and (7) the time dimension. We summarized the challenges across all 7 domains and classified them as simple (+++), complicated (++), or complex (+). Technologies in which multiple domains are complicated have proven difficult to implement, whereas those with multiple complex domains may not even become mainstreamed. Results: The technology that we used and the linked program (IBD-live) allowed us to select and target the teenagers who were most likely to benefit from a face-to-face encounter with their specialist (+++). The value proposition of the technology was clear, with a distinct benefit for patients and an affordable service model, but health providers had plausible personal reasons to resist (double data entry, ++). The organization was not yet ready for the innovation, as it requires a shift to new ways of working (+). We had no concerns about reimbursement, as Dutch health insurers agreed that screen-to-screen consultations will be reimbursed at a rate equivalent to face-to-face consultations (+++). Finally, the technology was considered easy to adapt and evolve over time to meet the needs of its users (+++). Conclusions: The challenges to be addressed are merely complicated (++) rather than complex (+), which means that our program may be difficult but not impossible to sustain within existing sites. After integrating the technology and its use with local workflows first, we believe that our telemonitoring strategy will be ready for sustained adoption. In contrast with what we did ourselves, we recommend others to use the NASSS framework prospectively and in real time to predict and explore the challenges to implementing new technologies. UR - http://www.jmir.org/2019/3/e11761/ UR - http://dx.doi.org/10.2196/11761 UR - http://www.ncbi.nlm.nih.gov/pubmed/30924785 ID - info:doi/10.2196/11761 ER - TY - JOUR AU - Wang, Dongwen AU - Abrams, Meredith PY - 2019/03/28 TI - Health Care Providers? Profiles and Evaluations of a Statewide Online Education Program for Dissemination of Clinical Evidence on HIV, Hepatitis C Virus, and Sexually Transmitted Disease: Cross-Sectional Study JO - JMIR Med Educ SP - e10722 VL - 5 IS - 1 KW - information dissemination KW - online systems KW - continuing education KW - HIV KW - hepatitis C KW - sexually transmitted diseases KW - multimedia N2 - Background: Timely and effective dissemination of the latest clinical evidence to health care providers is essential for translating biomedical research into routine patient care. Online platforms offer unique opportunities for dissemination of medical knowledge. Objective: In this study, we report the profiles of health care providers participating in the New York State HIV-HCV-STD Clinical Education Initiative online program and their evaluations of the online continuing professional development courses. Methods: We compiled professional and personal background information of the clinicians who completed at least one online course. We collected their self-reported program evaluation data with regard to the course content, format, knowledge increase, and impact on clinical practice. Results: We recorded a total of 4363 completions of 88 online courses by 1976 unique clinicians during a 12-month study period. The clinicians? background was diverse in terms of demographics, education levels, professional disciplines, practice years, employment settings, caseloads, and clinical services. The evaluation of online courses was very positive (usefulness/relevance, 91.08%; easy comprehension, 89.09%; knowledgeable trainer, 92.00%; appropriate format, 84.35%; knowledge increase, 48.52%; intention to use knowledge, 85.26%; and plan to change practice, 21.98%). Comparison with the reference data indicated that the online program successfully reached out to the primary care communities. Both the younger generation and the senior health care providers were attracted to the online program. High-quality multimedia resources, flexibility of access, ease of use, and provision of continuing professional development credits contributed to the initial success of this online clinical education program. Conclusions: We have successfully characterized a diverse group of clinicians participating in a statewide online continuing professional development program. The evaluation has shown effective use of online resources to disseminate clinical evidence on HIV, hepatitis C virus, and sexually transmitted disease to primary care clinicians. UR - http://mededu.jmir.org/2019/1/e10722/ UR - http://dx.doi.org/10.2196/10722 UR - http://www.ncbi.nlm.nih.gov/pubmed/30920374 ID - info:doi/10.2196/10722 ER - TY - JOUR AU - Lander, Bryn AU - Balka, Ellen PY - 2019/03/28 TI - Exploring How Evidence is Used in Care Through an Organizational Ethnography of Two Teaching Hospitals JO - J Med Internet Res SP - e10769 VL - 21 IS - 3 KW - clinical practice guidelines KW - evidence-based medicine KW - mindlines KW - ethnography N2 - Background: Numerous published articles show that clinicians do not follow clinical practice guidelines (CPGs). However, a few studies explore what clinicians consider evidence and how they use different forms of evidence in their care decisions. Many of these existing studies occurred before the advent of smartphones and advanced Web-based information retrieval technologies. It is important to understand how these new technologies influence the ways clinicians use evidence in their clinical practice. Mindlines are a concept that explores how clinicians draw on different sources of information (including context, experience, medical training, and evidence) to develop collectively reinforced, internalized tacit guidelines. Objective: The aim of this paper was to explore how evidence is integrated into mindline development and the everyday use of mindlines and evidence in care. Methods: We draw on ethnographic data collected by shadowing internal medicine teams at 2 teaching hospitals. Fieldnotes were tagged by evidence category, teaching and care, and role of the person referencing evidence. Counts of these tags were integrated with fieldnote vignettes and memos. The findings were verified with an advisory council and through member checks. Results: CPGs represent just one of several sources of evidence used when making care decisions. Some forms of evidence were predominately invoked from mindlines, whereas other forms were read to supplement mindlines. The majority of scientific evidence was accessed on the Web, often through smartphones. How evidence was used varied by role. As team members gained experience, they increasingly incorporated evidence into their mindlines. Evidence was often blended together to arrive at shared understandings and approaches to patient care that included ways to filter evidence. Conclusions: This paper outlines one way through which the ethos of evidence-based medicine has been incorporated into the daily work of care. Here, multiple Web-based forms of evidence were mixed with other information. This is different from the way that is often articulated by health administrators and policy makers whereby clinical practice guideline adherence is equated with practicing evidence-based medicine. UR - http://www.jmir.org/2019/3/e10769/ UR - http://dx.doi.org/10.2196/10769 UR - http://www.ncbi.nlm.nih.gov/pubmed/30920371 ID - info:doi/10.2196/10769 ER - TY - JOUR AU - McLinden, Daniel AU - Myers, Sarah AU - Seid, Michael AU - Busch, Melida AU - Davis, David AU - Murphy, John PY - 2019/03/14 TI - The Learning Exchange, a Community Knowledge Commons for Learning Networks: Qualitative Evaluation to Test Acceptability, Feasibility, and Utility JO - JMIR Form Res SP - e9858 VL - 3 IS - 1 KW - quality improvement KW - knowledge management KW - community networks KW - intersectoral collaboration KW - database management systems KW - patient-centered care N2 - Background: Learning Networks are distributed learning health systems that enable collaboration at scale to improve health and health care. A key requirement for such networks is having a way to create and share information and knowledge in furtherance of the work of the community. Objective: We describe a Learning Exchange?a bespoke, scalable knowledge management and exchange platform initially built and tested for improving pediatric inflammatory bowel disease outcomes in the ImproveCareNow (ICN) Network?and assess evidence of its acceptability, feasibility, and utility in facilitating creation and sharing of information in furtherance of the work of the community and as a model for other communities. Methods: Acceptability was assessed via growth in active users and activity. Feasibility was measured in terms of the percentage of users with a log-in who became active users as well as user surveys and a case study. Utility was measured in terms of the type of work that the Learning Exchange facilitated for the community. Results: The ICNExchange has over 1000 users and supported sharing of resources across all care centers in ICN. Users reported that the Learning Exchange has facilitated their work and resulted in increased ability to find resources relevant to local information needs. Conclusions: The ICNExchange is acceptable, feasible, and useful as a knowledge management and exchange platform in service of the work of ICN. Experience with the ICNExchange suggests that the design principles are extensible to other chronic care Learning Networks. UR - http://formative.jmir.org/2019/1/e9858/ UR - http://dx.doi.org/10.2196/formative.9858 UR - http://www.ncbi.nlm.nih.gov/pubmed/30869643 ID - info:doi/10.2196/formative.9858 ER - TY - JOUR AU - Lee, Jaehoon AU - Hulse, C. Nathan PY - 2019/02/27 TI - An Analytics Framework for Physician Adherence to Clinical Practice Guidelines: Knowledge-Based Approach JO - JMIR Biomed Eng SP - e11659 VL - 4 IS - 1 KW - clinical practice guidelines KW - care process model KW - visual analytics KW - clinical decision support N2 - Background: One of the problems in evaluating clinical practice guidelines (CPGs) is the occurrence of knowledge gaps. These gaps may occur when evaluation logics and definitions in analytics pipelines are translated differently. Objective: The objective of this paper is to develop a systematic method that will fill in the cognitive and computational gaps of CPG knowledge components in analytics pipelines. Methods: We used locally developed CPGs that resulted in care process models (CPMs). We derived adherence definitions from the CPMs, transformed them into computationally executable queries, and deployed them into an enterprise knowledge base that specializes in managing clinical knowledge content. We developed a visual analytics framework, whose data pipelines are connected to queries in the knowledge base, to automate the extraction of data from clinical databases and calculation of evaluation metrics. Results: In this pilot study, we implemented 21 CPMs within the proposed framework, which is connected to an enterprise data warehouse (EDW) as a data source. We built a Web?based dashboard for monitoring and evaluating adherence to the CPMs. The dashboard ran for 18 months during which CPM adherence definitions were updated a number of times. Conclusions: The proposed framework was demonstrated to accommodate complicated knowledge management for CPM adherence evaluation in analytics pipelines using a knowledge base. At the same time, knowledge consistency and computational efficiency were maintained. UR - http://biomedeng.jmir.org/2019/1/e11659/ UR - http://dx.doi.org/10.2196/11659 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/11659 ER - TY - JOUR AU - Vis, Christiaan AU - Ruwaard, Jeroen AU - Finch, Tracy AU - Rapley, Tim AU - de Beurs, Derek AU - van Stel, Henk AU - van Lettow, Britt AU - Mol, Mayke AU - Kleiboer, Annet AU - Riper, Heleen AU - Smit, Jan PY - 2019/02/20 TI - Toward an Objective Assessment of Implementation Processes for Innovations in Health Care: Psychometric Evaluation of the Normalization Measure Development (NoMAD) Questionnaire Among Mental Health Care Professionals JO - J Med Internet Res SP - e12376 VL - 21 IS - 2 KW - implementation science KW - eHealth KW - psychometrics KW - eMental health KW - normalization process theory KW - implementation assessment N2 - Background: Successfully implementing eMental health (eMH) interventions in routine mental health care constitutes a major challenge. Reliable instruments to assess implementation progress are essential. The Normalization MeAsure Development (NoMAD) study developed a brief self-report questionnaire that could be helpful in measuring implementation progress. Based on the Normalization Process Theory, this instrument focuses on 4 generative mechanisms involved in implementation processes: coherence, cognitive participation, collective action, and reflexive monitoring. Objective: The aim of this study was to translate the NoMAD questionnaire to Dutch and to confirm the factor structure in Dutch mental health care settings. Methods: Dutch mental health care professionals involved in eMH implementation were invited to complete the translated NoMAD questionnaire. Confirmatory factor analysis (CFA) was conducted to verify interpretability of scale scores for 3 models: (1) the theoretical 4-factor structure, (2) a unidimensional model, and (3) a hierarchical model. Potential improvements were explored, and correlated scale scores with 3 control questions were used to assess convergent validity. Results: A total of 262 professionals from mental health care settings in the Netherlands completed the questionnaire (female: 81.7%; mean age: 45 [SD=11]). The internal consistency of the 20-item questionnaire was acceptable (.62?alpha?.85). The theorized 4-factor model fitted the data slightly better in the CFA than the hierarchical model (Comparative Fit Index=0.90, Tucker Lewis Index=0.88, Root Mean Square Error of Approximation=0.10, Standardized Root Mean Square Residual=0.12, ?22=22.5, P?.05). However, the difference is small and possibly not outweighing the practical relevance of a total score and subscale scores combined in one hierarchical model. One item was identified as weak (?CA.2=0.10). A moderate-to-strong convergent validity with 3 control questions was found for the Collective Participation scale (.47?r?.54, P?.05). Conclusions: NoMAD?s theoretical factor structure was confirmed in Dutch mental health settings to acceptable standards but with room for improvement. The hierarchical model might prove useful in increasing the practical utility of the NoMAD questionnaire by combining a total score with information on the 4 generative mechanisms. Future research should assess the predictive value and responsiveness over time and elucidate the conceptual interpretability of NoMAD in eMH implementation practices. UR - http://www.jmir.org/2019/2/e12376/ UR - http://dx.doi.org/10.2196/12376 UR - http://www.ncbi.nlm.nih.gov/pubmed/30785402 ID - info:doi/10.2196/12376 ER - TY - JOUR AU - Car, Josip AU - Carlstedt-Duke, Jan AU - Tudor Car, Lorainne AU - Posadzki, Pawel AU - Whiting, Penny AU - Zary, Nabil AU - Atun, Rifat AU - Majeed, Azeem AU - Campbell, James AU - PY - 2019/02/14 TI - Digital Education in Health Professions: The Need for Overarching Evidence Synthesis JO - J Med Internet Res SP - e12913 VL - 21 IS - 2 KW - methods KW - education, medical KW - systematic reviews KW - evidence-based KW - education, distance KW - education, professional UR - http://www.jmir.org/2019/2/e12913/ UR - http://dx.doi.org/10.2196/12913 UR - http://www.ncbi.nlm.nih.gov/pubmed/30762583 ID - info:doi/10.2196/12913 ER - TY - JOUR AU - Beidas, S. Rinad AU - Volpp, G. Kevin AU - Buttenheim, N. Alison AU - Marcus, C. Steven AU - Olfson, Mark AU - Pellecchia, Melanie AU - Stewart, E. Rebecca AU - Williams, J. Nathaniel AU - Becker-Haimes, M. Emily AU - Candon, Molly AU - Cidav, Zuleyha AU - Fishman, Jessica AU - Lieberman, Adina AU - Zentgraf, Kelly AU - Mandell, David PY - 2019/02/12 TI - Transforming Mental Health Delivery Through Behavioral Economics and Implementation Science: Protocol for Three Exploratory Projects JO - JMIR Res Protoc SP - e12121 VL - 8 IS - 2 KW - implementation science KW - behavioral economics KW - mental health N2 - Background: Efficacious psychiatric treatments are not consistently deployed in community practice, and clinical outcomes are attenuated compared with those achieved in clinical trials. A major focus for mental health services research is to develop effective and cost-effective strategies that increase the use of evidence-based assessment, prevention, and treatment approaches in community settings. Objective: The goal of this program of research is to apply insights from behavioral economics and participatory design to advance the science and practice of implementing evidence-based practice (EBP) for individuals with psychiatric disorders across the life span. Methods: Project 1 (Assisting Depressed Adults in Primary care Treatment [ADAPT]) is patient-focused and leverages decision-making heuristics to compare ways to incentivize adherence to antidepressant medications in the first 6 weeks of treatment among adults newly diagnosed with depression. Project 2 (App for Strengthening Services In Specialized Therapeutic Support [ASSISTS]) is provider-focused and utilizes normative pressure and social status to increase data collection among community mental health workers treating children with autism. Project 3 (Motivating Outpatient Therapists to Implement: Valuing a Team Effort [MOTIVATE]) explores how participatory design can be used to design organizational-level implementation strategies to increase clinician use of EBPs. The projects are supported by a Methods Core that provides expertise in implementation science, behavioral economics, participatory design, measurement, and associated statistical approaches. Results: Enrollment for project ADAPT started in 2018; results are expected in 2020. Enrollment for project ASSISTS will begin in 2019; results are expected in 2021. Enrollment for project MOTIVATE started in 2018; results are expected in 2019. Data collection had begun for ADAPT and MOTIVATE when this protocol was submitted. Conclusions: This research will advance the science of implementation through efforts to improve implementation strategy design, measurement, and statistical methods. First, we will test and refine approaches to collaboratively design implementation strategies with stakeholders (eg, discrete choice experiments and innovation tournaments). Second, we will refine the measurement of mechanisms related to heuristics used in decision making. Third, we will develop new ways to test mechanisms in multilevel implementation trials. This trifecta, coupled with findings from our 3 exploratory projects, will lead to improvements in our knowledge of what causes successful implementation, what variables moderate and mediate the effects of those causal factors, and how best to leverage this knowledge to increase the quality of care for people with psychiatric disorders. Trial Registration: ClinicalTrials.gov NCT03441399; https://www.clinicaltrials.gov/ct2/show/NCT03441399 (Archived by WebCite at http://www.webcitation.org/74dRbonBD) International Registered Report Identifier (IRRID): DERR1-10.2196/12121 UR - http://www.researchprotocols.org/2019/2/e12121/ UR - http://dx.doi.org/10.2196/12121 UR - http://www.ncbi.nlm.nih.gov/pubmed/30747719 ID - info:doi/10.2196/12121 ER - TY - JOUR AU - Jemielniak, Dariusz AU - Masukume, Gwinyai AU - Wilamowski, Maciej PY - 2019/01/18 TI - The Most Influential Medical Journals According to Wikipedia: Quantitative Analysis JO - J Med Internet Res SP - e11429 VL - 21 IS - 1 KW - citizen science KW - medical journals KW - open knowledge KW - Wikipedia KW - knowledge translation KW - journalology KW - medical publishing KW - scholarly publishing N2 - Background: Wikipedia, the multilingual encyclopedia, was founded in 2001 and is the world?s largest and most visited online general reference website. It is widely used by health care professionals and students. The inclusion of journal articles in Wikipedia is of scholarly interest, but the time taken for a journal article to be included in Wikipedia, from the moment of its publication to its incorporation into Wikipedia, is unclear. Objective: We aimed to determine the ranking of the most cited journals by their representation in the English-language medical pages of Wikipedia. In addition, we evaluated the number of days between publication of journal articles and their citation in Wikipedia medical pages, treating this measure as a proxy for the information-diffusion rate. Methods: We retrieved the dates when articles were included in Wikipedia and the date of journal publication from Crossref by using an application programming interface. Results: From 11,325 Wikipedia medical articles, we identified citations to 137,889 journal articles from over 15,000 journals. There was a large spike in the number of journal articles published in or after 2002 that were cited by Wikipedia. The higher the importance of a Wikipedia article, the higher was the mean number of journal citations it contained (top article, 48.13 [SD 33.67]; lowest article, 6.44 [SD 9.33]). However, the importance of the Wikipedia article did not affect the speed of reference addition. The Cochrane Database of Systematic Reviews was the most cited journal by Wikipedia, followed by The New England Journal of Medicine and The Lancet. The multidisciplinary journals Nature, Science, and the Proceedings of the National Academy of Sciences were among the top 10 journals with the highest Wikipedia medical article citations. For the top biomedical journal papers cited in Wikipedia's medical pages in 2016-2017, it took about 90 days (3 months) for the citation to be used in Wikipedia. Conclusions: We found evidence of ?recentism,? which refers to preferential citation of recently published journal articles in Wikipedia. Traditional high-impact medical and multidisciplinary journals were extensively cited by Wikipedia, suggesting that Wikipedia medical articles have robust underpinnings. In keeping with the Wikipedia policy of citing reviews/secondary sources in preference to primary sources, the Cochrane Database of Systematic Reviews was the most referenced journal. UR - http://www.jmir.org/2019/1/e11429/ UR - http://dx.doi.org/10.2196/11429 UR - http://www.ncbi.nlm.nih.gov/pubmed/30664451 ID - info:doi/10.2196/11429 ER - TY - JOUR AU - Cross, Andrea AU - Rosenbaum, Peter AU - Grahovac, Danijela AU - Brocklehurst, Julie AU - Kay, Diane AU - Baptiste, Sue AU - Gorter, Willem Jan PY - 2018/12/21 TI - A Web-Based Knowledge Translation Resource for Families and Service Providers (The ?F-Words? in Childhood Disability Knowledge Hub): Developmental and Pilot Evaluation Study JO - JMIR Rehabil Assist Technol SP - e10439 VL - 5 IS - 2 KW - childhood disability KW - F-words KW - ICF KW - Knowledge Hub KW - knowledge-to-action framework KW - knowledge translation KW - Web-based resource N2 - Background: The ?F-words in Childhood Disability? (Function, Family, Fitness, Fun, Friends, and Future) are an adaptation and an attempt to operationalize the World Health Organization?s (2001) International Classification of Functioning, Disability and Health (ICF) framework. Since the paper was published (November 2011), the ?F-words? have attracted global attention (>12,000 downloads, January 2018). Internationally, people have adopted the ?F-words? ideas, and many families and service providers have expressed a need for more information, tools, and resources on the ?F-words?. Objective: This paper reports on the development and pilot evaluation of a Web-based knowledge translation (KT) resource, the ?F-words? Knowledge Hub that was created to inform people about the ?F-words? and to provide action-oriented tools to support the use of the ?F-words? in practice. Methods: An integrated research team of families and researchers at CanChild Centre for Childhood Disability Research collaborated to develop, implement, and evaluate the Knowledge Hub. A pilot study design was chosen to assess the usability and utility of the Web-based hub before implementing a larger evaluation study. Data were collected using a brief anonymous Web-based survey that included both closed-ended and open-ended questions, with the closed-ended responses being based on a five-point Likert-type scale. We used descriptive statistics and a summary of key themes to report findings. Results: From August to November 2017, the Knowledge Hub received >6,800 unique visitors. In 1 month (November 2017), 87 people completed the survey, of whom 63 completed the full survey and 24 completed 1 or 2 sections. The respondents included 42 clinicians and 30 family members or individuals with a disability. The majority of people visited the Knowledge Hub 1-5 times (n=63) and spent up to 45 minutes exploring (n=61) before providing feedback. Overall, 66 people provided information on the perceived usefulness of the Knowledge Hub, of which 92% (61/66) found the Knowledge Hub user-friendly and stated that they enjoyed exploring the hub, and a majority (n=52) reported that the Knowledge Hub would influence what they did when working with others. From the open-ended responses (n=48), the ?F-words? videos (n=21) and the ?F-words? tools (n=15) were rated as the best features on the Knowledge Hub. Conclusions: The ?F-words? Knowledge Hub is an evidence-informed Web-based KT resource that was useful for respondents, most of whom were seen as ?early adopters? of the ?F-words? concepts. Based on the findings, minor changes are to be made to improve the Knowledge Hub before completing a larger evaluation study on the impact at the family, clinician, and organizational levels with a wider group of users. Our hope is that the ?F-words? Knowledge Hub will become a go-to resource for knowledge sharing and exchange for families and service providers. UR - http://rehab.jmir.org/2018/2/e10439/ UR - http://dx.doi.org/10.2196/10439 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578233 ID - info:doi/10.2196/10439 ER - TY - JOUR AU - Al-Durra, Mustafa AU - Nolan, P. Robert AU - Seto, Emily AU - Cafazzo, A. Joseph AU - Eysenbach, Gunther PY - 2018/12/18 TI - Nonpublication Rates and Characteristics of Registered Randomized Clinical Trials in Digital Health: Cross-Sectional Analysis JO - J Med Internet Res SP - e11924 VL - 20 IS - 12 KW - clinical protocols KW - clinical trial KW - eHealth KW - mHealth KW - mobile health KW - publications KW - publication bias KW - randomized controlled trial KW - registries KW - telehealth KW - telemedicine N2 - Background: Clinical trials are key to advancing evidence-based medical research. The medical research literature has identified the impact of publication bias in clinical trials. Selective publication for positive outcomes or nonpublication of negative results could misdirect subsequent research and result in literature reviews leaning toward positive outcomes. Digital health trials face specific challenges, including a high attrition rate, usability issues, and insufficient formative research. These challenges may contribute to nonpublication of the trial results. To our knowledge, no study has thus far reported the nonpublication rates of digital health trials. Objective: The primary research objective was to evaluate the nonpublication rate of digital health randomized clinical trials registered in ClinicalTrials.gov. Our secondary research objective was to determine whether industry funding contributes to nonpublication of digital health trials. Methods: To identify digital health trials, a list of 47 search terms was developed through an iterative process and applied to the ?Title,? ?Interventions,? and ?Outcome Measures? fields of registered trials with completion dates between April 1, 2010, and April 1, 2013. The search was based on the full dataset exported from the ClinlicalTrials.gov database, with 265,657 trials entries downloaded on February 10, 2018, to allow publication of studies within 5 years of trial completion. We identified publications related to the results of the trials through a comprehensive approach that included an automated and manual publication-identification process. Results: In total, 6717 articles matched the a priori search terms, of which 803 trials matched our latest completion date criteria. After screening, 556 trials were included in this study. We found that 150 (27%) of all included trials remained unpublished 5 years after their completion date. In bivariate analyses, we observed statistically significant differences in trial characteristics between published and unpublished trials in terms of the intervention target condition, country, trial size, trial phases, recruitment, and prospective trial registration. In multivariate analyses, differences in trial characteristics between published and unpublished trials remained statistically significant for the intervention target condition, country, trial size, trial phases, and recruitment; the odds of publication for non-US?based trials were significant, and these trials were 3.3 (95% CI 1.845-5.964) times more likely to be published than US?based trials. We observed a trend of 1.5 times higher nonpublication rates for industry-funded trials. However, the trend was not statistically significant. Conclusions: In the domain of digital health, 27% of registered clinical trials results are unpublished, which is lower than nonpublication rates in other fields. There are substantial differences in nonpublication rates between trials funded by industry and nonindustry sponsors. Further research is required to define the determinants and reasons for nonpublication and, more importantly, to articulate the impact and risk of publication bias in the field of digital health trials. UR - http://www.jmir.org/2018/12/e11924/ UR - http://dx.doi.org/10.2196/11924 UR - http://www.ncbi.nlm.nih.gov/pubmed/30485832 ID - info:doi/10.2196/11924 ER - TY - JOUR AU - Turner, Tari AU - Steele, Emily AU - Mavergames, Chris AU - Elliott, Julian AU - PY - 2018/12/13 TI - Facilitating Web-Based Collaboration in Evidence Synthesis (TaskExchange): Development and Analysis JO - JMIR Res Protoc SP - e188 VL - 7 IS - 12 KW - review, systematic KW - intersectoral collaboration KW - software KW - internet N2 - Background: The conduct and publication of scientific research are increasingly open and collaborative. There is growing interest in Web-based platforms that can effectively enable global, multidisciplinary scientific teams and foster networks of scientists in areas of shared research interest. Designed to facilitate Web-based collaboration in research evidence synthesis, TaskExchange highlights the potential of these kinds of platforms. Objective: This paper describes the development, growth, and future of TaskExchange, a Web-based platform facilitating collaboration in research evidence synthesis. Methods: The original purpose of TaskExchange was to create a platform that connected people who needed help with their Cochrane systematic reviews (rigorous syntheses of health research) with people who had the time and expertise to help. The scope of TaskExchange has now been expanded to include other evidence synthesis tasks, including guideline development. The development of TaskExchange was initially undertaken in 5 agile development phases with substantial user engagement. In each phase, software was iteratively deployed as it was developed and tested, enabling close cycles of development and refinement. Results: TaskExchange enables users to browse and search tasks and members by keyword or nested filters, post and respond to tasks, sign up to notification emails, and acknowledge the work of TaskExchange members. The pilot platform has been open access since August 2016, has over 2300 members, and has hosted more than 630 tasks, covering a wide range of research synthesis-related tasks. Response rates are consistently over 75%, and user feedback has been positive. Conclusions: TaskExchange demonstrates the potential for new technologies to support Web-based collaboration in health research. Development of a relatively simple platform for peer-to-peer exchange has provided opportunities for systematic reviewers to get their reviews completed more quickly and provides an effective pathway for people to join the global health evidence community. UR - https://www.researchprotocols.org/2018/12/e188/ UR - http://dx.doi.org/10.2196/resprot.9285 UR - http://www.ncbi.nlm.nih.gov/pubmed/30545818 ID - info:doi/10.2196/resprot.9285 ER - TY - JOUR AU - Tougas, E. Michelle AU - Chambers, T. Christine AU - Corkum, Penny AU - Robillard, M. Julie AU - Gruzd, Anatoliy AU - Howard, Vivian AU - Kampen, Andrea AU - Boerner, E. Katelynn AU - Hundert, S. Amos PY - 2018/12/11 TI - Social Media Content About Children?s Pain and Sleep: Content and Network Analysis JO - JMIR Pediatr Parent SP - e11193 VL - 1 IS - 2 KW - child health KW - knowledge translation KW - pain KW - sleep KW - social media N2 - Background: Social media is often used for health communication and can facilitate fast information exchange. Despite its increasing use, little is known about child health information sharing and engagement over social media. Objective: The primary objectives of this study are to systematically describe the content of social media posts about child pain and sleep and identify the level of research evidence in these posts. The secondary objective is to examine user engagement with information shared over social media. Methods: Twitter, Instagram, and Facebook were searched by members of the research team over a 2-week period using a comprehensive search strategy. Codes were used to categorize the content of posts to identify the frequency of content categories shared over social media platforms. Posts were evaluated by content experts to determine the frequency of posts consistent with existing research evidence. User engagement was analyzed using Netlytic, a social network analysis program, to examine visual networks illustrating the level of user engagement. Results: From the 2-week period, nearly 1500 pain-related and 3800 sleep-related posts were identified and analyzed. Twitter was used most often to share knowledge about child pain (639/1133, 56.40% of posts), and personal experiences for child sleep (2255/3008, 75.00% of posts). For both topics, Instagram posts shared personal experiences (53/68, 78% pain; 413/478, 86.4% sleep), Facebook group posts shared personal experiences (30/49, 61% pain; 230/345, 66.7% sleep) and Facebook pages shared knowledge (68/198, 34.3% pain; 452/1026, 44.05% sleep). Across platforms, research evidence was shared in 21.96% (318/1448) of pain- and 9.16% (445/4857) of sleep-related posts; 5.38% (61/1133) of all pain posts and 2.82% (85/3008) of all sleep posts shared information inconsistent with the evidence, while the rest were absent of evidence. User interactions were indirect, with mostly one-way, rather than reciprocal conversations. Conclusions: Social media is commonly used to discuss child health, yet the majority of posts do not contain research evidence, and user engagement is primarily one-way. These findings represent an opportunity to expand engagement through open conversations with credible sources. Research and health care communities can benefit from incorporating specific information about evidence within social media posts to improve communication with the public and empower users to distinguish evidence-based content better. Together, these findings have identified potential gaps in social media communication that may be informative targets to guide future strategies for improving the translation of child health evidence over social media. UR - http://pediatrics.jmir.org/2018/2/e11193/ UR - http://dx.doi.org/10.2196/11193 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518292 ID - info:doi/10.2196/11193 ER - TY - JOUR AU - Lo, Ambrose Wai Leung AU - Lei, Di AU - Li, Le AU - Huang, Feng Dong AU - Tong, Kin-Fai PY - 2018/11/26 TI - The Perceived Benefits of an Artificial Intelligence?Embedded Mobile App Implementing Evidence-Based Guidelines for the Self-Management of Chronic Neck and Back Pain: Observational Study JO - JMIR Mhealth Uhealth SP - e198 VL - 6 IS - 11 KW - low back pain KW - neck pain KW - mobile app KW - exercise therapy KW - mHealth N2 - Background: Chronic musculoskeletal neck and back pain are disabling conditions among adults. Use of technology has been suggested as an alternative way to increase adherence to exercise therapy, which may improve clinical outcomes. Objective: The aim was to investigate the self-perceived benefits of an artificial intelligence (AI)?embedded mobile app to self-manage chronic neck and back pain. Methods: A total of 161 participants responded to the invitation. The evaluation questionnaire included 14 questions that were intended to explore if using the AI rehabilitation system may (1) increase time spent on therapeutic exercise, (2) affect pain level (assessed by the 0-10 Numerical Pain Rating Scale), and (3) reduce the need for other interventions. Results: An increase in time spent on therapeutic exercise per day was observed. The median Numerical Pain Rating Scale scores were 6 (interquartile range [IQR] 5-8) before and 4 (IQR 3-6) after using the AI-embedded mobile app (95% CI 1.18-1.81). A 3-point reduction was reported by the participants who used the AI-embedded mobile app for more than 6 months. Reduction in the usage of other interventions while using the AI-embedded mobile app was also reported. Conclusions: This study demonstrated the positive self-perceived beneficiary effect of using the AI-embedded mobile app to provide a personalized therapeutic exercise program. The positive results suggest that it at least warrants further study to investigate the physiological effect of the AI-embedded mobile app and how it compares with routine clinical care. UR - http://mhealth.jmir.org/2018/11/e198/ UR - http://dx.doi.org/10.2196/mhealth.8127 UR - http://www.ncbi.nlm.nih.gov/pubmed/30478019 ID - info:doi/10.2196/mhealth.8127 ER - TY - JOUR AU - Zafar, Sidra AU - Habboush, Yacob AU - Beidas, Sary PY - 2018/11/07 TI - Use of Grading of Recommendations, Assessment, Development, and Evaluation to Combat Fake News: A Case Study of Influenza Vaccination in Pregnancy JO - JMIR Med Educ SP - e10347 VL - 4 IS - 2 KW - GRADE KW - influenza KW - vaccination KW - spontaneous abortion KW - miscarriage N2 - Background: The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework is a validated evaluation tool used to assess the quality of scientific publications. It helps in enhancing clinicians? decision-making process and supports production of informed healthy policy. Objective: The purpose of this report was two-fold. First, we reviewed the interpretation of observational studies. The second purpose was to share or provide an example using the GRADE criteria. Methods: To illustrate the use of the GRADE framework to assess publications, we selected a study evaluating the risk of spontaneous abortion (SAB) after influenza vaccine administration. Results: Since 2004, the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practice have recommended influenza vaccination of pregnant women. Previous studies have not found an association between influenza vaccination and SAB. However, in a recent case-control study by Donahue et al, a correlation with SAB in women who received the H1N1 influenza vaccine was identified. For women who received H1N1?containing vaccine in the previous and current influenza season, the adjusted odds ratio (aOR) for SAB was 7.7 (95% CI, 2.2-27.3), while the aOR for women not vaccinated in the previous season but vaccinated in the current season was 1.3 (95% CI, 0.7-2.7). Conclusions: Our goal is to enable the readers to critique published literature using appropriate evaluation tools such as GRADE. UR - http://mededu.jmir.org/2018/2/e10347/ UR - http://dx.doi.org/10.2196/10347 UR - http://www.ncbi.nlm.nih.gov/pubmed/30404772 ID - info:doi/10.2196/10347 ER - TY - JOUR AU - Balls-Berry, Joyce AU - Sinicrope, Pamela AU - Valdez Soto, Miguel AU - Brockman, Tabetha AU - Bock, Martha AU - Patten, Christi PY - 2018/10/24 TI - Linking Podcasts With Social Media to Promote Community Health and Medical Research: Feasibility Study JO - JMIR Formativ Res SP - e10025 VL - 2 IS - 2 KW - biomedical research KW - community health KW - community and patient engagement in research KW - podcast KW - social media N2 - Background: Linking podcasts with social media is a strategy to promote and disseminate health and health research information to the community without constraints of time, weather, and geography. Objective: To describe the process of creating a podcast library and promoting it on social media as a strategy for disseminating health and biomedical research topics to the community. Methods: We used a community and patient engagement in research approach for developing a process to use podcasts for dissemination of health and health research information. We have reported the aspects of audience reach, impressions, and engagement on social media through the number of downloads, shares, and reactions posted on SoundCloud, Twitter, and Facebook, among others. Results: In collaboration with our local community partner, we produced 45 podcasts focused on topics selected from a community health needs assessment with input from health researchers. Episodes lasted about 22 minutes and presented health-related projects, community events, and community resources, with most featured guests from Olmsted County (24/45, 53%). Health research was the most frequently discussed topic. Between February 2016 and June 2017, episodes were played 1843 times on SoundCloud and reached 1702 users on our Facebook page. Conclusions: This study demonstrated the process and feasibility of creating a content library of podcasts for disseminating health- and research-related information. Further examination is needed to determine the best methods to develop a sustainable social media plan that will further enhance dissemination (audience reach), knowledge acquisition, and communication of health topics. UR - http://formative.jmir.org/2018/2/e10025/ UR - http://dx.doi.org/10.2196/10025 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684430 ID - info:doi/10.2196/10025 ER - TY - JOUR AU - Al Bawab, Qader Abdel AU - AlQahtani, Fahad AU - McElnay, James PY - 2018/10/22 TI - Health Care Apps Reported in Newspapers: Content Analysis JO - JMIR Mhealth Uhealth SP - e10237 VL - 6 IS - 10 KW - apps KW - newspaper articles KW - newspapers KW - health N2 - Background: Newspapers are considered one of the most viewed and influential media sources in both the United Kingdom and United States. However, information about how newspapers portray health care apps to the readers has been lacking. Objective: This study investigated the reporting on health care apps in newspapers published in the United Kingdom and United States. Methods: The Nexis UK database was used to identify and select relevant articles. Systematic content analysis of the articles that met the inclusion criteria (articles of any format that contained reference to health care apps or medical apps) within the highest circulated newspapers in the United Kingdom and United States over a period of 10 years (2006-2015) was conducted. Interrater reliability of coding was established using a 10% sample of the chosen articles. Results: A total of 220 (151 UK and 69 US) relevant newspaper articles were retrieved. Health care apps were most frequently reported on in the Daily Mail and The Guardian (UK newspapers) and in the New York Times and the Washington Post (US newspapers). An exponential rise in published scientific articles (PubMed) on health care-related apps was noted during the study period. A total of 26.4% (58/220) and 19.1% (42/220) of the retrieved newspaper articles appeared in the features and main news sections, respectively. General information about health care apps was the main theme coved by the newspapers (45.9%, 101/220). Most of the articles represented a societal point of view (72.3%, 159/220). The main focus of the articles was on general health matters (48.2%, 106/220) and specific disease matters (36.8%, 81/220). Diabetes was the most frequently mentioned disease in the articles. A high proportion (91.4%, 201/220) of the articles mentioned benefits of using health care apps mainly for personalized care, whereas 24.1% (53/220) of the articles commented on related risks such as anxiety and confidentiality issues. Almost half (45.9%, 101/220) of the articles mentioned potential facilitators to the use of apps; less than 10% (16/220) discussed barriers. Most of the articles (83.6%, 184/220) were judged as having balanced judgment on the present topic and more than half (60.0%, 132/220) of the articles were judged to be of generally low quality. Conclusions: Health care apps were not widely reported in newspaper articles in the United Kingdom and United States over the study period; however, there appeared to be much more recent interest. Characteristically, the articles focused more frequently on societal impact and on general health rather than on disease-specific apps. UR - http://mhealth.jmir.org/2018/10/e10237/ UR - http://dx.doi.org/10.2196/10237 UR - http://www.ncbi.nlm.nih.gov/pubmed/30348632 ID - info:doi/10.2196/10237 ER - TY - JOUR AU - Nault, Daryl AU - Beccia, Ariel AU - Ito, Haruka AU - Kashdan, Sarah AU - Senders, Angela PY - 2018/10/01 TI - Health Information Discrepancies Between Internet Media and Scientific Papers Reporting on Omega-3 Supplement Research: Comparative Analysis JO - Interact J Med Res SP - e15 VL - 7 IS - 2 KW - consumer health information KW - health literacy KW - health communication KW - health promotion KW - evidence-based practice KW - dietary supplements KW - omega-3 fatty acids KW - journalism N2 - Background: Dietary supplements are the most used complementary and alternative health modality in the United States, and omega-3 supplements continue to be the most popularly used nonvitamin or nonmineral supplements by adults. Users of dietary supplements report that they obtain health guidance from internet media resources, but there is question as to whether or not these resources provide the necessary evidence to guide health decisions. Current evidence suggests that there is a mistranslation occurring somewhere between researchers and the media. Objective: The aim of this study was to conduct a comparative cross-sectional analysis to identify areas of discordance created when science is translated from the laboratory to Web-based news media. Methods: A Google news search provided our convenience sample of 40 omega-3 supplement?based media reports stratified by the years 2009 to 2012. Media reports (n=17) were compared with the corresponding scientific papers for content. Report and scientific paper content were extracted using commonly accepted reporting guideline domains, and domains were then compared for detecting underlying omissions or mistranslations in reporting. Mean scores for all of the scientific papers and media reports were assessed for each domain. Results: Scientific papers (n=14) generally maintained a mean close to complete for each reporting domain. The only domain where there was not a significant difference between media and scientific reporting match was within the objectives domain (?21= 0.8, P=.36). Media reports (n=17) more frequently reported potential caveats and warnings for consumers with a mean domain for caveat reporting of 0.88, with possible scores falling between 0 and 1. Conclusions: There are inherent differences in the intended audience, structure, and goals in scientific and media communications. These differences should be explored further, and consumers should be made aware of them. Additional considerations for balanced reporting and reader accessibility are also necessary to take into account and are explored further in this analysis. UR - http://www.i-jmr.org/2018/2/e15/ UR - http://dx.doi.org/10.2196/ijmr.8981 UR - http://www.ncbi.nlm.nih.gov/pubmed/30274960 ID - info:doi/10.2196/ijmr.8981 ER - TY - JOUR AU - Healy, Nissa Genevieve AU - Eakin, G. Elizabeth AU - Winkler, AH Elisabeth AU - Hadgraft, Nyssa AU - Dunstan, W. David AU - Gilson, D. Nicholas AU - Goode, D. Ana PY - 2018/08/28 TI - Assessing the Feasibility and Pre-Post Impact Evaluation of the Beta (Test) Version of the BeUpstanding Champion Toolkit in Reducing Workplace Sitting: Pilot Study JO - JMIR Formativ Res SP - e17 VL - 2 IS - 2 KW - BeUpstanding Champion Toolkit KW - implementation KW - physical activity KW - sedentary KW - workplace sitting N2 - Background: The Web-based, evidence-informed BeUpstanding Champion Toolkit was developed to provide employers (via a ?train-the-champion approach?) with resources and support to help in reducing prolonged sitting in their own desk-based workplace. As part of a five-phase research-to-dissemination process, this study reports on the evaluation of the beta (test) version of this toolkit (Phase 2). Objective: The objective of our study was to evaluate (1) the implementation of the toolkit by workplace champions and (2) the impact of the toolkit on sitting (primary outcome), standing, and moving; use of activity-promoting strategies; knowledge and attitudes; and indicators of health and work performance. Methods: An implementation study using a pre-post design was conducted in 7 desk-based workplaces in Australia (September 2015 to May 2016), with work teams (one per workplace) purposively recruited to ensure representation across a range of sectors (white- or blue-collar), organizational sizes (small or medium or large), and locations (metropolitan or regional). All staff within participating teams were invited to participate in the relevant toolkit activities. Implementation outcomes (time commitment required by champions and toolkit activities completed) were collected from each champion via telephone interviews. Changes in impact outcomes, measured via a Web-based questionnaire completed by employees at baseline and 3 months postimplementation, were assessed using mixed models, correcting for clustering. Results: Champions reported a 30-60 minutes per week time commitment to the toolkit activities. All teams formed a wellbeing committee and sent the staff surveys at both time points; most champions held a staff consultation workshop (6/7), identified team-level strategies within that workshop (5/7), used the communication resources provided within the toolkit (emails, posters; 6/7), and completed the action plan (5/7). In total, 52% (315 of ?600) employees participated in at least one survey and 97 (16%) participated in both. At follow-up, there was a significant (P<.05) reduction in self-reported workplace sitting time compared to baseline (?6.3%, 95% CI ?10.1 to ?2.5; n=85) equating to ?30 minutes per workday. Significant benefits were also observed for the use of activity-promoting strategies, with small, nonsignificant changes observed for knowledge and attitudes and indicators of health and work performance. Conclusions: The beta version of the BeUpstanding Champion Toolkit was feasible to implement and effective in reducing self-reported workplace sitting across a broad range of desk-based workplaces. The next phase (Phase 3) will build on these findings to optimize the toolkit for wider-scale implementation and longer term evaluation. UR - http://formative.jmir.org/2018/2/e17/ UR - http://dx.doi.org/10.2196/formative.9343 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684420 ID - info:doi/10.2196/formative.9343 ER - TY - JOUR AU - Ware, Patrick AU - Ross, J. Heather AU - Cafazzo, A. Joseph AU - Laporte, Audrey AU - Gordon, Kayleigh AU - Seto, Emily PY - 2018/07/31 TI - Evaluating the Implementation of a Mobile Phone?Based Telemonitoring Program: Longitudinal Study Guided by the Consolidated Framework for Implementation Research JO - JMIR Mhealth Uhealth SP - e10768 VL - 6 IS - 7 KW - Consolidated Framework for Implementation Research KW - eHealth KW - heart failure KW - implementation KW - telemonitoring N2 - Background: Telemonitoring has shown promise for alleviating the burden of heart failure on individuals and health systems. However, real-world implementation of sustained programs is rare. Objective: The objective of this study was to evaluate the implementation of a mobile phone?based telemonitoring program, which has been implemented as part of standard care in a specialty heart function clinic by answering two research questions: (1) To what extent was the telemonitoring program successfully implemented? (2) What were the barriers and facilitators to implementing the telemonitoring program? Methods: We conducted a longitudinal single case study. The implementation success was evaluated using the following four implementation outcomes: adoption, penetration, feasibility, and fidelity. Semistructured interviews based on the Consolidated Framework for Implementation Research (CFIR) were conducted at 0, 4, and 12 months with 12 program staff members to identify the barriers and facilitators of the implementation. Results: One year after the implementation, 98 patients and 8 clinicians were enrolled in the program. Despite minor technical issues, the intervention was used as intended. We obtained qualitative data from clinicians (n=8) and implementation staff members (n=4) for 24 CFIR constructs. A total of 12 constructs were facilitators clustered in the CFIR domains of inner setting (culture, tension for change, compatibility, relative priority, learning climate, leadership engagement, and available resources), characteristics of individuals (knowledge and beliefs about the intervention and self-efficacy), and process (engaging and reflecting and evaluating). In addition, we identified other notable facilitators from the characteristics of the intervention domain (relative advantage and adaptability) and the outer setting (patient needs and resources). Four constructs were perceived as minor barriers? the complexity of the intervention, cost, inadequate communication among high-level stakeholders, and the absence of a formal implementation plan. The remaining CFIR constructs had a neutral impact on the overall implementation. Conclusions: This is the first comprehensive evaluation of the implementation of a mobile phone?based telemonitoring program. Although the acceptability of the telemonitoring system was high, the strongest facilitators to the implementation success were related to the implementation context. By identifying what works and what does not in a real-world clinical context using a framework-guided approach, this work will inform the design of telemonitoring services and implementation strategies of similar telemonitoring interventions. UR - http://mhealth.jmir.org/2018/7/e10768/ UR - http://dx.doi.org/10.2196/10768 UR - http://www.ncbi.nlm.nih.gov/pubmed/30064970 ID - info:doi/10.2196/10768 ER - TY - JOUR AU - Tilahun, Binyam AU - Smillie, Kirsten AU - Bardosh, Louis Kevin AU - Murray, Melanie AU - Fitzgerald, Mark AU - Cook, Victoria AU - Poureslami, Iraj AU - Forrest, Jamie AU - Lester, Richard PY - 2018/07/03 TI - Identifying Barriers and Facilitators of 13 mHealth Projects in North America and Africa: Protocol for a 5-Year Implementation Science Study JO - JMIR Res Protoc SP - e162 VL - 7 IS - 7 KW - mobile health KW - mHealth KW - text messaging KW - digital health KW - implementation science KW - Africa KW - North America N2 - Background: Although many mHealth interventions have shown efficacy in research, few have been effectively implemented and sustained in real-world health system settings. Despite this programmatic gap, there is limited conclusive evidence identifying the factors that affect the implementation and successful integration of mHealth into a health system. Objective: The aim of this study is to examine the individual, organizational, and external level factors associated with the effective implementation of WelTel, an mHealth intervention designed to support outpatient medication adherence and engagement in care in Africa and North America. Methods: We will adopt the Consolidated Framework for Implementation Research (CFIR) constructs for evaluation of mHealth implementation including a scoring and monitoring system. We will apply the adapted tool to identify facilitators and barriers to implementation of the WelTel mHealth intervention in order to determine how the technology platform is perceived, diffused, adapted, and used by different mHealth project teams and health system actors in Africa and North America. We will use a mixed-methods approach to quantitatively test whether the factors identified in the CFIR framework are associated with the successful uptake of the mHealth intervention toward implementation goals. We will triangulate these data through interviews and focus group discussion with project stakeholders, exploring factors associated with successful implementation and sustainment of these interventions. Results: The development of the customized CFIR is finalized and currently is in pilot testing. The initial results of the use of the tool in those 13 implementations will be available in 2019. Continuous conference and peer- reviewed publications will be published in the coming years. Conclusions: The results of this study will provide an in-depth understanding of individual, organizational, and external level factors that influence the successful implementation of mHealth in different health systems and geographic contexts over time. Via the tool?s unique scoring system connected to qualitative descriptors, these data will inform the most critical implementation targets and contribute to the tailoring of strategies that will assist the health system in overcoming barriers to implementation, and ultimately, improve treatment adherence and engagement in care. Registered Report Identifier: RR1-10.2196/9633 UR - http://www.researchprotocols.org/2018/7/e162/ UR - http://dx.doi.org/10.2196/resprot.9633 UR - http://www.ncbi.nlm.nih.gov/pubmed/29970360 ID - info:doi/10.2196/resprot.9633 ER - TY - JOUR AU - Del Fiol, Guilherme AU - Michelson, Matthew AU - Iorio, Alfonso AU - Cotoi, Chris AU - Haynes, Brian R. PY - 2018/06/25 TI - A Deep Learning Method to Automatically Identify Reports of Scientifically Rigorous Clinical Research from the Biomedical Literature: Comparative Analytic Study JO - J Med Internet Res SP - e10281 VL - 20 IS - 6 KW - information retrieval KW - evidence-based medicine KW - deep learning KW - machine learning KW - literature databases N2 - Background: A major barrier to the practice of evidence-based medicine is efficiently finding scientifically sound studies on a given clinical topic. Objective: To investigate a deep learning approach to retrieve scientifically sound treatment studies from the biomedical literature. Methods: We trained a Convolutional Neural Network using a noisy dataset of 403,216 PubMed citations with title and abstract as features. The deep learning model was compared with state-of-the-art search filters, such as PubMed?s Clinical Query Broad treatment filter, McMaster?s textword search strategy (no Medical Subject Heading, MeSH, terms), and Clinical Query Balanced treatment filter. A previously annotated dataset (Clinical Hedges) was used as the gold standard. Results: The deep learning model obtained significantly lower recall than the Clinical Queries Broad treatment filter (96.9% vs 98.4%; P<.001); and equivalent recall to McMaster?s textword search (96.9% vs 97.1%; P=.57) and Clinical Queries Balanced filter (96.9% vs 97.0%; P=.63). Deep learning obtained significantly higher precision than the Clinical Queries Broad filter (34.6% vs 22.4%; P<.001) and McMaster?s textword search (34.6% vs 11.8%; P<.001), but was significantly lower than the Clinical Queries Balanced filter (34.6% vs 40.9%; P<.001). Conclusions: Deep learning performed well compared to state-of-the-art search filters, especially when citations were not indexed. Unlike previous machine learning approaches, the proposed deep learning model does not require feature engineering, or time-sensitive or proprietary features, such as MeSH terms and bibliometrics. Deep learning is a promising approach to identifying reports of scientifically rigorous clinical research. Further work is needed to optimize the deep learning model and to assess generalizability to other areas, such as diagnosis, etiology, and prognosis. UR - http://www.jmir.org/2018/6/e10281/ UR - http://dx.doi.org/10.2196/10281 UR - http://www.ncbi.nlm.nih.gov/pubmed/29941415 ID - info:doi/10.2196/10281 ER - TY - JOUR AU - Walters, Marolana Laticha Elizabeth AU - Scott, Ernest Richard AU - Mars, Maurice PY - 2018/06/20 TI - A Teledermatology Scale-Up Framework and Roadmap for Sustainable Scaling: Evidence-Based Development JO - J Med Internet Res SP - e224 VL - 20 IS - 6 KW - teledermatology KW - scale-up KW - Teledermatology Scale-up Framework KW - TDSF KW - Teledermatology Scale-up Framework Implementation Roadmap KW - TDSF-IR KW - design science research KW - KwaZulu-Natal KW - South Africa N2 - Background: The objectives of South Africa?s electronic health (eHealth) strategy recognize the value proposition that telemedicine practices hold for rural and urban referrals, but a lack of accepted and formalized scale-up has impeded realization of benefits. While both synchronous and asynchronous teledermatology exist, these remain localized and not scaled-up. Skin pathology is often the first sign of an HIV/AIDS infection, which remains a major cause of morbidity and mortality in South Africa. It is essential to replace the current inefficient dermatology referral process with a swift, organized, and efficacious one. Objective: The objective of this study is to present an evidenced-based teledermatology scale-up framework (TDSF) and implementation roadmap (TDSF-IR). Methods: A qualitative method with a design science research process model was used which consisted of 5 phases: (1) Awareness, which confirmed the need for an evidence-based TDSF and supporting TDSF-IR; (2) Suggestion, where a proposal was delivered on how to develop a TDSF and TDSF-IR; (3) Development, where we identified recommended design requirements and used these to identify and critique existing teledermatology or related scale-up frameworks; (4) Evaluation and validation, where we assessed outputs of the development phase against the design requirements and validated by confirming the veracity of the TDSF and TDSF-IR (validation involved 4 key senior teledermatology stakeholders using a questionnaire with a 5-point Likert scale); and (5) Conclusion, where validation results were used to finalize and communicate the TDSF and TDSF-IR to users. Results: The study identified 5 TDSF components: eHealth building blocks, eHealth strategic objectives and budget, scale-up continuum periods, scale-up drivers, and scale-up phases. In addition, 36 subcomponents were identified. Each was further characterized and described to enable design of the final evidence-based TDSF. An implementation roadmap (TDSF-IR) was also prepared as a guide for an implementer with step-by-step instructions for application of the TDSF. For the validation study of the TDSF and supporting TDSF-IR, 4 purposively selected key senior teledermatology management stakeholders were asked if they found it useful as a guide to assist the South African public health system with teledermatology scale-up. The mean (SD) of Likert-scale rating was 4.0 (0.53) where 4=Agree and 33 of 36 responses were either agree or strongly agree. Conclusions: This study developed a TDSF and supporting roadmap (TDSF-IR) that are evidence-based. The proposed approach and described tools could be adapted to assist with ensuring scale-up and sustainability for other eHealth practices in other locations. UR - http://www.jmir.org/2018/6/e224/ UR - http://dx.doi.org/10.2196/jmir.9940 UR - http://www.ncbi.nlm.nih.gov/pubmed/29925492 ID - info:doi/10.2196/jmir.9940 ER - TY - JOUR AU - Zhao, Jingsong AU - Mir, Nageen AU - Ackermann, Nicole AU - Kaphingst, A. Kimberly AU - Politi, C. Mary PY - 2018/06/20 TI - Dissemination of a Web-Based Tool for Supporting Health Insurance Plan Decisions (Show Me Health Plans): Cross-Sectional Observational Study JO - J Med Internet Res SP - e209 VL - 20 IS - 6 KW - Affordable Care Act KW - health insurance decision aid KW - health literacy KW - public health N2 - Background: The rate of uninsured people has decreased dramatically since the Affordable Care Act was passed. To make an informed decision, consumers need assistance to understand the advantages and disadvantages of health insurance plans. The Show Me Health Plans Web-based decision support tool was developed to improve the quality of health insurance selection. In response to the promising effectiveness of Show Me Health Plans in a randomized controlled trial (RCT) and the growing need for Web-based health insurance decision support, the study team used expert recommendations for dissemination and implementation, engaged external stakeholders, and made the Show Me Health Plans tool available to the public. Objective: The purpose of this study was to implement the public dissemination of the Show Me Health Plans tool in the state of Missouri and to evaluate its impact compared to the RCT. Methods: This study used a cross-sectional observational design. Dissemination phase users were compared with users in the RCT study across the same outcome measures. Time spent using the Show Me Health Plans tool, knowledge, importance rating of 9 health insurance features, and intended plan choice match with algorithm predictions were examined. Results: During the dissemination phase (November 2016 to January 2017), 10,180 individuals visited the SMHP website, and the 1069 users who stayed on the tool for more than one second were included in our analyses. Dissemination phase users were more likely to live outside St. Louis City or County (P<.001), were less likely to be below the federal poverty level (P<.001), and had a higher income (P=.03). Overall, Show Me Health Plans users from St. Louis City or County spent more time on the Show Me Health Plans tool than those from other Missouri counties (P=.04); this association was not observed in the RCT. Total time spent on the tool was not correlated with knowledge scores, which were associated with lower poverty levels (P=.009). The users from the RCT phase were more likely to select an insurance plan that matched the tool?s recommendations (P<.001) compared with the dissemination phase users. Conclusions: The study suggests that a higher income population may be more likely to seek information and online help when making a health insurance plan decision. We found that Show Me Health Plans users in the dissemination phase were more selective in the information they reviewed. This study illustrates one way of disseminating and implementing an empirically tested Web-based decision aid tool. Distributing Web-based tools is feasible and may attract a large number of potential users, educate them on basic health insurance information, and make recommendations based on personal information and preference. However, using Web-based tools may differ according to the demographics of the general public compared to research study participants. UR - http://www.jmir.org/2018/6/e209/ UR - http://dx.doi.org/10.2196/jmir.9829 UR - http://www.ncbi.nlm.nih.gov/pubmed/29925498 ID - info:doi/10.2196/jmir.9829 ER - TY - JOUR AU - Shen, Lining AU - Xiong, Bing AU - Li, Wei AU - Lan, Fuqiang AU - Evans, Richard AU - Zhang, Wei PY - 2018/06/05 TI - Visualizing Collaboration Characteristics and Topic Burst on International Mobile Health Research: Bibliometric Analysis JO - JMIR Mhealth Uhealth SP - e135 VL - 6 IS - 6 KW - collaboration characteristics KW - topic bursts KW - international mobile health KW - mHealth KW - telemedicine KW - bibliometric analysis KW - bibliometrics KW - research trends N2 - Background: In the last few decades, mobile technologies have been widely adopted in the field of health care services to improve the accessibility to and the quality of health services received. Mobile health (mHealth) has emerged as a field of research with increasing attention being paid to it by scientific researchers and a rapid increase in related literature being reported. Objective: The purpose of this study was to analyze the current state of research, including publication outputs, in the field of mHealth to uncover in-depth collaboration characteristics and topic burst of international mHealth research. Methods: The authors collected literature that has been published in the last 20 years and indexed by Thomson Reuters Web of Science Core Collection (WoSCC). Various statistical techniques and bibliometric measures were employed, including publication growth analysis; journal distribution; and collaboration network analysis at the author, institution, and country collaboration level. The temporal visualization map of burst terms was drawn, and the co-occurrence matrix of these burst terms was analyzed by hierarchical cluster analysis and social network analysis. Results: A total of 2704 bibliographic records on mHealth were collected. The earliest paper centered on mHealth was published in 1997, with the number of papers rising continuously since then. A total of 21.28% (2318/10,895) of authors publishing mHealth research were first author, whereas only 1.29% (141/10,895) of authors had published one paper. The total degree of author collaboration was 4.42 (11,958/2704) and there are 266 core authors who have collectively published 53.07% (1435/2704) of the total number of publications, which means that the core group of authors has fundamentally been formed based on the Law of Price. The University of Michigan published the highest number of mHealth-related publications, but less collaboration among institutions exits. The United States is the most productive country in the field and plays a leading role in collaborative research on mHealth. There are 5543 different identified keywords in the cleaned records. The temporal bar graph clearly presents overall topic evolutionary process over time. There are 12 important research directions identified, which are in the imbalanced development. Moreover, the density of the network was 0.007, a relatively low level. These 12 topics can be categorized into 4 areas: (1) patient engagement and patient intervention, (2) health monitoring and self-care, (3) mobile device and mobile computing, and (4) security and privacy. Conclusions: The collaboration of core authors on mHealth research is not tight and stable. Furthermore, collaboration between institutions mainly occurs in the United States, although country collaboration is seen as relatively scarce. The focus of research topics on mHealth is decentralized. Our study might provide a potential guide for future research in mHealth. UR - http://mhealth.jmir.org/2018/6/e135/ UR - http://dx.doi.org/10.2196/mhealth.9581 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/mhealth.9581 ER - TY - JOUR AU - Rapoport, J. Mark AU - Zucchero Sarracini, Carla AU - Kiss, Alex AU - Lee, Linda AU - Byszewski, Anna AU - Seitz, P. Dallas AU - Vrkljan, Brenda AU - Molnar, Frank AU - Herrmann, Nathan AU - Tang-Wai, F. David AU - Frank, Christopher AU - Henry, Blair AU - Pimlott, Nicholas AU - Masellis, Mario AU - Naglie, Gary PY - 2018/05/25 TI - Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e194 VL - 20 IS - 5 KW - dementia KW - mild cognitive impairment KW - automobile driving KW - decision support systems, clinical N2 - Background: Physicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports. Objective: The aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators. Methods: The study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm. Results: A total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ between the intervention and the control groups (50% vs 49%; Z=?0.19, P=.85). Two variables predicted algorithm-based reporting?caregiver concern (odds ratio [OR]=5.8, 95% CI 2.5-13.6, P<.001) and abnormal clock drawing (OR 6.1, 95% CI 3.1-11.8, P<.001). Conclusions: On the basis of this quantitative analysis, in-office abnormal clock drawing and expressions of concern about driving from caregivers substantially influenced physicians to report patients with mild dementia or mild cognitive impairment to transportation administrators, but the DD-DT tool itself did not increase such reports among these expert physicians. Trial Registration: ClinicalTrials.gov NCT02036099; https://clinicaltrials.gov/ct2/show/NCT02036099 (Archived by WebCite at http://www.webcitation.org/6zGMF1ky8) UR - http://www.jmir.org/2018/5/e194/ UR - http://dx.doi.org/10.2196/jmir.9126 UR - http://www.ncbi.nlm.nih.gov/pubmed/29802093 ID - info:doi/10.2196/jmir.9126 ER - TY - JOUR AU - DeJonckheere, Melissa AU - Robinson, H. Claire AU - Evans, Lindsey AU - Lowery, Julie AU - Youles, Bradley AU - Tremblay, Adam AU - Kelley, Caitlin AU - Sussman, B. Jeremy PY - 2018/04/24 TI - Designing for Clinical Change: Creating an Intervention to Implement New Statin Guidelines in a Primary Care Clinic JO - JMIR Hum Factors SP - e19 VL - 5 IS - 2 KW - cardiovascular disease KW - preventative medicine KW - clinical decision support KW - user-centered design KW - qualitative research KW - implementation N2 - Background: Recent clinical practice guidelines from major national organizations, including a joint United States Department of Veterans Affairs (VA) and Department of Defense (DoD) committee, have substantially changed recommendations for the use of the cholesterol-lowering statin medications after years of relative stability. Because statin medications are among the most commonly prescribed treatments in the United States, any change in their use may have significant implications for patients and providers alike. Prior research has shown that effective implementation interventions should be both user centered and specifically chosen to address identified barriers. Objective: The objectives of this study were to identify potential determinants of provider uptake of the new statin guidelines and to use that information to tailor a coordinated and streamlined local quality improvement intervention focused on prescribing appropriate statins. Methods: We employed user-centered design principles to guide the development and testing of a multicomponent guideline implementation intervention to improve statin prescribing. This paper describes the intervention development process whereby semistructured qualitative interviews with providers were conducted to (1) illuminate the knowledge, attitudes, and behaviors of providers and (2) elicit feedback on intervention prototypes developed to align with and support the use of the VA/DoD guidelines. Our aim was to use this information to design a local quality improvement intervention focused on statin prescribing that was tailored to the needs of primary care providers at our facility. Cabana?s Clinical Practice Guidelines Framework for Improvement and Nielsen?s Usability Heuristics were used to guide the analysis of data obtained in the intervention development process. Results: Semistructured qualitative interviews were conducted with 15 primary care Patient Aligned Care Team professionals (13 physicians and 2 clinical pharmacists) at a single VA medical center. Findings highlight that providers were generally comfortable with the paradigm shift to risk-based guidelines but less clear on the need for the VA/DoD guidelines in specific. Providers preferred a clinical decision support tool that helped them calculate patient risk and guide their care without limiting autonomy. They were less comfortable with risk communication and performance measurement systems that do not account for shared decision making. When possible, we incorporated their recommendations into the intervention. Conclusions: By combining qualitative methods and user-centered design principles, we could inform the design of a multicomponent guideline implementation intervention to better address the needs and preferences of providers, including clear and direct language, logical decision prompts with an option to dismiss a clinical decision support tool, and logical ordering of feedback information. Additionally, this process allowed us to identify future design considerations for quality improvement interventions. UR - http://humanfactors.jmir.org/2018/2/e19/ UR - http://dx.doi.org/10.2196/humanfactors.9030 UR - http://www.ncbi.nlm.nih.gov/pubmed/29691206 ID - info:doi/10.2196/humanfactors.9030 ER - TY - JOUR AU - Feijt, A. Milou AU - de Kort, AW Yvonne AU - Bongers, MB Inge AU - IJsselsteijn, A. Wijnand PY - 2018/04/24 TI - Perceived Drivers and Barriers to the Adoption of eMental Health by Psychologists: The Construction of the Levels of Adoption of eMental Health Model JO - J Med Internet Res SP - e153 VL - 20 IS - 4 KW - eHealth KW - mental health KW - psychology, clinical KW - diffusion of innovation KW - technology N2 - Background: The internet offers major opportunities in supporting mental health care, and a variety of technology-mediated mental and behavioral health services have been developed. Yet, despite growing evidence for the effectiveness of these services, their acceptance and use in clinical practice remains low. So far, the current literature still lacks a structured insight into the experienced drivers and barriers to the adoption of electronic mental health (eMental health) from the perspective of clinical psychologists. Objective: The aim of this study was to gain an in-depth and comprehensive understanding of the drivers and barriers for psychologists in adopting eMental health tools, adding to previous work by also assessing drivers and analyzing relationships among these factors, and subsequently by developing a structured representation of the obtained findings. Methods: The study adopted a qualitative descriptive approach consisting of in-depth semistructured interviews with clinical psychologists working in the Netherlands (N=12). On the basis of the findings, a model was constructed that was then examined through a communicative validation. Results: In general, a key driver for psychologists to adopt eMental health is the belief and experience that it can be beneficial to them or their clients. Perceived advantages that are novel to literature include the acceleration of the treatment process, increased intimacy of the therapeutic relationship, and new treatment possibilities due to eMental health. More importantly, a relation was found between the extent to which psychologists have adopted eMental health and the particular drivers and barriers they experience. This differentiation is incorporated in the Levels of Adoption of eMental Health (LAMH) model that was developed during this study to provide a structured representation of the factors that influence the adoption of eMental health. Conclusions: The study identified both barriers and drivers, several of which are new to the literature and found a relationship between the nature and importance of the various drivers and barriers perceived by psychologists and the extent to which they have adopted eMental health. These findings were structured in a conceptual model to further enhance the current understanding. The LAMH model facilitates further research on the process of adopting eMental health, which will subsequently enable targeted recommendations with respect to technology, training, and clinical practice to ensure that mental health care professionals as well as their clients will benefit optimally from the current (and future) range of available eMental health options. UR - http://www.jmir.org/2018/4/e153/ UR - http://dx.doi.org/10.2196/jmir.9485 UR - http://www.ncbi.nlm.nih.gov/pubmed/29691215 ID - info:doi/10.2196/jmir.9485 ER - TY - JOUR AU - Burke-Garcia, Amelia AU - Kreps, L. Gary AU - Wright, B. Kevin PY - 2018/04/24 TI - Perceptions About Disseminating Health Information Among Mommy Bloggers: Quantitative Study JO - JMIR Res Protoc SP - e116 VL - 7 IS - 4 KW - mommy bloggers KW - social media KW - health messages KW - health information dissemination N2 - Background: Social media are potentially powerful channels for communicating relevant health information in culturally sensitive and influential ways to key audiences. Moreover, these channels hold promise for promoting awareness and knowledge of health risks, prevention, and treatment by utilizing opinion leaders for message dissemination. Despite limited empirical evidence to-date, early promising results suggest that blogs are a form of social media that should be examined as worthy channels for health communication. Objectives: This formative study explored mommy bloggers? perceptions about sharing health-related information on their blogs with their readers. It also sought to analyze which topics would be of most interest to mommy bloggers, what motivates them to write about health issues, and how they perceive interest in these topics among their readers. Methods: This study employed survey methodology, including the use of open-ended questions, the responses to which were coded for analysis. Specifically, a 14-item survey was fielded with mommy bloggers between October 1 and October 28, 2016. Bloggers were recruited through The Motherhood network. A total of 461 mommy bloggers responded to the survey; 163 were removed for low quality responses and incomplete data. As a result, 298 eligible participants completed the survey. For open-ended questions in the survey, a sample of responses were coded and analyzed. Results: The majority of the respondents (87.2%, 260/298) reported that they have written about health issues in the past; 97.3% (290/298) of the respondents reported that they would consider writing about health issues sometime in the future, and 96.3% (287/298) of the respondents reported that their readers like to read about health issues on their blogs. In terms of content priorities for this sample of bloggers, Nutrition and Physical Activity dominate the current conversation and similarly, Physical Activity and Nutrition remain top content priorities for these bloggers for the future. Moreover, 21.3% of the respondents reported that their readers would be interested in these topics. Finally, having a personal connection with a health issue was found to be positively associated with likeliness to write about health issues on their blog (P<.001). Conclusions: This study illustrates that there are potentially rich opportunities for working with mommy bloggers to communicate with key health decision makers (moms) on important health issues. There is a great support among mommy bloggers for health information dissemination as well as interest for accessing relevant health information from their readers. This presents an opportunity for public health research and communication campaigns to more broadly promote their messages, thereby contributing to their behavior change objectives. Limitations included overrepresentation of white, higher-educated, and younger women. It suggests a need for more targeted engagement of a diverse sample for future work. UR - http://www.researchprotocols.org/2018/4/e116/ UR - http://dx.doi.org/10.2196/resprot.7764 UR - http://www.ncbi.nlm.nih.gov/pubmed/29691204 ID - info:doi/10.2196/resprot.7764 ER - TY - JOUR AU - Abidi, Samina AU - Vallis, Michael AU - Piccinini-Vallis, Helena AU - Imran, Ali Syed AU - Abidi, Raza Syed Sibte PY - 2018/04/18 TI - Diabetes-Related Behavior Change Knowledge Transfer to Primary Care Practitioners and Patients: Implementation and Evaluation of a Digital Health Platform JO - JMIR Med Inform SP - e25 VL - 6 IS - 2 KW - type 2 diabetes mellitus KW - self-management KW - health behavior KW - knowledge management KW - clinical decision support system N2 - Background: Behavioral science is now being integrated into diabetes self-management interventions. However, the challenge that presents itself is how to translate these knowledge resources during care so that primary care practitioners can use them to offer evidence-informed behavior change support and diabetes management recommendations to patients with diabetes. Objective: The aim of this study was to develop and evaluate a computerized decision support platform called ?Diabetes Web-Centric Information and Support Environment? (DWISE) that assists primary care practitioners in applying standardized behavior change strategies and clinical practice guidelines?based recommendations to an individual patient and empower the patient with the skills and knowledge required to self-manage their diabetes through planned, personalized, and pervasive behavior change strategies. Methods: A health care knowledge management approach is used to implement DWISE so that it features the following functionalities: (1) assessment of primary care practitioners? readiness to administer validated behavior change interventions to patients with diabetes; (2) educational support for primary care practitioners to help them offer behavior change interventions to patients; (3) access to evidence-based material, such as the Canadian Diabetes Association?s (CDA) clinical practice guidelines, to primary care practitioners; (4) development of personalized patient self-management programs to help patients with diabetes achieve healthy behaviors to meet CDA targets for managing type 2 diabetes; (5) educational support for patients to help them achieve behavior change; and (6) monitoring of the patients? progress to assess their adherence to the behavior change program and motivating them to ensure compliance with their program. DWISE offers these functionalities through an interactive Web-based interface to primary care practitioners, whereas the patient?s self-management program and associated behavior interventions are delivered through a mobile patient diary via mobile phones and tablets. DWISE has been tested for its usability, functionality, usefulness, and acceptance through a series of qualitative studies. Results: For the primary care practitioner tool, most usability problems were associated with the navigation of the tool and the presentation, formatting, understandability, and suitability of the content. For the patient tool, most issues were related to the tool?s screen layout, design features, understandability of the content, clarity of the labels used, and navigation across the tool. Facilitators and barriers to DWISE use in a shared decision-making environment have also been identified. Conclusions: This work has provided a unique electronic health solution to translate complex health care knowledge in terms of easy-to-use, evidence-informed, point-of-care decision aids for primary care practitioners. Patients? feedback is now being used to make necessary modification to DWISE. UR - http://medinform.jmir.org/2018/2/e25/ UR - http://dx.doi.org/10.2196/medinform.9629 UR - http://www.ncbi.nlm.nih.gov/pubmed/29669705 ID - info:doi/10.2196/medinform.9629 ER - TY - JOUR AU - Araujo, Costa Amanda AU - Nascimento, Port Dafne AU - Gonzalez, Zoldan Gabrielle AU - Maher, G. Christopher AU - Costa, Pena Leonardo Oliveira PY - 2018/04/05 TI - Impact of Low Back Pain Clinical Trials Measured by the Altmetric Score: Cross-Sectional Study JO - J Med Internet Res SP - e86 VL - 20 IS - 4 KW - Altmetric KW - social impact KW - clinical trials KW - low back pain N2 - Background: There is interest from authors and publishers in sharing the results of their studies over the Internet in order to increase their readership. In this way, articles tend to be discussed and the impact of these articles tends to be increased. In order to measure this type of impact, a new score (named Altmetric) was created. Altmetric aims to understand the individual impact of each article through the attention attracted online. Objective: The primary objective of this study was to analyze potential factors related with the publishing journal and the publishing trial that could be associated with Altmetric scores on a random sample of low back pain randomized controlled trials (RCTs). The secondary objective of this study was to describe the characteristics of these trials and their Altmetric scores. Methods: We searched for all low back pain RCTs indexed on the Physiotherapy Evidence Database (PEDro; www.pedro.org.au) published between 2010 and 2015. A total of 200 articles were randomly selected, and we extracted data related to the publishing trial, the publishing journal, methodological quality of the trials (measured by the 0-10 item PEDro scale), and total and individual scores of Altmetric mentioned and Altmetric reader. The study was a cross-sectional study, and multivariate regression models and descriptive statistics were used. Results: A total of four variables were associated with Altmetric mentioned score: impact factor (?-coefficient=3.4 points), number of years since publication (?-coefficient=?4.9 points), number of citations divided by years since publication (?-coefficient=5.2 points), and descriptive title (?-coefficient=?29.4 points). Only one independent variable was associated with Altmetric reader score: number of citations divided by years since publication (?-coefficient=10.1 points, 95% CI 7.74-12.46). We also found that the majority of articles were published in English, with a descriptive title, and published in open access journals endorsing the Consolidated Standards of Reporting Trials (CONSORT) statement. Conclusions: Researchers should preferably select high impact factor journals for submission and use declarative or interrogative titles, as these factors are likely to increase the visibility of their studies in social media. UR - http://www.jmir.org/2018/4/e86/ UR - http://dx.doi.org/10.2196/jmir.9368 UR - http://www.ncbi.nlm.nih.gov/pubmed/29622526 ID - info:doi/10.2196/jmir.9368 ER - TY - JOUR AU - Stopka, J. Thomas AU - Brinkley-Rubinstein, Lauren AU - Johnson, Kendra AU - Chan, A. Philip AU - Hutcheson, Marga AU - Crosby, Richard AU - Burke, Deirdre AU - Mena, Leandro AU - Nunn, Amy PY - 2018/04/03 TI - HIV Clustering in Mississippi: Spatial Epidemiological Study to Inform Implementation Science in the Deep South JO - JMIR Public Health Surveill SP - e35 VL - 4 IS - 2 KW - hotspots KW - HIV KW - racial disparities KW - social determinants of health KW - HIV treatment KW - HIV screening N2 - Background: In recent years, more than half of new HIV infections in the United States occur among African Americans in the Southeastern United States. Spatial epidemiological analyses can inform public health responses in the Deep South by identifying HIV hotspots and community-level factors associated with clustering. Objective: The goal of this study was to identify and characterize HIV clusters in Mississippi through analysis of state-level HIV surveillance data. Methods: We used a combination of spatial epidemiology and statistical modeling to identify and characterize HIV hotspots in Mississippi census tracts (n=658) from 2008 to 2014. We conducted spatial analyses of all HIV infections, infections among men who have sex with men (MSM), and infections among African Americans. Multivariable logistic regression analyses identified community-level sociodemographic factors associated with HIV hotspots considering all cases. Results: There were HIV hotspots for the entire population, MSM, and African American MSM identified in the Mississippi Delta region, Southern Mississippi, and in greater Jackson, including surrounding rural counties (P<.05). In multivariable models for all HIV cases, HIV hotspots were significantly more likely to include urban census tracts (adjusted odds ratio [AOR] 2.01, 95% CI 1.20-3.37) and census tracts that had a higher proportion of African Americans (AOR 3.85, 95% CI 2.23-6.65). The HIV hotspots were less likely to include census tracts with residents who had less than a high school education (AOR 0.95, 95% CI 0.92-0.98), census tracts with residents belonging to two or more racial/ethnic groups (AOR 0.46, 95% CI 0.30-0.70), and census tracts that had a higher percentage of the population living below the poverty level (AOR 0.51, 95% CI 0.28-0.92). Conclusions: We used spatial epidemiology and statistical modeling to identify and characterize HIV hotspots for the general population, MSM, and African Americans. HIV clusters concentrated in Jackson and the Mississippi Delta. African American race and urban location were positively associated with clusters, whereas having less than a high school education and having a higher percentage of the population living below the poverty level were negatively associated with clusters. Spatial epidemiological analyses can inform implementation science and public health response strategies, including improved HIV testing, targeted prevention and risk reduction education, and tailored preexposure prophylaxis to address HIV disparities in the South. UR - http://publichealth.jmir.org/2018/2/e35/ UR - http://dx.doi.org/10.2196/publichealth.8773 UR - http://www.ncbi.nlm.nih.gov/pubmed/29615383 ID - info:doi/10.2196/publichealth.8773 ER - TY - JOUR AU - Pahwa, Parika AU - Lunsford, Sarah AU - Livesley, Nigel PY - 2018/03/01 TI - Experiences of Indian Health Workers Using WhatsApp for Improving Aseptic Practices With Newborns: Exploratory Qualitative Study JO - JMIR Med Inform SP - e13 VL - 6 IS - 1 KW - quality improvement KW - mobile apps KW - communication KW - patient care team N2 - Background: Quality improvement (QI) involves the following 4 steps: (1) forming a team to work on a specific aim, (2) analyzing the reasons for current underperformance, (3) developing changes that could improve care and testing these changes using plan-do-study-act cycles (PDSA), and (4) implementing successful interventions to sustain improvements. Teamwork and group discussion are key for effective QI, but convening in-person meetings with all staff can be challenging due to workload and shift changes. Mobile technologies can support communication within a team when face-to-face meetings are not possible. WhatsApp, a mobile messaging platform, was implemented as a communication tool by a neonatal intensive care unit (NICU) team in an Indian tertiary hospital seeking to reduce nosocomial infections in newborns. Objective: This exploratory qualitative study aimed to examine experiences with WhatsApp as a communication tool among improvement team members and an external coach to improve adherence to aseptic protocols. Methods: Ten QI team members and the external coach were interviewed on communication processes and approaches and thematically analyzed. The WhatsApp transcript for the implementation period was also included in the analysis. Results: WhatsApp was effective for disseminating information, including guidance on QI and clinical practice, and data on performance indicators. It was not effective as a platform for group discussion to generate change ideas or analyze the performance indicator data. The decision of who to include in the WhatsApp group and how members engaged in the group may have reinforced existing hierarchies. Using WhatsApp created a work environment in which members were accessible all the time, breaking down barriers between personal and professional time. The continual influx of messages was distracting to some respondents, and how respondents managed these messages (eg, using the silent function) may have influenced their perceptions of WhatsApp. The coach used WhatsApp to share information, schedule site visits, and prompt action on behalf of the team. Conclusions: WhatsApp is a productive communication tool that can be used by teams and coaches to disseminate information and prompt action to improve the quality of care, but cannot replace in-person meetings. UR - http://medinform.jmir.org/2018/1/e13/ UR - http://dx.doi.org/10.2196/medinform.8154 UR - http://www.ncbi.nlm.nih.gov/pubmed/29496651 ID - info:doi/10.2196/medinform.8154 ER - TY - JOUR AU - Bond, Evan Stuart AU - Crowther, P. Shelley AU - Adhikari, Suman AU - Chubaty, J. Adriana AU - Yu, Ping AU - Borchard, P. Jay AU - Boutlis, Steven Craig AU - Yeo, Winston Wilfred AU - Miyakis, Spiros PY - 2018/02/26 TI - Evaluating the Effect of a Web-Based E-Learning Tool for Health Professional Education on Clinical Vancomycin Use: Comparative Study JO - JMIR Med Educ SP - e5 VL - 4 IS - 1 KW - nursing education KW - pharmacy education KW - medical education KW - continuing education KW - survey methods KW - antibacterial agents N2 - Background: Internet-based learning for health professional education is increasing. It offers advantages over traditional learning approaches, as it enables learning to be completed at a time convenient to the user and improves access where facilities are geographically disparate. We developed and implemented the Vancomycin Interactive (VI) e-learning tool to improve knowledge on the clinical use of the antibiotic vancomycin, which is commonly used for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Objective: The aims of this study were to evaluate the effect of the VI e-learning tool on (1) survey knowledge scores and (2) clinical use of vancomycin among health professionals. Methods: We conducted a comparative pre-post intervention study across the 14 hospitals of two health districts in New South Wales, Australia. A knowledge survey was completed by nurses, doctors, and pharmacists before and after release of a Web-based e-learning tool. Survey scores were compared with those obtained following traditional education in the form of an email intervention. Survey questions related to dosing, administration, and monitoring of vancomycin. Outcome measures were survey knowledge scores among the three health professional groups, vancomycin plasma trough levels, and vancomycin approvals recorded on a computerized clinical decision support system. Results: Survey response rates were low at 26.87% (577/2147) preintervention and 8.24% (177/2147) postintervention. The VI was associated with an increase in knowledge scores (maximum score=5) among nurses (median 2, IQR 1-2 to median 2, IQR 1-3; P<.001), but not among other professional groups. The comparator email intervention was associated with an increase in knowledge scores among doctors (median 3, IQR 2-4 to median 4, IQR 2-4; P=.04). Participants who referred to Web-based resources while completing the e-learning tool achieved higher overall scores than those who did not (P<.001). The e-learning tool was not shown to be significantly more effective than the comparator email in the clinical use of vancomycin, as measured by plasma levels within the therapeutic range. Conclusions: The e-learning tool was associated with improved knowledge scores among nurses, whereas the comparator email was associated with improved scores among doctors. This implies that different strategies may be required for optimizing the effectiveness of education among different health professional groups. Low survey response rates limited conclusions regarding the tool?s effectiveness. Improvements to design and evaluation methodology may increase the likelihood of a demonstrable effect from e-learning tools in the future. UR - http://mededu.jmir.org/2018/1/e5/ UR - http://dx.doi.org/10.2196/mededu.7719 UR - http://www.ncbi.nlm.nih.gov/pubmed/29483071 ID - info:doi/10.2196/mededu.7719 ER - TY - JOUR AU - Dumas, Audrée-Anne AU - Lapointe, Annie AU - Desroches, Sophie PY - 2018/02/20 TI - Users, Uses, and Effects of Social Media in Dietetic Practice: Scoping Review of the Quantitative and Qualitative Evidence JO - J Med Internet Res SP - e55 VL - 20 IS - 2 KW - social media KW - diet KW - review N2 - Background: Social media platforms are increasingly used by registered dietitians (RDs) to improve knowledge translation and exchange in nutrition. However, a thorough understanding of social media in dietetic practice is lacking. Objective: The objective of this study was to map and summarize the evidence about the users, uses, and effects of social media in dietetic practice to identify gaps in the literature and inform future research by using a scoping review methodology. Methods: Stages for conducting the scoping review included the following: (1) identifying the research question; (2) identifying relevant studies through a comprehensive multidatabase and gray literature search strategy; (3) selecting eligible studies; (4) charting the data; and (5) collating, summarizing, and reporting results for dissemination. Finally, knowledge users (RDs working for dietetic professional associations and public health organizations) were involved in each review stage to generate practical findings. Results: Of the 47 included studies, 34 were intervention studies, 4 were descriptive studies, 2 were content analysis studies, and 7 were expert opinion papers in dietetic practice. Discussion forums were the most frequent social media platform evaluated (n=19), followed by blogs (n=13) and social networking sites (n=10). Most studies targeted overweight and obese or healthy users, with adult populations being most studied. Social media platforms were used to deliver content as part of larger multiple component interventions for weight management. Among intervention studies using a control group with no exposition to social media, we identified positive, neutral, and mixed effects of social media for outcomes related to users? health behaviors and status (eg, dietary intakes and body weight), participation rates, and professional knowledge. Factors associated with the characteristics of the specific social media, such as ease of use, a design for quick access to desired information, and concurrent reminders of use, were perceived as the main facilitators to the use of social media in dietetic practice, followed to a lesser extent by interactions with an RD and social support from fellow users. Barriers to social media use were mostly related to complicated access to the site and time issues. Conclusions: Research on social media in dietetic practice is at its infancy, but it is growing fast. So far, this field of research has targeted few social media platforms, most of which were assessed in multiple-component interventions for weight management among overweight or obese adults. Trials isolating the effects and mechanisms of action of specific social media platforms are needed to draw conclusions regarding the effectiveness of those tools to support dietetic practice. Future studies should address barriers and facilitators related to the use of social media written by RDs and should explore how to make these tools useful for RDs to reach health consumers to improve health through diet. UR - http://www.jmir.org/2018/2/e55/ UR - http://dx.doi.org/10.2196/jmir.9230 UR - http://www.ncbi.nlm.nih.gov/pubmed/29463487 ID - info:doi/10.2196/jmir.9230 ER - TY - JOUR AU - Wieringa, Sietse AU - Engebretsen, Eivind AU - Heggen, Kristin AU - Greenhalgh, Trisha PY - 2018/02/02 TI - How Knowledge Is Constructed and Exchanged in Virtual Communities of Physicians: Qualitative Study of Mindlines Online JO - J Med Internet Res SP - e34 VL - 20 IS - 2 KW - knowledge management KW - translational medical research KW - guidelines as topic KW - evidence-based medicine KW - evidence-based practice N2 - Background: As a response to the criticisms evidence-based practice currently faces, groups of health care researchers and guideline makers have started to call for the appraisal and inclusion of different kinds of knowledge in guideline production (other than randomized controlled trials [RCTs]) to better link with the informal knowledge used in clinical practice. In an ethnographic study, Gabbay and Le May showed that clinicians in everyday practice situations do not explicitly or consciously use guidelines. Instead, they use mindlines: collectively shared, mostly tacit knowledge that is shaped by many sources, including accumulated personal experiences, education (formal and informal), guidance, and the narratives about patients that are shared among colleagues. In this study on informal knowledge, we consider virtual networks of clinicians as representative of the mindlines in the wider medical community, as holders of knowledge, as well as catalysts of knowing. Objective: The aim of this study was to explore how informal knowledge and its creation in communities of clinicians can be characterized as opposed to the more structured knowledge produced in guideline development. Methods: This study included a qualitative study of postings on three large virtual networks for physicians in the United Kingdom, the Netherlands, and Norway, taking the topic of statins as a case study and covering more than 1400 posts. Data were analyzed thematically with reference to theories of collaborative knowledge construction and communities of practice. Results: The dataset showed very few postings referring to, or seeking to adhere to, explicit guidance and recommendations. Participants presented many instances of individual case narratives that highlighted quantitative test results and clinical examination findings. There was an emphasis on outliers and the material, regulatory, and practical constraints on knowledge use by clinicians. Participants conveyed not-so-explicit knowledge as tacit and practical knowledge and used a prevailing style of pragmatic reasoning focusing on what was likely to work in a particular case. Throughout the discussions, a collective conceptualization of statins was generated and reinforced in many contexts through stories, jokes, and imagery. Conclusions: Informal knowledge and knowing in clinical communities entail an inherently collective dynamic practice that includes explicit and nonexplicit components. It can be characterized as knowledge-in-context in practice, with a strong focus on casuistry. Validity of knowledge appears not to be based on criteria of consensus, coherence, or correspondence but on a more polyphonic understanding of truth. We contend that our findings give enough ground for further research on how exploring mindlines of clinicians online could help improve guideline development processes. UR - https://www.jmir.org/2018/2/e34/ UR - http://dx.doi.org/10.2196/jmir.8325 UR - http://www.ncbi.nlm.nih.gov/pubmed/29396385 ID - info:doi/10.2196/jmir.8325 ER - TY - JOUR AU - Reid, Kathy AU - Hartling, Lisa AU - Ali, Samina AU - Le, Anne AU - Norris, Allison AU - Scott, D. Shannon PY - 2017/12/14 TI - Development and Usability Evaluation of an Art and Narrative-Based Knowledge Translation Tool for Parents With a Child With Pediatric Chronic Pain: Multi-Method Study JO - J Med Internet Res SP - e412 VL - 19 IS - 12 KW - pain KW - child health KW - parents KW - art N2 - Background: Chronic pain in childhood is increasingly being recognized as a significant clinical problem for children and their families. Previous research has identified that families want information about the causes of their child?s chronic pain, treatment options, and effective strategies to help their child cope with the pain. Unfortunately, parents have reported that finding this information can be challenging. Objective: The aim of this study was to actively work together with children attending a pediatric chronic pain clinic and their parents to develop, refine, and evaluate the usability of an art and narrative-based electronic book (e-book) for pediatric chronic pain. Methods: A multiphase, multi-method research design employing patient engagement techniques was used to develop, refine, and evaluate the usability of an art and narrative based e-book for pediatric chronic pain management to facilitate knowledge translation for parents with a child with chronic pain. The multiple phases included the following: (1) qualitative interviews to compile parents? narratives using qualitative interviews; (2) qualitative data analysis; (3) development of an e-book prototype; (4) expert clinician feedback; (5) parent usability evaluation, knowledge change, and confidence in knowledge responses using an electronic survey; (6) e-book refinement; and (7) dissemination of the e-book. Results: A 48-page e-book was developed to characterize the experiences of a family living with a child with chronic pain. The e-book was a composite narrative of the parent interviews and encompassed descriptions of the effects the condition has on each member of the family. This was merged with the best available research evidence on the day-to-day management of pediatric chronic pain. The e-book was vetted for clinical accuracy by expert pediatric pain clinicians. All parents that participated in the usability evaluation (N=14) agreed or strongly agreed the content of the e-book was easy to understand and stated that they would recommend the e-book to other families who have children with chronic pain. Our research identified up to a 21.4% increase in knowledge after using the e-book, and paired t tests demonstrated a statistically significant difference in confidence in answering two of the five knowledge questions (chronic pain is a disease involving changes in the nervous system; the use of ibuprofen is usually effective at controlling chronic pain); t13=0.165, P=.001 and t13=0.336, P=.002, respectively, after being exposed to the e-book. Conclusions: Our results demonstrate that parents positively rated an e-book developed for parents with a child with chronic pain. Our results also identify that overall, parents? knowledge increased after using the e-book, and confidence in their knowledge about chronic pain and its management increased in two aspects after e-book exposure. These results suggest that art and narrative-based knowledge translation interventions may be useful in transferring complex health information to parents. UR - http://www.jmir.org/2017/12/e412/ UR - http://dx.doi.org/10.2196/jmir.8877 UR - http://www.ncbi.nlm.nih.gov/pubmed/29242180 ID - info:doi/10.2196/jmir.8877 ER - TY - JOUR AU - Amann, Julia AU - Rubinelli, Sara PY - 2017/10/10 TI - Views of Community Managers on Knowledge Co-creation in Online Communities for People With Disabilities: Qualitative Study JO - J Med Internet Res SP - e320 VL - 19 IS - 10 KW - community networks KW - internet KW - patient-centered care KW - telemedicine KW - community participation KW - co-creation N2 - Background: The use of online communities to promote end user involvement and co-creation in the product and service innovation process is well documented in the marketing and management literature. Whereas online communities are widely used for health care service provision and peer-to-peer support, only little is known about how they could be integrated into the health care innovation process. Objective: The overall objective of this qualitative study was to explore community managers? views on and experiences with knowledge co-creation in online communities for people with disabilities. Methods: A descriptive qualitative research design was used. Data were collected through semi-structured interviews with nine community managers. To complement the interview data, additional information was retrieved from the communities in the form of structural information (number of registered users, number and names of topic areas covered by the forum) and administrative information (terms and conditions and privacy statements, forum rules). Data were analyzed using thematic analysis. Results: Our results highlight two main aspects: peer-to-peer knowledge co-creation and types of collaboration with external actors. Although community managers strongly encouraged peer-to-peer knowledge co-creation, our findings indicated that these activities were not common practice in the communities under investigation. In fact, much of what related to co-creation, prototyping, and product development was still perceived to be directed by professionals and experts. Community managers described the role of their respective communities as informing this process rather than a driving force. The role of community members as advisors to researchers, health care professionals, and businesses was discussed in the context of types of collaboration with external actors. According to the community managers, most of the external inquiries related to research projects of students or health care professionals in training, who often joined a community for the sole purpose of recruiting participants for their research. Despite this unilateral form of knowledge co-creation, community managers acknowledged the mere interest of these user groups as beneficial, as long as their interest was not purely financially motivated. Being able to contribute to advancing research, improving products, and informing the planning and design of health care services were described as some of the key motivations to engage with external stakeholders. Conclusions: This paper draws attention to the currently under-investigated role of online communities as platforms for collaboration and co-creation between patients, health care professionals, researchers, and businesses. It describes community managers? views on and experiences with knowledge co-creation and provides recommendations on how these activities can be leveraged to foster knowledge co-creation in health care. Engaging in knowledge co-creation with online health communities may ultimately help to inform the planning and design of products, services, and research activities that better meet the actual needs of those living with a disability. UR - https://www.jmir.org/2017/10/e320/ UR - http://dx.doi.org/10.2196/jmir.7406 UR - http://www.ncbi.nlm.nih.gov/pubmed/29017993 ID - info:doi/10.2196/jmir.7406 ER - TY - JOUR AU - Dyson, P. Michele AU - Newton, S. Amanda AU - Shave, Kassi AU - Featherstone, M. Robin AU - Thomson, Denise AU - Wingert, Aireen AU - Fernandes, M. Ricardo AU - Hartling, Lisa PY - 2017/09/01 TI - Social Media for the Dissemination of Cochrane Child Health Evidence: Evaluation Study JO - J Med Internet Res SP - e308 VL - 19 IS - 9 KW - social media KW - translational medical research KW - health knowledge, attitudes, practice KW - pediatrics N2 - Background: Health care providers value ready access to reliable synthesized information to support point-of-care decision making. Web-based communities, facilitated by the adoption of social media tools such as Facebook, Twitter, and YouTube, are increasingly being used for knowledge dissemination, bridging the gap between knowledge generation and synthesis and knowledge implementation. Objective: Our objective was to implement and evaluate a structured social media strategy, using multiple platforms, to disseminate Cochrane Child Health evidence to health care providers caring for children. Methods: Our social media strategy had three components: daily ?tweets? using the Cochrane Child Health Twitter account, weekly WordPress blog posts, and a monthly journal club on Twitter (?tweet chat?). Each tweet, blog, and journal club shared Cochrane evidence on a child health topic. We evaluated the strategy through (1) Twitter and blog site analytics, (2) traceable link (Bitly) statistics, (3) Altmetric.com scores for promoted evidence, and (4) participant feedback. We also tracked the resources required to write the blog, tweet content, and manage the strategy. Results: The 22-week social media strategy ran between November 2014 and April 2015. We created 25 blog posts, sent 585 tweets, and hosted 3 tweet chats. Monthly blog visits and views and Twitter account followers increased over time. During the study period, the blog received 2555 visitors and 3967 page views from a geographically diverse audience of health care providers, academics, and health care organizations. In total, 183 traceable Bitly links received 3463 clicks, and the Twitter account gained 469 new followers. The most visited and viewed blog posts included gastrointestinal topics (lactose avoidance), research on respiratory conditions (honey for cough and treatments for asthma), and maternal newborn care (skin-to-skin contact). On Twitter, popular topics were related to public health (vaccination) and pain management. We collected Altmetric.com scores for 61 studies promoted during the study period and recorded an average increase of 11 points. Research staff (n=3) contributed approximately 433 hours to promotion activities and planning (6.5 hours each per week) to implement the social media strategy, and study investigators reviewed all content (blog posts and tweets). Conclusions: This study provides empirical evidence on the use of a coordinated social media strategy for the dissemination of evidence to professionals providing health services to children and youth. The results and lessons learned from our study provide guidance for future knowledge dissemination activities using social media tools. UR - http://www.jmir.org/2017/9/e308/ UR - http://dx.doi.org/10.2196/jmir.7819 UR - http://www.ncbi.nlm.nih.gov/pubmed/28864427 ID - info:doi/10.2196/jmir.7819 ER - TY - JOUR AU - Leese, Jenny AU - Kerr, Sheila AU - McKinnon, Annette AU - Carruthers, Erin AU - Backman, Catherine AU - Li, Linda AU - Townsend, Anne PY - 2017/08/04 TI - Evolving Patient-Researcher Collaboration: An Illustrative Case Study of a Patient-Led Knowledge Translation Event JO - J Participat Med SP - e13 VL - 9 IS - 1 KW - Patient engagement KW - research collaboration KW - knowledge translation KW - patient-led UR - http://jopm.jmir.org/2017/1/e13/ UR - http://dx.doi.org/10.2196/jopm.8756 UR - http://www.ncbi.nlm.nih.gov/pubmed/36262007 ID - info:doi/10.2196/jopm.8756 ER - TY - JOUR AU - Roland, Damian AU - Spurr, Jesse AU - Cabrera, Daniel PY - 2017/07/14 TI - Preliminary Evidence for the Emergence of a Health Care Online Community of Practice: Using a Netnographic Framework for Twitter Hashtag Analytics JO - J Med Internet Res SP - e252 VL - 19 IS - 7 KW - social media KW - network KW - community networks KW - community of practice KW - #FOAMed KW - Twitter N2 - Background: Online communities of practice (oCoPs) may emerge from interactions on social media. These communities offer an open digital space and flat role hierarchy for information sharing and provide a strong group identity, rapid flow of information, content curation, and knowledge translation. To date, there is only a small body of evidence in medicine or health care to verify the existence of an oCoP. Objective: We aimed to examine the emergence of an oCoP through the study of social media interactions of the free open access medical education (FOAM) movement. Methods: We examined social media activity in Twitter by analyzing the network centrality metrics of tweets with the #FOAMed hashtag and compared them with previously validated criteria of a community of practice (CoP). Results: The centrality analytics of the FOAM community showed concordance with aspects of a general CoP (in terms of community, domain, and practice), as well as some specific traits of a health care community, including social control, common purpose, flat hierarchy, and network-based and concrete achievement. Conclusions: This study demonstrated preliminary evidence of an oCoP focused on education and based on social media interactions. Further examination of the topology of the network is needed to definitely prove the existence of an oCoP. Given that these communities result in significant knowledge translation and practice change, further research in this area appears warranted. UR - http://www.jmir.org/2017/7/e252/ UR - http://dx.doi.org/10.2196/jmir.7072 UR - http://www.ncbi.nlm.nih.gov/pubmed/28710054 ID - info:doi/10.2196/jmir.7072 ER - TY - JOUR AU - Damarell, A. Raechel AU - Tieman, J. Jennifer PY - 2017/07/13 TI - How Do Clinicians Learn About Knowledge Translation? An Investigation of Current Web-Based Learning Opportunities JO - JMIR Med Educ SP - e12 VL - 3 IS - 2 KW - knowledge KW - translational medical research KW - diffusion of innovation KW - health personnel KW - education, medical, continuing KW - quality assurance, health care N2 - Background: Clinicians are important stakeholders in the translation of well-designed research evidence into clinical practice for optimal patient care. However, the application of knowledge translation (KT) theories and processes may present conceptual and practical challenges for clinicians. Online learning platforms are an effective means of delivering KT education, providing an interactive, time-efficient, and affordable alternative to face-to-face education programs. Objective: This study investigates the availability and accessibility of online KT learning opportunities for health professionals. It also provides an analysis of the types of resources and associated disciplines retrieved by a range of KT synonyms. Methods: We searched a range of bibliographic databases and the Internet (Google advanced option) using 9 KT terms to identify online KT learning resources. To be eligible, resources had to be free, aimed at clinicians, educational in intent, and interactive in design. Each term was searched using two different search engines. The details of the first 100 websites captured per browser (ie, n=200 results per term) were entered into EndNote. Each site was subsequently visited to determine its status as a learning resource. Eligible websites were appraised for quality using the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) tool. Results: We identified 971 unique websites via our multiple search strategies. Of these, 43 were health-related and educational in intent. Once these sites were evaluated for interactivity, a single website matched our inclusion criteria (Dementia Knowledge Translation Learning Centre). Conclusions: KT is an important but complex system of processes. These processes overlap with knowledge, practice, and improvement processes that go by a range of different names. For clinicians to be informed and competent in KT, they require better access to free learning opportunities. These resources should be designed from the viewpoint of the clinician, presenting KT?s multifaceted theories and processes in an engaging, interactive way. This learning should empower clinicians to contextualize and apply KT strategies within their own care settings. UR - http://mededu.jmir.org/2017/2/e12/ UR - http://dx.doi.org/10.2196/mededu.7825 UR - http://www.ncbi.nlm.nih.gov/pubmed/28705788 ID - info:doi/10.2196/mededu.7825 ER - TY - JOUR AU - Liang, Jun AU - Wei, Kunyan AU - Meng, Qun AU - Chen, Zhenying AU - Zhang, Jiajie AU - Lei, Jianbo PY - 2017/06/21 TI - The Gap in Medical Informatics and Continuing Education Between the United States and China: A Comparison of Conferences in 2016 JO - J Med Internet Res SP - e224 VL - 19 IS - 6 KW - medical informatics KW - conferences KW - continuing education KW - Sino-American comparison N2 - Background: China launched its second health reform in 2010 with considerable investments in medical informatics (MI). However, to the best of our knowledge, research on the outcomes of this ambitious undertaking has been limited. Objective: Our aim was to understand the development of MI and the state of continuing education in China and the United States from the perspective of conferences. Methods: We conducted a quantitative and qualitative analysis of four MI conferences in China and two in the United States: China Medical Information Association Annual Symposium (CMIAAS), China Hospital Information Network Annual Conference (CHINC), China Health Information Technology Exchange Annual Conference (CHITEC), China Annual Proceeding of Medical Informatics (CPMI) versus the American Medical Informatics Association (AMIA) and Healthcare Information and Management Systems Society (HIMSS). The scale, composition, and regional distribution of attendees, topics, and research fields for each conference were summarized and compared. Results: CMIAAS and CPMI are mainstream academic conferences, while CHINC and CHITEC are industry conferences in China. Compared to HIMSS 2016, the meeting duration of CHITEC was 3 versus 5 days, the number of conference sessions was 132 versus 950+, the number of attendees was 5000 versus 40,000+, the number of vendors was 152 versus 1400+, the number of subforums was 12 versus 230, the number of preconference education symposiums and workshops was 0 versus 12, and the duration of preconference educational symposiums and workshops was 0 versus 1 day. Compared to AMIA, the meeting duration of Chinese CMIAAS was 2 versus 5 days, the number of conference sessions was 42 versus 110, the number of attendees was 200 versus 2500+, the number of vendors was 5 versus 75+, and the number of subforums was 4 versus 10. The number of preconference tutorials and working groups was 0 versus 29, and the duration of tutorials and working group was 0 versus 1.5 days. Conclusions: Given the size of the Chinese economy and the substantial investment in MI, the output in terms of conferences remains low. The impact of conferences on continuing education to professionals is not significant. Chinese researchers and professionals should approach MI with greater rigor, including validated research methods, formal training, and effective continuing education, in order to utilize knowledge gained by other countries and to expand collaboration. UR - http://www.jmir.org/2017/6/e224/ UR - http://dx.doi.org/10.2196/jmir.8014 UR - http://www.ncbi.nlm.nih.gov/pubmed/28637638 ID - info:doi/10.2196/jmir.8014 ER - TY - JOUR AU - Hébert, Jessica AU - Robitaille, Hubert AU - Turcotte, Stéphane AU - Légaré, France PY - 2017/02/24 TI - Online Dissemination Strategies of a Canada Research Chair: Overview and Lessons Learned JO - JMIR Res Protoc SP - e27 VL - 6 IS - 2 KW - social media KW - knowledge translation KW - shared decision making KW - online dissemination KW - knowledge dissemination N2 - Background: Little is known about the use of online dissemination strategies, such as websites and social media, to increase the visibility and uptake of research. Objective: To describe two online dissemination strategies of the Canada Research Chair in Implementation of Shared Decision Making in Primary Care over an eight-year period. Methods: Our two sources of online dissemination data were the website of the Canada Research Chair in Implementation of Shared Decision Making in Primary Care and the Chair?s Twitter account. We conducted a content analysis of the news section of the website. We extracted website usage statistics using Google Analytics and analyzed indicators such as total number of visits, new and returning visitors, page views per visit, time spent onsite per visit, visitors? country of origin, and most popular pages. From the Chair?s Twitter account, we collected the number of tweets, followers, and follows. We consulted Google Scholar to chart the trend in citations of the Chair?s articles over the same period. Results: From the website?s inception in January 2008 to December 2015, we recorded an average of 7906 visits per year (3809 in 2008; 8874 in 2015), 65.85% of which involved new visitors (5206/7906). The average number of pages viewed per visit was 3.2 and average bounce rate was 57.87% (4575/7906). Visitors spent an average of two minutes and 12 seconds per visit. We computed visits from 162 countries, with the majority from Canada (5910/7906, 74.75%). In order of frequency, the seven most visited pages were: (1) home page with news of publications and grants (24,787 visits), (2) profile of Chairholder (8041 visits), (3) profiles of research team members (6272 visits), (4) list of research team members (4593 visits), (5) inventory of shared decision making (SDM) programs (1856 visits), (6) interprofessional approaches to SDM (1689 visits), and (7) description of Chair activities (1350 visits). From the inception of the Twitter account in April 2011 to November 30, 2016 we recorded 5831 tweets in French and English, 1679 followers, and 1112 follows. The total number of visits and visitors to the website increased during the first three years, stabilized, and then dropped slightly, while the number of returning visitors rose slightly. In comparison, citations of the Chair?s articles increased steadily over the same period, rising more sharply as visits to the website declined. Conclusions: Over an eight-year period, visitors to the website increased in the first three years before levelling off. Meanwhile, the Chair?s citations rose continuously. There was no observable association between website visits or Twitter activity and rising citations. Our results suggest that online dissemination may not yet be a major determinant of research uptake or visibility in the scientific community. UR - http://www.researchprotocols.org/2017/2/e27/ UR - http://dx.doi.org/10.2196/resprot.6413 UR - http://www.ncbi.nlm.nih.gov/pubmed/28235751 ID - info:doi/10.2196/resprot.6413 ER - TY - JOUR AU - De Angelis, Gino AU - Davies, Barbara AU - King, Judy AU - McEwan, Jessica AU - Cavallo, Sabrina AU - Loew, Laurianne AU - Wells, A. George AU - Brosseau, Lucie PY - 2016/11/30 TI - Information and Communication Technologies for the Dissemination of Clinical Practice Guidelines to Health Professionals: A Systematic Review JO - JMIR Med Educ SP - e16 VL - 2 IS - 2 KW - health information technologies KW - electronic mail KW - email KW - Web 2.0 KW - practice guidelines KW - health professions KW - information dissemination N2 - Background: The transfer of research knowledge into clinical practice can be a continuous challenge for researchers. Information and communication technologies, such as websites and email, have emerged as popular tools for the dissemination of evidence to health professionals. Objective: The objective of this systematic review was to identify research on health professionals? perceived usability and practice behavior change of information and communication technologies for the dissemination of clinical practice guidelines. Methods: We used a systematic approach to retrieve and extract data about relevant studies. We identified 2248 citations, of which 21 studies met criteria for inclusion; 20 studies were randomized controlled trials, and 1 was a controlled clinical trial. The following information and communication technologies were evaluated: websites (5 studies), computer software (3 studies), Web-based workshops (2 studies), computerized decision support systems (2 studies), electronic educational game (1 study), email (2 studies), and multifaceted interventions that consisted of at least one information and communication technology component (6 studies). Results: Website studies demonstrated significant improvements in perceived usefulness and perceived ease of use, but not for knowledge, reducing barriers, and intention to use clinical practice guidelines. Computer software studies demonstrated significant improvements in perceived usefulness, but not for knowledge and skills. Web-based workshop and email studies demonstrated significant improvements in knowledge, perceived usefulness, and skills. An electronic educational game intervention demonstrated a significant improvement from baseline in knowledge after 12 and 24 weeks. Computerized decision support system studies demonstrated variable findings for improvement in skills. Multifaceted interventions demonstrated significant improvements in beliefs about capabilities, perceived usefulness, and intention to use clinical practice guidelines, but variable findings for improvements in skills. Most multifaceted studies demonstrated significant improvements in knowledge. Conclusions: The findings suggest that health professionals? perceived usability and practice behavior change vary by type of information and communication technology. Heterogeneity and the paucity of properly conducted studies did not allow for a clear comparison between studies and a conclusion on the effectiveness of information and communication technologies as a knowledge translation strategy for the dissemination of clinical practice guidelines. UR - http://mededu.jmir.org/2016/2/e16/ UR - http://dx.doi.org/10.2196/mededu.6288 UR - http://www.ncbi.nlm.nih.gov/pubmed/27903488 ID - info:doi/10.2196/mededu.6288 ER - TY - JOUR AU - Hand, K. Rosa AU - Kenne, Deric AU - Wolfram, M. Taylor AU - Abram, K. Jenica AU - Fleming, Michael PY - 2016/11/15 TI - Assessing the Viability of Social Media for Disseminating Evidence-Based Nutrition Practice Guideline Through Content Analysis of Twitter Messages and Health Professional Interviews: An Observational Study JO - J Med Internet Res SP - e295 VL - 18 IS - 11 KW - social media KW - information dissemination KW - medical nutrition therapy KW - evidence-based medicine KW - heart failure N2 - Background: Given the high penetration of social media use, social media has been proposed as a method for the dissemination of information to health professionals and patients. This study explored the potential for social media dissemination of the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline (EBNPG) for Heart Failure (HF). Objectives: The objectives were to (1) describe the existing social media content on HF, including message content, source, and target audience, and (2) describe the attitude of physicians and registered dietitian nutritionists (RDNs) who care for outpatient HF patients toward the use of social media as a method to obtain information for themselves and to share this information with patients. Methods: The methods were divided into 2 parts. Part 1 involved conducting a content analysis of tweets related to HF, which were downloaded from Twitonomy and assigned codes for message content (19 codes), source (9 codes), and target audience (9 codes); code frequency was described. A comparison in the popularity of tweets (those marked as favorites or retweeted) based on applied codes was made using t tests. Part 2 involved conducting phone interviews with RDNs and physicians to describe health professionals? attitude toward the use of social media to communicate general health information and information specifically related to the HF EBNPG. Interviews were transcribed and coded; exemplar quotes representing frequent themes are presented. Results: The sample included 294 original tweets with the hashtag ?#heartfailure.? The most frequent message content codes were ?HF awareness? (166/294, 56.5%) and ?patient support? (97/294, 33.0%). The most frequent source codes were ?professional, government, patient advocacy organization, or charity? (112/277, 40.4%) and ?patient or family? (105/277, 37.9%). The most frequent target audience codes were ?unable to identify? (111/277, 40.1%) and ?other? (55/277, 19.9%). Significant differences were found in the popularity of tweets with (mean 1, SD 1.3 favorites) or without (mean 0.7, SD 1.3 favorites), the content code being ?HF research? (P=.049). Tweets with the source code ?professional, government, patient advocacy organizations, or charities? were significantly more likely to be marked as a favorite and retweeted than those without this source code (mean 1.2, SD 1.4 vs mean 0.8, SD 1.2, P=.03) and (mean 1.5, SD 1.8 vs mean 0.9, SD 2.0, P=.03). Interview participants believed that social media was a useful way to gather professional information. They did not believe that social media was useful for communicating with patients due to privacy concerns and the fact that the information had to be kept general rather than be tailored for a specific patient and the belief that their patients did not use social media or technology. Conclusions: Existing Twitter content related to HF comes from a combination of patients and evidence-based organizations; however, there is little nutrition content. That gap may present an opportunity for EBNPG dissemination. Health professionals use social media to gather information for themselves but are skeptical of its value when communicating with patients, particularly due to privacy concerns and misconceptions about the characteristics of social media users. UR - http://www.jmir.org/2016/11/e295/ UR - http://dx.doi.org/10.2196/jmir.5811 UR - http://www.ncbi.nlm.nih.gov/pubmed/27847349 ID - info:doi/10.2196/jmir.5811 ER - TY - JOUR AU - Johnson, Emily AU - Emani, K. Vamsi AU - Ren, Jinma PY - 2016/10/12 TI - Breadth of Coverage, Ease of Use, and Quality of Mobile Point-of-Care Tool Information Summaries: An Evaluation JO - JMIR Mhealth Uhealth SP - e117 VL - 4 IS - 4 KW - mHealth KW - mobile health KW - mobile app KW - assessment KW - internal medicine KW - point-of-care tools N2 - Background: With advances in mobile technology, accessibility of clinical resources at the point of care has increased. Objective: The objective of this research was to identify if six selected mobile point-of-care tools meet the needs of clinicians in internal medicine. Point-of-care tools were evaluated for breadth of coverage, ease of use, and quality. Methods: Six point-of-care tools were evaluated utilizing four different devices (two smartphones and two tablets). Breadth of coverage was measured using select International Classification of Diseases, Ninth Revision, codes if information on summary, etiology, pathophysiology, clinical manifestations, diagnosis, treatment, and prognosis was provided. Quality measures included treatment and diagnostic inline references and individual and application time stamping. Ease of use covered search within topic, table of contents, scrolling, affordance, connectivity, and personal accounts. Analysis of variance based on the rank of score was used. Results: Breadth of coverage was similar among Medscape (mean 6.88), Uptodate (mean 6.51), DynaMedPlus (mean 6.46), and EvidencePlus (mean 6.41) (P>.05) with DynaMed (mean 5.53) and Epocrates (mean 6.12) scoring significantly lower (P<.05). Ease of use had DynaMedPlus with the highest score, and EvidencePlus was lowest (6.0 vs 4.0, respectively, P<.05). For quality, reviewers rated the same score (4.00) for all tools except for Medscape, which was rated lower (P<.05). Conclusions: For breadth of coverage, most point-of-care tools were similar with the exception of DynaMed. For ease of use, only UpToDate and DynaMedPlus allow for search within a topic. All point-of-care tools have remote access with the exception of UpToDate and Essential Evidence Plus. All tools except Medscape covered criteria for quality evaluation. Overall, there was no significant difference between the point-of-care tools with regard to coverage on common topics used by internal medicine clinicians. Selection of point-of-care tools is highly dependent on individual preference based on ease of use and cost of the application. UR - http://mhealth.jmir.org/2016/4/e117/ UR - http://dx.doi.org/10.2196/mhealth.6189 UR - http://www.ncbi.nlm.nih.gov/pubmed/27733328 ID - info:doi/10.2196/mhealth.6189 ER - TY - JOUR AU - Shibasaki, Sanchia AU - Gardner, Karen AU - Sibthorpe, Beverly PY - 2016/10/05 TI - Using Knowledge Translation to Craft ?Sticky? Social Media Health Messages That Provoke Interest, Raise Awareness, Impart Knowledge, and Inspire Change JO - JMIR Mhealth Uhealth SP - e115 VL - 4 IS - 4 KW - knowledge translation KW - social media KW - Indigenous health KW - health promotion N2 - Background: In Australia, there is growing use of technology supported knowledge translation (KT) strategies such as social media and mobile apps in health promotion and in Indigenous health. However, little is known about how individuals use technologies and the evidence base for the impact of these health interventions on health behavior change is meager. Objective: The objective of our study was to examine how Facebook is used to promote health messages to Indigenous people and discuss how KT can support planning and implementing health messages to ensure chosen strategies are fit for the purpose and achieve impact. Methods: A desktop audit of health promotion campaigns on smoking prevention and cessation for Australian Indigenous people using Facebook was conducted. Results: Our audit identified 13 out of 21 eligible campaigns that used Facebook. Facebook pages with the highest number of likes (more than 5000) were linked to a website and to other social media applications and demonstrated stickiness characteristics by posting frequently (triggers and unexpected), recruiting sporting or public personalities to promote campaigns (social currency and public), recruiting Indigenous people from the local region (stories and emotion), and sharing stories and experiences based on real-life events (credible and practical value). Conclusions: KT planning may support campaigns to identify and select KT strategies that are best suited and well-aligned to the campaign?s goals, messages, and target audiences. KT planning can also help mitigate unforeseen and expected risks, reduce unwarranted costs and expenses, achieve goals, and limit the peer pressure of using strategies that may not be fit for purpose. One of the main challenges in using KT systems and processes involves coming to an adequate conceptualization of the KT process itself. UR - http://mhealth.jmir.org/2016/4/e115/ UR - http://dx.doi.org/10.2196/mhealth.5987 UR - http://www.ncbi.nlm.nih.gov/pubmed/27707685 ID - info:doi/10.2196/mhealth.5987 ER - TY - JOUR AU - Laws, A. Rachel AU - Litterbach, V. Eloise-Kate AU - Denney-Wilson, A. Elizabeth AU - Russell, G. Catherine AU - Taki, Sarah AU - Ong, Kok-Leong AU - Elliott, M. Rosalind AU - Lymer, J. Sharyn AU - Campbell, J. Karen PY - 2016/09/15 TI - A Comparison of Recruitment Methods for an mHealth Intervention Targeting Mothers: Lessons from the Growing Healthy Program JO - J Med Internet Res SP - e248 VL - 18 IS - 9 KW - recruitment KW - mHealth KW - parents KW - social media KW - obesity prevention KW - infant feeding KW - children KW - infants KW - practitioners KW - primary health care N2 - Background: Mobile health (mHealth) programs hold great promise for increasing the reach of public health interventions. However, mHealth is a relatively new field of research, presenting unique challenges for researchers. A key challenge is understanding the relative effectiveness and cost of various methods of recruitment to mHealth programs. Objective: The objectives of this study were to (1) compare the effectiveness of various methods of recruitment to an mHealth intervention targeting healthy infant feeding practices, and (2) explore factors influencing practitioner referral to the intervention. Methods: The Growing healthy study used a quasi-experimental design with an mHealth intervention group and a concurrent nonrandomized comparison group. Eligibility criteria included: expectant parents (>30 weeks of gestation) or parents with an infant <3 months old, ability to read and understand English, own a mobile phone, ?18 years old, and living in Australia. Recruitment to the mHealth program consisted of: (1) practitioner-led recruitment through Maternal and Child Health nurses, midwives, and nurses in general practice; (2) face-to-face recruitment by researchers; and (3) online recruitment. Participants? baseline surveys provided information regarding how participants heard about the study, and their sociodemographic details. Costs per participant recruited were calculated by taking into account direct advertising costs and researcher time/travel costs. Practitioner feedback relating to the recruitment process was obtained through a follow-up survey and qualitative interviews. Results: A total of 300 participants were recruited to the mHealth intervention. The cost per participant recruited was lowest for online recruitment (AUD $14) and highest for practice nurse recruitment (AUD $586). Just over half of the intervention group (50.3%, 151/300) were recruited online over a 22-week period compared to practitioner recruitment (29.3%, 88/300 over 46 weeks) and face-to-face recruitment by researchers (7.3%, 22/300 over 18 weeks). No significant differences were observed in participant sociodemographic characteristics between recruitment methods, with the exception that practitioner/face-to-face recruitment resulted in a higher proportion of first-time parents (68% versus 48%, P=.002). Less than half of the practitioners surveyed reported referring to the program often or most of the time. Key barriers to practitioner referral included lack of time, difficulty remembering to refer, staff changes, lack of parental engagement, and practitioner difficulty in accessing the app. Conclusions: Online recruitment using parenting-related Facebook pages was the most cost effective and timely method of recruitment to an mHealth intervention targeting parents of young infants. Consideration needs to be given to addressing practitioner barriers to referral, to further explore if this can be a viable method of recruitment. UR - http://www.jmir.org/2016/9/e248/ UR - http://dx.doi.org/10.2196/jmir.5691 UR - http://www.ncbi.nlm.nih.gov/pubmed/27634633 ID - info:doi/10.2196/jmir.5691 ER - TY - JOUR AU - Valdez Soto, Miguel AU - Balls-Berry, E. Joyce AU - Bishop, G. Shawn AU - Aase, A. Lee AU - Timimi, K. Farris AU - Montori, M. Victor AU - Patten, A. Christi PY - 2016/09/09 TI - Use of Web 2.0 Social Media Platforms to Promote Community-Engaged Research Dialogs: A Preliminary Program Evaluation JO - JMIR Res Protoc SP - e183 VL - 5 IS - 3 KW - Web 2.0 KW - social media KW - platforms KW - analytics KW - community KW - engagement KW - stakeholders KW - WordPress KW - Twitter KW - Facebook N2 - Background: Community-engaged research is defined by the Institute of Medicine as the process of working collaboratively with groups of people affiliated by geographic proximity, special interests, or similar situations with respect to issues affecting their well-being. Traditional face-to-face community-engaged research is limited by geographic location, limited in resources, and/or uses one-way communications. Web 2.0 technologies including social media are novel communication channels for community-engaged research because these tools can reach a broader audience while promoting bidirectional dialogs. Objective: This paper reports on a preliminary program evaluation of the use of social media platforms for promoting engagement of researchers and community representatives in dialogs about community-engaged research. Methods: For this pilot program evaluation, the Clinical and Translational Science Office for Community Engagement in Research partnered with the Social Media Network at our institution to create a WordPress blog and Twitter account. Both social media platforms were facilitated by a social media manager. We used descriptive analytics for measuring engagement with WordPress and Twitter over an 18-month implementation period during 2014-2016. For the blog, we examined type of user (researcher, community representative, other) and used content analysis to generate the major themes from blog postings. For use of Twitter, we examined selected demographics and impressions among followers. Results: There were 76 blog postings observed from researchers (48/76, 64%), community representatives (23/76, 32%) and funders (5/76, 8%). The predominant themes of the blog content were research awareness and dissemination of community-engaged research (35/76, 46%) and best practices (23/76, 30%). For Twitter, we obtained 411 followers at the end of the 18-month evaluation period, with an increase of 42% (from 280 to 411) over the final 6 months. Followers reported varied geographic location (321/411, 78%, resided in the United States); 99% (407/411) spoke English; and about half (218/411, 53%) were female. Followers produced 132,000 Twitter impressions. Conclusions: Researchers and community stakeholders use social medial platforms for dialogs related to community-engaged research. This preliminary work is novel because we used Web 2.0 social media platforms to engage these stakeholders whereas prior work used face-to-face formats. Future research is needed to explore additional social media platforms; expanded reach to other diverse stakeholders including patients, providers, and payers; and additional outcomes related to engagement. UR - http://www.researchprotocols.org/2016/3/e183/ UR - http://dx.doi.org/10.2196/resprot.4808 UR - http://www.ncbi.nlm.nih.gov/pubmed/27613231 ID - info:doi/10.2196/resprot.4808 ER - TY - JOUR AU - M Barbara, Angela AU - Dobbins, Maureen AU - Haynes, Brian R. AU - Iorio, Alfonso AU - Lavis, N. John AU - Levinson, J. Anthony PY - 2016/08/19 TI - User Experiences of the McMaster Optimal Aging Portal?s Evidence Summaries and Blog Posts: Usability Study JO - JMIR Hum Factors SP - e22 VL - 3 IS - 2 KW - Web-based health information KW - consumer health information KW - usability testing KW - knowledge translation KW - aging N2 - Background: Evidence summaries and blogs can support evidence-informed healthy aging, by presenting high-quality health research evidence in plain language for a nonprofessional (citizen) audience. Objective: Our objective was to explore citizens? perceptions about the usability of evidence summaries and blog posts on the Web-based McMaster Optimal Aging Portal. Methods: Twenty-two citizens (aged 50 years and older) and informal caregivers participated in a qualitative study using a think-aloud method and semistructured interviews. Eleven interviews were conducted in person, 7 over the telephone, and 4 by Skype. Results: We identified themes that fell under 4 user-experience categories: (1) desirability: personal relevance, (2) understandability: language comprehension, grasping the message, dealing with uncertainty, (3) usability: volume of information, use of numbers, and (4) usefulness: intention to use, facility for sharing. Conclusions: Participants recognized that high-quality evidence on aging was valuable. Their intended use of the information was influenced by how much it applied to their own health circumstances or those of a loved one. Some specific formatting features that were preferred included consistent layout, content organized by subheadings, catchy titles, numerical information summarized in a table, and inclusion of a glossary. UR - http://humanfactors.jmir.org/2016/2/e22/ UR - http://dx.doi.org/10.2196/humanfactors.6208 UR - http://www.ncbi.nlm.nih.gov/pubmed/27542995 ID - info:doi/10.2196/humanfactors.6208 ER - TY - JOUR AU - Winandy, Marcel AU - Kostkova, Patty AU - de Quincey, Ed AU - St Louis, Connie AU - Szomszor, Martin PY - 2016/07/19 TI - Follow #eHealth2011: Measuring the Role and Effectiveness of Online and Social Media in Increasing the Outreach of a Scientific Conference JO - J Med Internet Res SP - e191 VL - 18 IS - 7 KW - social media KW - social media networks KW - Web conferencing KW - marketing N2 - Background: Social media promotion is increasingly adopted by organizers of industry and academic events; however, the success of social media strategies is rarely questioned or the real impact scientifically analyzed. Objective: We propose a framework that defines and analyses the impact, outreach, and effectiveness of social media for event promotion and research dissemination to participants of a scientific event as well as to the virtual audience through the Web. Methods: Online communication channels Twitter, Facebook, Flickr, and a Liveblog were trialed and their impact measured on outreach during five phases of an eHealth conference: the setup, active and last-minute promotion phases before the conference, the actual event, and after the conference. Results: Planned outreach through online channels and social media before and during the event reached an audience several magnitudes larger in size than would have been possible using traditional means. In the particular case of eHealth 2011, the outreach using traditional means would have been 74 attendees plus 23 extra as sold proceedings and the number of downloaded articles from the online proceedings (4107 until October 2013). The audience for the conference reached via online channels and social media was estimated at more than 5300 in total during the event. The role of Twitter for promotion before the event was complemented by an increased usage of the website and Facebook during the event followed by a sharp increase of views of posters on Flickr after the event. Conclusions: Although our case study is focused on a particular audience around eHealth 2011, our framework provides a template for redefining ?audience? and outreach of events, merging traditional physical and virtual communities and providing an outline on how these could be successfully reached in clearly defined event phases. UR - http://www.jmir.org/2016/7/e191/ UR - http://dx.doi.org/10.2196/jmir.4480 UR - http://www.ncbi.nlm.nih.gov/pubmed/27436012 ID - info:doi/10.2196/jmir.4480 ER - TY - JOUR AU - Janssen, Anna AU - Robinson, Elizabeth Tracy AU - Provan, Pamela AU - Shaw, Tim PY - 2016/06/29 TI - The Sydney West Knowledge Portal: Evaluating the Growth of a Knowledge Portal to Support Translational Research JO - J Med Internet Res SP - e170 VL - 18 IS - 6 KW - knowledge management KW - web-based collaborative networks KW - translational research KW - cancer KW - capacity building KW - enabling factors N2 - Background: The Sydney West Translational Cancer Research Centre is an organization funded to build capacity for translational research in cancer. Translational research is essential for ensuring the integration of best available evidence into practice and for improving patient outcomes. However, there is a low level of awareness regarding what it is and how to conduct it optimally. One solution to addressing this gap is the design and deployment of web-based knowledge portals to disseminate new knowledge and engage with and connect dispersed networks of researchers. A knowledge portal is an web-based platform for increasing knowledge dissemination and management in a specialized area. Objective: To measure the design and growth of an web-based knowledge portal for increasing individual awareness of translational research and to build organizational capacity for the delivery of translational research projects in cancer. Methods: An adaptive methodology was used to capture the design and growth of an web-based knowledge portal in cancer. This involved stakeholder consultations to inform initial design of the portal. Once the portal was live, site analytics were reviewed to evaluate member usage of the portal and to measure growth in membership. Results: Knowledge portal membership grew consistently for the first 18 months after deployment, before leveling out. Analysis of site metrics revealed members were most likely to visit portal pages with community-generated content, particularly pages with a focus on translational research. This was closely followed by pages that disseminated educational material about translational research. Conclusions: Preliminary data from this study suggest that knowledge portals may be beneficial tools for translating new evidence and fostering an environment of communication and collaboration. UR - http://www.jmir.org/2016/6/e170/ UR - http://dx.doi.org/10.2196/jmir.5786 UR - http://www.ncbi.nlm.nih.gov/pubmed/27357641 ID - info:doi/10.2196/jmir.5786 ER - TY - JOUR AU - Shafer, R. Paul AU - Davis, C. Kevin AU - Patel, Deesha AU - Rodes, Robert AU - Beistle, Diane PY - 2016/02/17 TI - Association Between Media Dose, Ad Tagging, and Changes in Web Traffic for a National Tobacco Education Campaign: A Market-Level Longitudinal Study JO - J Med Internet Res SP - e39 VL - 18 IS - 2 KW - Internet KW - advertising KW - health communication KW - smoking cessation KW - public health KW - tobacco control N2 - Background: In 2012, the US Centers for Disease Control and Prevention (CDC) launched Tips From Former Smokers (Tips), the first federally funded national tobacco education campaign. In 2013, a follow-up Tips campaign aired on national cable television networks, radio, and other channels, with supporting digital advertising to drive traffic to the Tips campaign website. Objective: The objective of this study was to use geographic and temporal variability in 2013 Tips campaign television media doses and ad tagging to evaluate changes in traffic to the campaign website in response to specific doses of campaign media. Methods: Linear regression models were used to estimate the dose-response relationship between weekly market-level television gross rating points (GRPs) and weekly Web traffic to the Tips campaign website. This relationship was measured using unique visitors, total visits, and page views as outcomes. Ad GRP effects were estimated separately for ads tagged with the Tips campaign website URL and 1-800-QUIT-NOW. Results: In the average media market, an increase of 100 television GRPs per week for ads tagged with the Tips campaign website URL was associated with an increase of 650 unique visitors (P<.001), 769 total visits (P<.001), and 1255 total page views (P<.001) per week. The associations between GRPs for ads tagged with 1-800-QUIT-NOW and each Web traffic measure were also statistically significant (P<.001), but smaller in magnitude. Conclusions: Based on these findings, we estimate that the 16-week 2013 Tips television campaign generated approximately 660,000 unique visitors, 900,000 total visits, and 1,390,000 page views for the Tips campaign website. These findings can help campaign planners forecast the likely impact of targeted advertising efforts on consumers? use of campaign-specific websites. UR - http://www.jmir.org/2016/2/e39/ UR - http://dx.doi.org/10.2196/jmir.5343 UR - http://www.ncbi.nlm.nih.gov/pubmed/26887959 ID - info:doi/10.2196/jmir.5343 ER - TY - JOUR AU - Kwag, Hyogene Koren AU - González-Lorenzo, Marien AU - Banzi, Rita AU - Bonovas, Stefanos AU - Moja, Lorenzo PY - 2016/01/19 TI - Providing Doctors With High-Quality Information: An Updated Evaluation of Web-Based Point-of-Care Information Summaries JO - J Med Internet Res SP - e15 VL - 18 IS - 1 KW - point-of-care summaries KW - internet information KW - evidence-based medicine KW - information science N2 - Background: The complexity of modern practice requires health professionals to be active information-seekers. Objective: Our aim was to review the quality and progress of point-of-care information summaries?Web-based medical compendia that are specifically designed to deliver pre-digested, rapidly accessible, comprehensive, and periodically updated information to health care providers. We aimed to evaluate product claims of being evidence-based. Methods: We updated our previous evaluations by searching Medline, Google, librarian association websites, and conference proceedings from August 2012 to December 2014. We included Web-based, regularly updated point-of-care information summaries with claims of being evidence-based. We extracted data on the general characteristics and content presentation of products, and we quantitatively assessed their breadth of disease coverage, editorial quality, and evidence-based methodology. We assessed potential relationships between these dimensions and compared them with our 2008 assessment. Results: We screened 58 products; 26 met our inclusion criteria. Nearly a quarter (6/26, 23%) were newly identified in 2014. We accessed and analyzed 23 products for content presentation and quantitative dimensions. Most summaries were developed by major publishers in the United States and the United Kingdom; no products derived from low- and middle-income countries. The main target audience remained physicians, although nurses and physiotherapists were increasingly represented. Best Practice, Dynamed, and UptoDate scored the highest across all dimensions. The majority of products did not excel across all dimensions: we found only a moderate positive correlation between editorial quality and evidence-based methodology (r=.41, P=.0496). However, all dimensions improved from 2008: editorial quality (P=.01), evidence-based methodology (P=.015), and volume of diseases and medical conditions (P<.001). Conclusions: Medical and scientific publishers are investing substantial resources towards the development and maintenance of point-of-care summaries. The number of these products has increased since 2008 along with their quality. Best Practice, Dynamed, and UptoDate scored the highest across all dimensions, while others that were marketed as evidence-based were less reliable. Individuals and institutions should regularly assess the value of point-of-care summaries as their quality changes rapidly over time. UR - http://www.jmir.org/2016/1/e15/ UR - http://dx.doi.org/10.2196/jmir.5234 UR - http://www.ncbi.nlm.nih.gov/pubmed/26786976 ID - info:doi/10.2196/jmir.5234 ER - TY - JOUR AU - Ngune, Irene AU - Jiwa, Moyez AU - McManus, Alexandra AU - Parsons, Richard AU - Pagey, Georgina AU - Hodder, Rupert PY - 2015/11/05 TI - Do Patients Treated for Colorectal Cancer Benefit from General Practitioner Support? A Video Vignette Study JO - J Med Internet Res SP - e249 VL - 17 IS - 11 KW - colorectal cancer KW - general practice KW - Internet survey KW - side effects KW - video vignettes N2 - Background: Patients who have been treated for colorectal cancer in Australia can consult their general practitioner (GP) for advice about symptoms or side effects at any time following their treatment. However, there is no evidence that such patients are consistently advised by GPs, and patients experience substantial unmet need for reassurance and advice. Objective: To explore the patient management options selected by GPs to treat a set of patients describing their symptoms following treatment for colorectal cancer. Methods: This was an Internet-based survey. Participants (GPs) viewed 6 video vignettes of actors representing patients who had been treated for colorectal cancer. The actor-patients presented problems that resulted from their treatment. Participants indicated their diagnosis and stated if they would prescribe, refer, or order tests, based on that diagnosis. These responses were then rated against the management decisions for those vignettes as recommended by a team of colorectal cancer experts. Results: In total, 52 GPs consented to take part in the study, and 40 (77%) completed the study. Most GPs made a diagnosis of colorectal cancer treatment side effects/symptoms of recurrence that was consistent with the experts? opinions. However, correct diagnosis was dependent on the type of case viewed. Compared with radiation proctitis, GPs were more likely to recognize peripheral neuropathy (odds ratio, OR, 4.43, 95% CI 1.41-13.96, P=.011) and erectile dysfunction (OR 9.70, 95% CI 2.48-38.03, P=.001), but less likely to identify chemotherapy-induced fatigue (OR 0.19, 95% CI 0.08-0.44). GPs who had more hours of direct patient care (OR 0.38, 95% CI 0.17-0.84, P=.02), were experienced (OR 9.78, 95% CI 1.18-8.84, P=.02), and consulted more patients per week (OR 2.48, 95% CI 1.16-5.30, P=.02) suggested a management plan that was consistent with the expert opinion. Conclusions: In this pilot study, years of experience and direct patient contact hours had a significant and positive impact on the management of patients. This study also showed promising results indicating that management of the common side effects of colorectal cancer treatment can be delegated to general practice. Such an intervention could support the application of shared models of care. However, a larger study, including the management of side effects in real patients, needs to be conducted before this can be safely recommended. UR - http://www.jmir.org/2015/11/e249/ UR - http://dx.doi.org/10.2196/jmir.4942 UR - http://www.ncbi.nlm.nih.gov/pubmed/26541077 ID - info:doi/10.2196/jmir.4942 ER - TY - JOUR AU - Connelly, Marie AU - Beals, Aaron AU - VanDerlip, Aaron AU - Singaraju, Koundinya AU - Weintraub, L. Rebecca PY - 2015/10/27 TI - Professional Virtual Communities for Health Care Implementers: Impact of Participation on Practice JO - iProc SP - e11 VL - 1 IS - 1 KW - Professional Virtual Communities KW - Health care delivery KW - Knowledge dissemination KW - Communities of Practice KW - Online Communities N2 - Background: Since 2008, GHDonline.org has provided a platform of professional virtual communities (PVCs) for health care implementers around the world to connect and discuss delivery challenges. Initially focused on low-resource settings internationally, GHDonline received funding from the Agency for Healthcare Research and Quality (AHRQ) in 2013 to expand the platform and launch the US Communities Initiative (USCI), PVCs for US-based health care professionals working with underserved populations. Objective: Over the course of the three-year funding period, we established four PVCs focused on population health, quality and safety, costs of care, and delivery innovations. We aim to develop a greater understanding of the challenges facing US health care professionals while also facilitating the dissemination and translation of evidence-based resources and novel approaches to delivering care. We seek to understand the impact that participation in these PVCs has on the implementation and integration of best practices in care delivery around the country. Methods: Each PVC is supported by a team of expert moderators who guide and shape community goals, content, and programming. GHDonline works closely with these moderators to organize virtual Expert Panels (week-long, asynchronous online conferences), which facilitate the spread of evidence-based resources and, through dialogue with experts, educate members on strategies for adapting these tools for a range of delivery settings. Our impact evaluation includes three methods: analysis of site data, member surveys, and phone interviews. Site data shows the scope and engagement of readership in the PVCs. Surveys, fielded before and after each Expert Panel, assess members? knowledge of and ability to implement relevant best practices. Individual interviews identify examples of PVC participation impacting practice, as well as opportunities to improve the PVCs themselves. Results: While evaluation efforts are ongoing, current survey data shows a majority of respondents, 91% (149/163), found information shared in Expert Panels relevant to the populations they serve. A strong majority, 73% (127/175), report an intention to make changes in their practice, and 47% (81/172) report implementing changes based on knowledge gained through PVC participation.We randomly selected 500 active members to participate in interviews and have completed 50 interviews to date. A significant majority of interviewees, 82% (41/50), recommended GHDonline to colleagues, and many, 60% (30/50), indicated they are making changes in their practice based on information gained through PVC participation. Conclusions: Recognizing the limitations of self-reported surveys and interview responses, and the preliminary nature of our current findings, we believe these results show strong potential for PVCs to facilitate dissemination and translation of evidence-based practices and improve care delivery in the US. Trial Registration: Not applicable. UR - http://www.iproc.org/2015/1/e11/ UR - http://dx.doi.org/10.2196/iproc.4695 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/iproc.4695 ER - TY - JOUR AU - Maloney, Stephen AU - Tunnecliff, Jacqueline AU - Morgan, Prue AU - Gaida, E. Jamie AU - Clearihan, Lyn AU - Sadasivan, Sivalal AU - Davies, David AU - Ganesh, Shankar AU - Mohanty, Patitapaban AU - Weiner, John AU - Reynolds, John AU - Ilic, Dragan PY - 2015/10/26 TI - Translating Evidence Into Practice via Social Media: A Mixed-Methods Study JO - J Med Internet Res SP - e242 VL - 17 IS - 10 KW - social media KW - medical informatics KW - evidence-based practice KW - e-learning N2 - Background: Approximately 80% of research evidence relevant to clinical practice never reaches the clinicians delivering patient care. A key barrier for the translation of evidence into practice is the limited time and skills clinicians have to find and appraise emerging evidence. Social media may provide a bridge between health researchers and health service providers. Objective: The aim of this study was to determine the efficacy of social media as an educational medium to effectively translate emerging research evidence into clinical practice. Methods: The study used a mixed-methods approach. Evidence-based practice points were delivered via social media platforms. The primary outcomes of attitude, knowledge, and behavior change were assessed using a preintervention/postintervention evaluation, with qualitative data gathered to contextualize the findings. Results: Data were obtained from 317 clinicians from multiple health disciplines, predominantly from the United Kingdom, Australia, the United States, India, and Malaysia. The participants reported an overall improvement in attitudes toward social media for professional development (P<.001). The knowledge evaluation demonstrated a significant increase in knowledge after the training (P<.001). The majority of respondents (136/194, 70.1%) indicated that the education they had received via social media had changed the way they practice, or intended to practice. Similarly, a large proportion of respondents (135/193, 69.9%) indicated that the education they had received via social media had increased their use of research evidence within their clinical practice. Conclusions: Social media may be an effective educational medium for improving knowledge of health professionals, fostering their use of research evidence, and changing their clinical behaviors by translating new research evidence into clinical practice. UR - http://www.jmir.org/2015/10/e242/ UR - http://dx.doi.org/10.2196/jmir.4763 UR - http://www.ncbi.nlm.nih.gov/pubmed/26503129 ID - info:doi/10.2196/jmir.4763 ER - TY - JOUR AU - Perera, Marlon AU - Roberts, Matthew AU - Lawrentschuk, Nathan AU - Bolton, Damien PY - 2015/09/18 TI - Response to ?Twitter-Based Journal Clubs: Some Additional Facts and Clarifications? JO - J Med Internet Res SP - e217 VL - 17 IS - 9 UR - http://www.jmir.org/2015/9/e217/ UR - http://dx.doi.org/10.2196/jmir.4786 UR - http://www.ncbi.nlm.nih.gov/pubmed/26385506 ID - info:doi/10.2196/jmir.4786 ER - TY - JOUR AU - Topf, M. Joel AU - Sparks, A. Matthew AU - Iannuzzella, Francesco AU - Lerma, Edgar AU - Oates, Thomas AU - Phelan, J. Paul AU - Hiremath, Swapnil PY - 2015/09/16 TI - Twitter-Based Journal Clubs: Additional Facts and Clarifications JO - J Med Internet Res SP - e216 VL - 17 IS - 9 UR - http://www.jmir.org/2015/9/e216/ UR - http://dx.doi.org/10.2196/jmir.4639 UR - http://www.ncbi.nlm.nih.gov/pubmed/26376668 ID - info:doi/10.2196/jmir.4639 ER - TY - JOUR AU - Narayanaswami, Pushpa AU - Gronseth, Gary AU - Dubinsky, Richard AU - Penfold-Murray, Rebecca AU - Cox, Julie AU - Bever Jr, Christopher AU - Martins, Yolanda AU - Rheaume, Carol AU - Shouse, Denise AU - Getchius, SD Thomas PY - 2015/08/13 TI - The Impact of Social Media on Dissemination and Implementation of Clinical Practice Guidelines: A Longitudinal Observational Study JO - J Med Internet Res SP - e193 VL - 17 IS - 8 KW - information dissemination KW - social media KW - multiple sclerosis KW - complementary medicine KW - medicine, complementary KW - therapy, complementary KW - alternative medicine KW - alternative therapies KW - clinical practice guidelines KW - dissemination and implementation N2 - Background: Evidence-based clinical practice guidelines (CPGs) are statements that provide recommendations to optimize patient care for a specific clinical problem or question. Merely reading a guideline rarely leads to implementation of recommendations. The American Academy of Neurology (AAN) has a formal process of guideline development and dissemination. The last few years have seen a burgeoning of social media such as Facebook, Twitter, and LinkedIn, and newer methods of dissemination such as podcasts and webinars. The role of these media in guideline dissemination has not been studied. Systematic evaluation of dissemination methods and comparison of the effectiveness of newer methods with traditional methods is not available. It is also not known whether specific dissemination methods may be more effectively targeted to specific audiences. Objective: Our aim was to (1) develop an innovative dissemination strategy by adding social media-based dissemination methods to traditional methods for the AAN clinical practice guidelines ?Complementary and alternative medicine in multiple sclerosis? (?CAM in MS?) and (2) evaluate whether the addition of social media outreach improves awareness of the CPG and knowledge of CPG recommendations, and affects implementation of those recommendations. Methods: Outcomes were measured by four surveys in each of the two target populations: patients and physicians/clinicians (?physicians?). The primary outcome was the difference in participants? intent to discuss use of complementary and alternative medicine (CAM) with their physicians or patients, respectively, after novel dissemination, as compared with that after traditional dissemination. Secondary outcomes were changes in awareness of the CPG, knowledge of CPG content, and behavior regarding CAM use in multiple sclerosis (MS). Results: Response rates were 25.08% (622/2480) for physicians and 43.5% (348/800) for patients. Awareness of the CPG increased after traditional dissemination (absolute difference, 95% confidence interval: physicians 36%, 95% CI 25-46, and patients 10%, 95% CI 1-11) but did not increase further after novel dissemination (physicians 0%, 95% CI -11 to 11, and patients -4%, 95% CI -6 to 14). Intent to discuss CAM also increased after traditional dissemination but did not change after novel dissemination (traditional: physicians 12%, 95% CI 2-22, and patients 19%, 95% CI 3-33; novel: physicians 11%, 95% CI -1 to -21, and patients -8%, 95% CI -22 to 8). Knowledge of CPG recommendations and behavior regarding CAM use in MS did not change after either traditional dissemination or novel dissemination. Conclusions: Social media-based dissemination methods did not confer additional benefit over print-, email-, and Internet-based methods in increasing CPG awareness and changing intent in physicians or patients. Research on audience selection, message formatting, and message delivery is required to utilize Web 2.0 technologies optimally for dissemination. UR - http://www.jmir.org/2015/8/e193/ UR - http://dx.doi.org/10.2196/jmir.4414 UR - http://www.ncbi.nlm.nih.gov/pubmed/26272267 ID - info:doi/10.2196/jmir.4414 ER - TY - JOUR AU - Tunnecliff, Jacqueline AU - Ilic, Dragan AU - Morgan, Prue AU - Keating, Jennifer AU - Gaida, E. James AU - Clearihan, Lynette AU - Sadasivan, Sivalal AU - Davies, David AU - Ganesh, Shankar AU - Mohanty, Patitapaban AU - Weiner, John AU - Reynolds, John AU - Maloney, Stephen PY - 2015/05/20 TI - The Acceptability Among Health Researchers and Clinicians of Social Media to Translate Research Evidence to Clinical Practice: Mixed-Methods Survey and Interview Study JO - J Med Internet Res SP - e119 VL - 17 IS - 5 KW - social media KW - evidence-based medicine KW - communication KW - eLearning N2 - Background: Establishing and promoting connections between health researchers and health professional clinicians may help translate research evidence to clinical practice. Social media may have the capacity to enhance these connections. Objective: The aim of this study was to explore health researchers? and clinicians? current use of social media and their beliefs and attitudes towards the use of social media for communicating research evidence. Methods: This study used a mixed-methods approach to obtain qualitative and quantitative data. Participation was open to health researchers and clinicians. Data regarding demographic details, current use of social media, and beliefs and attitudes towards the use of social media for professional purposes were obtained through an anonymous Web-based survey. The survey was distributed via email to research centers, educational and clinical institutions, and health professional associations in Australia, India, and Malaysia. Consenting participants were stratified by country and role and selected at random for semistructured telephone interviews to explore themes arising from the survey. Results: A total of 856 participants completed the questionnaire with 125 participants declining to participate, resulting in a response rate of 87.3%. 69 interviews were conducted with participants from Australia, India, and Malaysia. Social media was used for recreation by 89.2% (749/840) of participants and for professional purposes by 80.0% (682/852) of participants. Significant associations were found between frequency of professional social media use and age, gender, country of residence, and graduate status. Over a quarter (26.9%, 229/852) of participants used social media for obtaining research evidence, and 15.0% (128/852) of participants used social media for disseminating research evidence. Most participants (95.9%, 810/845) felt there was a role for social media in disseminating or obtaining research evidence. Over half of the participants (449/842, 53.3%) felt they had a need for training in the use of social media for professional development. A key barrier to the professional use of social media was concerns regarding trustworthiness of information. Conclusions: A large majority of health researchers and clinicians use social media in recreational and professional contexts. Social media is less frequently used for communication of research evidence. Training in the use of social media for professional development and methods to improve the trustworthiness of information obtained via social media may enhance the utility of social media for communicating research evidence. Future studies should investigate the efficacy of social media in translating research evidence to clinical practice. UR - http://www.jmir.org/2015/5/e119/ UR - http://dx.doi.org/10.2196/jmir.4347 UR - http://www.ncbi.nlm.nih.gov/pubmed/25995192 ID - info:doi/10.2196/jmir.4347 ER - TY - JOUR AU - Roberts, John Matthew AU - Perera, Marlon AU - Lawrentschuk, Nathan AU - Romanic, Diana AU - Papa, Nathan AU - Bolton, Damien PY - 2015/04/23 TI - Globalization of Continuing Professional Development by Journal Clubs via Microblogging: A Systematic Review JO - J Med Internet Res SP - e103 VL - 17 IS - 4 KW - journal club KW - social media KW - continuing medical education KW - continuing professional development KW - systematic review N2 - Background: Journal clubs are an essential tool in promoting clinical evidence-based medical education to all medical and allied health professionals. Twitter represents a public, microblogging forum that can facilitate traditional journal club requirements, while also reaching a global audience, and participation for discussion with study authors and colleagues. Objective: The aim of the current study was to evaluate the current state of social media?facilitated journal clubs, specifically Twitter, as an example of continuing professional development. Methods: A systematic review of literature databases (Medline, Embase, CINAHL, Web of Science, ERIC via ProQuest) was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of Twitter, the followers of identified journal clubs, and Symplur was also performed. Demographic and monthly tweet data were extracted from Twitter and Symplur. All manuscripts related to Twitter-based journal clubs were included. Statistical analyses were performed in MS Excel and STATA. Results: From a total of 469 citations, 11 manuscripts were included and referred to five Twitter-based journal clubs (#ALiEMJC, #BlueJC, #ebnjc, #urojc, #meded). A Twitter-based journal club search yielded 34 potential hashtags/accounts, of which 24 were included in the final analysis. The median duration of activity was 11.75 (interquartile range [IQR] 19.9, SD 10.9) months, with 7 now inactive. The median number of followers and participants was 374 (IQR 574) and 157 (IQR 272), respectively. An overall increasing establishment of active Twitter-based journal clubs was observed, resulting in an exponential increase in total cumulative tweets (R2=.98), and tweets per month (R2=.72). Cumulative tweets for specific journal clubs increased linearly, with @ADC_JC, @EBNursingBMJ, @igsjc, @iurojc, and @NephJC, and showing greatest rate of change, as well as total impressions per month since establishment. An average of two tweets per month was estimated for the majority of participants, while the ?Top 10? tweeters for @iurojc showed a significantly lower contribution to overall tweets for each month (P<.005). A linearly increasing impression:tweet ratio was observed for the top five journal clubs. Conclusions: Twitter-based journal clubs are free, time-efficient, and publicly accessible means to facilitate international discussions regarding clinically important evidence-based research. UR - http://www.jmir.org/2015/4/e103/ UR - http://dx.doi.org/10.2196/jmir.4194 UR - http://www.ncbi.nlm.nih.gov/pubmed/25908092 ID - info:doi/10.2196/jmir.4194 ER - TY - JOUR AU - East, Lynette Marlene AU - Havard, C. Byron PY - 2015/03/31 TI - Mental Health Mobile Apps: From Infusion to Diffusion in the Mental Health Social System JO - JMIR Mental Health SP - e10 VL - 2 IS - 1 KW - clinical efficacy KW - counselors KW - ethical codes KW - innovation diffusion KW - instructional technology KW - mental health KW - mHealth KW - mobile health KW - smartphone UR - http://mental.jmir.org/2015/1/e10/ UR - http://dx.doi.org/10.2196/mental.3954 UR - http://www.ncbi.nlm.nih.gov/pubmed/26543907 ID - info:doi/10.2196/mental.3954 ER - TY - JOUR AU - Reynolds, Julia AU - Griffiths, M. Kathleen AU - Cunningham, A. John AU - Bennett, Kylie AU - Bennett, Anthony PY - 2015/03/23 TI - Clinical Practice Models for the Use of E-Mental Health Resources in Primary Health Care by Health Professionals and Peer Workers: A Conceptual Framework JO - JMIR Mental Health SP - e6 VL - 2 IS - 1 KW - translational medical research KW - professional practice KW - primary health care KW - treatment of mental disorders KW - Internet KW - health care technology KW - health promotion KW - case management KW - psychotherapy N2 - Background: Research into e-mental health technologies has developed rapidly in the last 15 years. Applications such as Internet-delivered cognitive behavioral therapy interventions have accumulated considerable evidence of efficacy and some evidence of effectiveness. These programs have achieved similar outcomes to face-to-face therapy, while requiring much less clinician time. There is now burgeoning interest in integrating e-mental health resources with the broader mental health delivery system, particularly in primary care. The Australian government has supported the development and deployment of e-mental health resources, including websites that provide information, peer-to-peer support, automated self-help, and guided interventions. An ambitious national project has been commissioned to promote key resources to clinicians, to provide training in their use, and to evaluate the impact of promotion and training upon clinical practice. Previous initiatives have trained clinicians to use a single e-mental health program or a suite of related programs. In contrast, the current initiative will support community-based service providers to access a diverse array of resources developed and provided by many different groups. Objective: The objective of this paper was to develop a conceptual framework to support the use of e-mental health resources in routine primary health care. In particular, models of clinical practice are required to guide the use of the resources by diverse service providers and to inform professional training, promotional, and evaluation activities. Methods: Information about service providers? use of e-mental health resources was synthesized from a nonsystematic overview of published literature and the authors? experience of training primary care service providers. Results: Five emerging clinical practice models are proposed: (1) promotion; (2) case management; (3) coaching; (4) symptom-focused treatment; and (5) comprehensive therapy. We also consider the service provider skills required for each model and the ways that e-mental health resources might be used by general practice doctors and nurses, pharmacists, psychologists, social workers, occupational therapists, counselors, and peer workers Conclusions: The models proposed in the current paper provide a conceptual framework for policy-makers, researchers and clinicians interested in integrating e-mental health resources into primary care. Research is needed to establish the safety and effectiveness of the models in routine care and the best ways to support their implementation. UR - http://mental.jmir.org/2015/1/e6/ UR - http://dx.doi.org/10.2196/mental.4200 UR - http://www.ncbi.nlm.nih.gov/pubmed/26543912 ID - info:doi/10.2196/mental.4200 ER - TY - JOUR AU - Heilman, M. James AU - West, G. Andrew PY - 2015/03/04 TI - Wikipedia and Medicine: Quantifying Readership, Editors, and the Significance of Natural Language JO - J Med Internet Res SP - e62 VL - 17 IS - 3 KW - health information systems KW - consumer health information KW - information sharing KW - information networks KW - information science KW - Internet KW - Web 2.0 KW - cooperative behavior N2 - Background: Wikipedia is a collaboratively edited encyclopedia. One of the most popular websites on the Internet, it is known to be a frequently used source of health care information by both professionals and the lay public. Objective: This paper quantifies the production and consumption of Wikipedia?s medical content along 4 dimensions. First, we measured the amount of medical content in both articles and bytes and, second, the citations that supported that content. Third, we analyzed the medical readership against that of other health care websites between Wikipedia?s natural language editions and its relationship with disease prevalence. Fourth, we surveyed the quantity/characteristics of Wikipedia?s medical contributors, including year-over-year participation trends and editor demographics. Methods: Using a well-defined categorization infrastructure, we identified medically pertinent English-language Wikipedia articles and links to their foreign language equivalents. With these, Wikipedia can be queried to produce metadata and full texts for entire article histories. Wikipedia also makes available hourly reports that aggregate reader traffic at per-article granularity. An online survey was used to determine the background of contributors. Standard mining and visualization techniques (eg, aggregation queries, cumulative distribution functions, and/or correlation metrics) were applied to each of these datasets. Analysis focused on year-end 2013, but historical data permitted some longitudinal analysis. Results: Wikipedia?s medical content (at the end of 2013) was made up of more than 155,000 articles and 1 billion bytes of text across more than 255 languages. This content was supported by more than 950,000 references. Content was viewed more than 4.88 billion times in 2013. This makes it one of if not the most viewed medical resource(s) globally. The core editor community numbered less than 300 and declined over the past 5 years. The members of this community were half health care providers and 85.5% (100/117) had a university education. Conclusions: Although Wikipedia has a considerable volume of multilingual medical content that is extensively read and well-referenced, the core group of editors that contribute and maintain that content is small and shrinking in size. UR - http://www.jmir.org/2015/3/e62/ UR - http://dx.doi.org/10.2196/jmir.4069 UR - http://www.ncbi.nlm.nih.gov/pubmed/25739399 ID - info:doi/10.2196/jmir.4069 ER - TY - JOUR AU - Badran, Hani AU - Pluye, Pierre AU - Grad, Roland PY - 2015/02/27 TI - Advantages and Disadvantages of Educational Email Alerts for Family Physicians: Viewpoint JO - J Med Internet Res SP - e49 VL - 17 IS - 2 KW - theory of planned behavior KW - continuing medical education KW - educational email alerts KW - electronic knowledge resources KW - family physicians KW - health informatics KW - knowledge translation KW - primary health care N2 - Background: Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search Web-based resources. On the other hand, technical difficulties and privacy issues are common obstacles. Objective: The purpose of this discussion paper, informed by a literature review and a small qualitative study, was to understand family physicians? knowledge, attitudes, and behavior in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants? suggestions to improve email alert services for CME. Methods: We conducted a qualitative descriptive study using the ?Knowledge, Attitude, Behavior? model. We conducted semi-structured face-to-face interviews with 15 family physicians. We analyzed the collected data using inductive-deductive thematic qualitative data analysis. Results: All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (1) advantages of educational email alerts such as saving time, convenience and valid information, and (2) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. Conclusions: The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by family physicians can help to improve educational email alerts. UR - http://www.jmir.org/2015/2/e49/ UR - http://dx.doi.org/10.2196/jmir.3773 UR - http://www.ncbi.nlm.nih.gov/pubmed/25803184 ID - info:doi/10.2196/jmir.3773 ER - TY - JOUR AU - Archambault, M. Patrick AU - Turgeon, F. Alexis AU - Witteman, O. Holly AU - Lauzier, François AU - Moore, Lynne AU - Lamontagne, François AU - Horsley, Tanya AU - Gagnon, Marie-Pierre AU - Droit, Arnaud AU - Weiss, Matthew AU - Tremblay, Sébastien AU - Lachaine, Jean AU - Le Sage, Natalie AU - Émond, Marcel AU - Berthelot, Simon AU - Plaisance, Ariane AU - Lapointe, Jean AU - Razek, Tarek AU - van de Belt, H. Tom AU - Brand, Kevin AU - Bérubé, Mélanie AU - Clément, Julien AU - Grajales III, Jose Francisco AU - Eysenbach, Gunther AU - Kuziemsky, Craig AU - Friedman, Debbie AU - Lang, Eddy AU - Muscedere, John AU - Rizoli, Sandro AU - Roberts, J. Derek AU - Scales, C. Damon AU - Sinuff, Tasnim AU - Stelfox, T. Henry AU - Gagnon, Isabelle AU - Chabot, Christian AU - Grenier, Richard AU - Légaré, France AU - PY - 2015/02/19 TI - Implementation and Evaluation of a Wiki Involving Multiple Stakeholders Including Patients in the Promotion of Best Practices in Trauma Care: The WikiTrauma Interrupted Time Series Protocol JO - JMIR Res Protoc SP - e21 VL - 4 IS - 1 KW - interrupted time series KW - wiki KW - quality improvement KW - knowledge translation KW - trauma care KW - stakeholder engagement KW - adapting knowledge tools N2 - Background: Trauma is the most common cause of mortality among people between the ages of 1 and 45 years, costing Canadians 19.8 billion dollars a year (2004 data), yet half of all patients with major traumatic injuries do not receive evidence-based care, and significant regional variation in the quality of care across Canada exists. Accordingly, our goal is to lead a research project in which stakeholders themselves will adapt evidence-based trauma care knowledge tools to their own varied institutional contexts and cultures. We will do this by developing and assessing the combined impact of WikiTrauma, a free collaborative database of clinical decision support tools, and Wiki101, a training course teaching participants how to use WikiTrauma. WikiTrauma has the potential to ensure that all stakeholders (eg, patients, clinicians, and decision makers) can all contribute to, and benefit from, evidence-based clinical knowledge about trauma care that is tailored to their own needs and clinical setting. Objective: Our main objective will be to study the combined effect of WikiTrauma and Wiki101 on the quality of care in four trauma centers in Quebec. Methods: First, we will pilot-test the wiki with potential users to create a version ready to test in practice. A rapid, iterative prototyping process with 15 health professionals from nonparticipating centers will allow us to identify and resolve usability issues prior to finalizing the definitive version for the interrupted time series. Second, we will conduct an interrupted time series to measure the impact of our combined intervention on the quality of care in four trauma centers that will be selected?one level I, one level II, and two level III centers. Participants will be health care professionals working in the selected trauma centers. Also, five patient representatives will be recruited to participate in the creation of knowledge tools destined for their use (eg, handouts). All participants will be invited to complete the Wiki101 training and then use, and contribute to, WikiTrauma for 12 months. The primary outcome will be the change over time of a validated, composite, performance indicator score based on 15 process performance indicators found in the Quebec Trauma Registry. Results: This project was funded in November 2014 by the Canadian Medical Protective Association. We expect to start this trial in early 2015 and preliminary results should be available in June 2016. Two trauma centers have already agreed to participate and two more will be recruited in the next months. Conclusions: We expect that this study will add important and unique evidence about the effectiveness, safety, and cost savings of using collaborative platforms to adapt knowledge implementation tools across jurisdictions. UR - http://www.researchprotocols.org/2015/1/e21/ UR - http://dx.doi.org/10.2196/resprot.4024 UR - http://www.ncbi.nlm.nih.gov/pubmed/25699546 ID - info:doi/10.2196/resprot.4024 ER - TY - JOUR AU - Brulet, Alexandre AU - Llorca, Guy AU - Letrilliart, Laurent PY - 2015/02/19 TI - Medical Wikis Dedicated to Clinical Practice: A Systematic Review SP - e48 VL - 17 IS - 2 KW - wikis KW - clinical medicine KW - review N2 - Background: Wikis may give clinician communities the opportunity to build knowledge relevant to their practice. The only previous study reviewing a set of health-related wikis, without specification of purpose or audience, globally showed a poor reliability. Objective: Our aim was to review medical wiki websites dedicated to clinical practices. Methods: We used Google in ten languages, PubMed, Embase, Lilacs, and Web of Science to identify websites. The review included wiki sites, accessible and operating, having a topic relevant for clinical medicine, targeting physicians or medical students. Wikis were described according to their purposes, platform, management, information framework, contributions, content, and activity. Purposes were classified as ?encyclopedic? or ?non-encyclopedic?. The information framework quality was assessed based on the Health On the Net (HONcode) principles for collaborative websites, with additional criteria related to users? transparency and editorial policy. From a sample of five articles per wikis, we assessed the readability using the Flesch test and compared articles according to the wikis? main purpose. Annual editorial activities were estimated using the Google engine. Results: Among 25 wikis included, 11 aimed at building an encyclopedia, five a textbook, three lessons, two oncology protocols, one a single article, and three at reporting clinical cases. Sixteen wikis were specialized with specific themes or disciplines. Fifteen wikis were using MediaWiki software as-is, three were hosted by online wiki farms, and seven were purpose-built. Except for one MediaWiki-based site, only purpose-built platforms managed detailed user disclosures. The owners were ten organizations, six individuals, four private companies, two universities, two scientific societies, and one unknown. Among 21 open communities, 10 required users? credentials to give editing rights. The median information framework quality score was 6 out of 16 (range 0-15). Beyond this score, only one wiki had standardized peer-reviews. Physicians contributed to 22 wikis, medical learners to nine, and lay persons to four. Among 116 sampled articles, those from encyclopedic wikis had more videos, pictures, and external resources, whereas others had more posology details and better readability. The median creation year was 2007 (1997-2011), the median number of content pages was 620.5 (3-98,039), the median of revisions per article was 17.7 (3.6-180.5) and 0.015 of talk pages per article (0-0.42). Five wikis were particularly active, whereas six were declining. Two wikis have been discontinued after the completion of the study. Conclusions: The 25 medical wikis we studied present various limitations in their format, management, and collaborative features. Professional medical wikis may be improved by using clinical cases, developing more detailed transparency and editorial policies, and involving postgraduate and continuing medical education learners. UR - http://www.jmir.org/16/2/e48/ UR - http://dx.doi.org/10.2196/jmir.3574 UR - http://www.ncbi.nlm.nih.gov/pubmed/25700482 ID - info:doi/10.2196/jmir.3574 ER - TY - JOUR AU - Brosseau, Lucie AU - Wells, George AU - Brooks-Lineker, Sydney AU - Bennell, Kim AU - Sherrington, Cathie AU - Briggs, Andrew AU - Sturnieks, Daina AU - King, Judy AU - Thomas, Roanne AU - Egan, Mary AU - Loew, Laurianne AU - De Angelis, Gino AU - Casimiro, Lynn AU - Toupin April, Karine AU - Cavallo, Sabrina AU - Bell, Mary AU - Ahmed, Rukhsana AU - Coyle, Doug AU - Poitras, Stéphane AU - Smith, Christine AU - Pugh, Arlanna AU - Rahman, Prinon PY - 2015/02/03 TI - Internet-Based Implementation of Non-Pharmacological Interventions of the "People Getting a Grip on Arthritis" Educational Program: An International Online Knowledge Translation Randomized Controlled Trial Design Protocol JO - JMIR Res Protoc SP - e19 VL - 4 IS - 1 KW - rheumatoid arthritis KW - technology KW - knowledge translation KW - clinical trial KW - social media N2 - Background: Rheumatoid arthritis (RA) affects 2.1% of the Australian population (1.5% males; 2.6% females), with the highest prevalence from ages 55 to over 75 years (4.4-6.1%). In Canada, RA affects approximately 0.9% of adults, and within 30 years that is expected to increase to 1.3%. With an aging population and a greater number of individuals with modifiable risk factors for chronic diseases, such as arthritis, there is an urgent need for co-care management of arthritic conditions. The increasing trend and present shifts in the health services and policy sectors suggest that digital information delivery is becoming more prominent. Therefore, it is necessary to further investigate the use of online resources for RA information delivery. Objective: The objective is to examine the effect of implementing an online program provided to patients with RA, the People Getting a Grip on Arthritis for RA (PGrip-RA) program, using information communication technologies (ie, Facebook and emails) in combination with arthritis health care professional support and electronic educational pamphlets. We believe this can serve as a useful and economical method of knowledge translation (KT). Methods: This KT randomized controlled trial will use a prospective randomized open-label blinded-endpoint design to compare four different intervention approaches of the PGrip-RA program to a control group receiving general electronic educational pamphlets self-management in RA via email. Depending on group allocation, links to the Arthritis Society PGrip-RA material will be provided either through Facebook or by email. One group will receive feedback online from trained health care professionals. The intervention period is 6 weeks. Participants will have access to the Internet-based material after the completion of the baseline questionnaires until the final follow-up questionnaire at 6 months. We will invite 396 patients from Canadian and Australian Arthritis Consumers? Associations to participate using online recruitment. Results: This study will build on a pilot study using Facebook, which revealed promising effects of knowledge acquisition/integration of the evidence-based self-management PGrip educational program. Conclusions: The use of online techniques to disseminate knowledge provides an opportunity to reduce health care costs by facilitating self-management of people with arthritis. Study design strengths include the incorporation of randomization and allocation concealment to ensure internal validity. To avoid intergroup contamination, the Facebook group page security settings will be set to ?closed?, thus allowing only invited participants to access it. Study limitations include the lack of participant blinding due to the characteristics of this KT randomized controlled trial and a potential bias of recruiting patients only online, though this was proven effective in the previous pilot study. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000397617; http://www.anzctr.org.au/TrialSearch.aspx (Archived by WebCite at http://www.webcitation.org/6PrP0kQf8). UR - http://www.researchprotocols.org/2015/1/e19/ UR - http://dx.doi.org/10.2196/resprot.3572 UR - http://www.ncbi.nlm.nih.gov/pubmed/25648515 ID - info:doi/10.2196/resprot.3572 ER - TY - JOUR AU - Lohan, Maria AU - Aventin, Áine AU - Oliffe, L. John AU - Han, S. Christina AU - Bottorff, L. Joan PY - 2015/01/29 TI - Knowledge Translation in Men?s Health Research: Development and Delivery of Content for Use Online JO - J Med Internet Res SP - e31 VL - 17 IS - 1 KW - men?s health KW - knowledge translation KW - development of online content N2 - Background: Men can be hard to reach with face-to-face health-related information, while increasingly, research shows that they are seeking health information from online sources. Recognizing this trend, there is merit in developing innovative online knowledge translation (KT) strategies capable of translating research on men?s health into engaging health promotion materials. While the concept of KT has become a new mantra for researchers wishing to bridge the gap between research evidence and improved health outcomes, little is written about the process, necessary skills, and best practices by which researchers can develop online knowledge translation. Objective: Our aim was to illustrate some of the processes and challenges involved in, and potential value of, developing research knowledge online to promote men?s health. Methods: We present experiences of KT across two case studies of men?s health. First, we describe a study that uses interactive Web apps to translate knowledge relating to Canadian men?s depression. Through a range of mechanisms, study findings were repackaged with the explicit aim of raising awareness and reducing the stigma associated with men?s depression and/or help-seeking. Second, we describe an educational resource for teenage men about unintended pregnancy, developed for delivery in the formal Relationship and Sexuality Education school curricula of Ireland, Northern Ireland (United Kingdom), and South Australia. The intervention is based around a Web-based interactive film drama entitled ?If I Were Jack?. Results: For each case study, we describe the KT process and strategies that aided development of credible and well-received online content focused on men?s health promotion. In both case studies, the original research generated the inspiration for the interactive online content and the core development strategy was working with a multidisciplinary team to develop this material through arts-based approaches. In both cases also, there is an acknowledgment of the need for gender and culturally sensitive information. Both aimed to engage men by disrupting stereotypes about men, while simultaneously addressing men through authentic voices and faces. Finally, in both case studies we draw attention to the need to think beyond placement of content online to delivery to target audiences from the outset. Conclusions: The case studies highlight some of the new skills required by academics in the emerging paradigm of translational research and contribute to the nascent literature on KT. Our approach to online KT was to go beyond dissemination and diffusion to actively repackage research knowledge through arts-based approaches (videos and film scripts) as health promotion tools, with optimal appeal, to target male audiences. Our findings highlight the importance of developing a multidisciplinary team to inform the design of content, the importance of adaptation to context, both in terms of the national implementation context and consideration of gender-specific needs, and an integrated implementation and evaluation framework in all KT work. UR - http://www.jmir.org/2015/1/e31/ UR - http://dx.doi.org/10.2196/jmir.3881 UR - http://www.ncbi.nlm.nih.gov/pubmed/25642787 ID - info:doi/10.2196/jmir.3881 ER - TY - JOUR AU - Eng, J. Janice AU - Noonan, K. Vanessa AU - Townson, F. Andrea AU - Higgins, E. Caroline AU - Rogers, Jess AU - Wolfe, L. Dalton PY - 2014/12/23 TI - Impact of an Online Medical Internet Site on Knowledge and Practice of Health Care Providers: A Mixed Methods Study of the Spinal Cord Injury Rehabilitation Evidence Project JO - J Med Internet Res SP - e296 VL - 16 IS - 12 KW - Internet KW - e-health KW - spinal cord injury KW - rehabilitation KW - evidence-based practice N2 - Background: It is not known whether ongoing access to a broad-based Internet knowledge resource can influence the practice of health care providers. We undertook a study to evaluate the impact of a Web-based knowledge resource on increasing access to evidence and facilitating best practice of health care providers. Objective: The objective of this study was to evaluate (1) the impact of the Spinal Cord Injury Rehabilitation Evidence (SCIRE) project on access to information for health care providers and researchers and (2) how SCIRE influenced health care providers' management of clients. Methods: A 4-part mixed methods evaluation was undertaken: (1) monitoring website traffic and utilization using Google Analytics, (2) online survey of users who accessed the SCIRE website, (3) online survey of targeted end-users, that is, rehabilitation health care providers known to work with spinal cord injury (SCI) clients, as well as researchers, and (4) focus groups with health care providers who had previously accessed SCIRE. Results: The online format allowed the content for a relatively specialized field to have far reach (eg, 26 countries and over 6500 users per month). The website survey and targeted end-user survey confirmed that health care providers, as well as researchers perceived that the website increased their access to SCI evidence. Access to SCIRE not only improved knowledge of SCI evidence but helped inform changes to the health providers? clinical practice and improved their confidence in treating SCI clients. The SCIRE information directly influenced the health providers? clinical decision making, in terms of choice of intervention, equipment needs, or assessment tool. Conclusions: A Web-based knowledge resource may be a relatively inexpensive method to increase access to evidence-based information, increase knowledge of the evidence, inform changes to the health providers? practice, and influence their clinical decision making. UR - http://www.jmir.org/2014/12/e296/ UR - http://dx.doi.org/10.2196/jmir.3453 UR - http://www.ncbi.nlm.nih.gov/pubmed/25537167 ID - info:doi/10.2196/jmir.3453 ER - TY - JOUR AU - Archambault, Michel Patrick AU - Gagnon, Susie AU - Gagnon, Marie-Pierre AU - Turcotte, Stéphane AU - Lapointe, Jean AU - Fleet, Richard AU - Côté, Mario AU - Beaupré, Pierre AU - Le Sage, Natalie AU - Émond, Marcel AU - Légaré, France PY - 2014/10/03 TI - Development and Validation of Questionnaires Exploring Health Care Professionals' Intention to Use Wiki-Based Reminders to Promote Best Practices in Trauma JO - JMIR Res Protoc SP - e50 VL - 3 IS - 4 KW - knowledge translation KW - wiki KW - collaborative writing applications KW - decision support tools KW - health informatics KW - Theory of Planned Behavior KW - trauma care KW - traumatic brain injury KW - interprofessional collaboration N2 - Background: Little is known about factors influencing professionals? use of wikis. Objective: We developed and validated two questionnaires to assess health care professionals? intention to use wiki-based reminders for the management of trauma patients. Methods: We developed questionnaires for emergency physicians (EPs) and allied health professions (AHPs) based on the Theory of Planned Behavior and adapted them to the salient beliefs of each, identified in an earlier study. Items measured demographics and direct and indirect theoretical constructs. We piloted the questionnaires with 2 focus groups (5 EPs and 5 AHPs) to identify problems of wording and length. Based on feedback, we adjusted the wording and combined certain items. A new convenience sample of 25 EPs and 26 AHPs then performed a test-retest of the questionnaires at a 2-week interval. We assessed internal consistency using Cronbach alpha coefficients and temporal stability of items with an agreement intraclass correlation coefficient (ICC). Results: Five EPs and 5 AHPs (3 nurses, 1 respiratory therapist, and 1 pharmacist) formed 2 focus groups; 25 EPs and 26 AHPs (12 nurses, 7 respiratory therapists, and 7 pharmacists) completed the test and retest. The EP questionnaire test-retest scores for consistency (Cronbach alpha) and stability (ICC) were intention (test: Cronbach alpha=.94; retest: Cronbach alpha=.98; ICC=.89), attitude (.74, .72, .70), subjective norm (.79, .78, .75), perceived behavioral control (.67, .65, .66), attitudinal beliefs (.94, .86, .60), normative beliefs (.83, .87, .79), and control beliefs barriers (.58, .67, .78) and facilitators (.97, .85, .30). The AHP questionnaire scores for consistency and stability were: intention (test Cronbach alpha=.69, retest Cronbach alpha=.81, ICC=.48), attitude (.85, .87, .83), subjective norm (.47, .82, .62), perceived behavioral control (.55, .62, .60), attitudinal beliefs (.92, .91, .82), normative beliefs (.85, .90, .74), and control beliefs barriers (.58, .55, .66) and facilitators (.72, .94, ?.05). To improve the psychometric properties of both questionnaires, we reformulated poorly consistent or unstable items. Conclusions: Our new theory-based questionnaires to measure health care professionals? intention to use wiki-based reminders have adequate validity and reliability for use in large surveys. In the long run, they can be used to develop a theory-based implementation intervention for a wiki promoting best practices in trauma care. UR - http://www.jmir.org/2014/4/e50/ UR - http://dx.doi.org/10.2196/resprot.3762 UR - http://www.ncbi.nlm.nih.gov/pubmed/25281856 ID - info:doi/10.2196/resprot.3762 ER - TY - JOUR AU - Jiwa, Moyez AU - Long, Anne AU - Shaw, Tim AU - Pagey, Georgina AU - Halkett, Georgia AU - Pillai, Vinita AU - Meng, Xingqiong PY - 2014/09/03 TI - The Management of Acute Adverse Effects of Breast Cancer Treatment in General Practice: A Video-Vignette Study JO - J Med Internet Res SP - e204 VL - 16 IS - 9 KW - breast cancer KW - treatment KW - general practice KW - adverse effects KW - patient care planning N2 - Background: There has been a focus recently on the use of the Internet and email to deliver education interventions to general practitioners (GPs). The treatment of breast cancer may include surgery, radiotherapy, chemotherapy, and/or hormone treatment. These treatments may have acute adverse effects. GPs need more information on the diagnosis and management of specific adverse effects encountered immediately after cancer treatment. Objective: The goal was to evaluate an Internet-based educational program developed for GPs to advise patients with acute adverse effects following breast cancer treatment. Methods: During phase 1, participants viewed 6 video vignettes of actor-patients reporting 1 of 6 acute symptoms following surgery and chemotherapy and/or radiotherapy treatment. GPs indicated their diagnosis and proposed management through an online survey program. They received feedback about each scenario in the form of a specialist clinic letter, as if the patient had been seen at a specialist clinic after they had attended the GP. This letter incorporated extracts from local guidelines on the management of the symptoms presented. This feedback was sent to the GPs electronically on the same survey platform. In phase 2, all GPs were invited to manage similar cases as phase 1. Their proposed management was compared to the guidelines. McNemar test was used to compare data from phases 1 and 2, and logistic regression was used to explore the GP characteristics that were associated with inappropriate case management. Results: A total of 50 GPs participated. Participants were younger and more likely to be female than other GPs in Australia. For 5 of 6 vignettes in phase 1, management was consistent with expert opinion in the minority of cases (6%-46%). Participant demographic characteristics had a variable effect on different management decisions in phase 1. The variables modeled explained 15%-28% of the differences observed. Diagnosis and management improved significantly in phase 2, especially for diarrhea, neutropenia, and seroma sample cases. The proportion of incorrect management responses was reduced to a minimum (25.3%-49.3%) in phase 2. Conclusions: There was evidence that providing feedback by experts on specific cases had an impact on GPs? knowledge about how to appropriately manage acute treatment adverse effects. This educational intervention could be targeted to support the implementation of shared care during cancer treatment. UR - http://www.jmir.org/2014/9/e204/ UR - http://dx.doi.org/10.2196/jmir.3585 UR - http://www.ncbi.nlm.nih.gov/pubmed/25274131 ID - info:doi/10.2196/jmir.3585 ER - TY - JOUR AU - Miron-Shatz, Talya AU - Shatz, Itamar AU - Becker, Stefan AU - Patel, Jigar AU - Eysenbach, Gunther PY - 2014/08/06 TI - Promoting Business and Entrepreneurial Awareness in Health Care Professionals: Lessons From Venture Capital Panels at Medicine 2.0 Conferences JO - J Med Internet Res SP - e184 VL - 16 IS - 8 KW - start-up KW - entrepreneurship KW - health technology KW - capital funding, telehealth, eHealth, mobile health, health technology, technology transfer KW - health 2.0 KW - business pitch KW - entrepreneurship programs UR - http://www.jmir.org/2014/8/e184/ UR - http://dx.doi.org/10.2196/jmir.3390 UR - http://www.ncbi.nlm.nih.gov/pubmed/25100579 ID - info:doi/10.2196/jmir.3390 ER - TY - JOUR AU - Frisch, Noreen AU - Atherton, Pat AU - Borycki, Elizabeth AU - Mickelson, Grace AU - Cordeiro, Jennifer AU - Novak Lauscher, Helen AU - Black, Agnes PY - 2014/02/21 TI - Growing a Professional Network to Over 3000 Members in Less Than 4 Years: Evaluation of InspireNet, British Columbia?s Virtual Nursing Health Services Research Network JO - J Med Internet Res SP - e49 VL - 16 IS - 2 KW - social networking KW - social media KW - nursing KW - health services KW - research KW - education N2 - Background: Use of Web 2.0 and social media technologies has become a new area of research among health professionals. Much of this work has focused on the use of technologies for health self-management and the ways technologies support communication between care providers and consumers. This paper addresses a new use of technology in providing a platform for health professionals to support professional development, increase knowledge utilization, and promote formal/informal professional communication. Specifically, we report on factors necessary to attract and sustain health professionals? use of a network designed to increase nurses? interest in and use of health services research and to support knowledge utilization activities in British Columbia, Canada. Objective: ?InspireNet?, a virtual professional network for health professionals, is a living laboratory permitting documentation of when and how professionals take up Web 2.0 and social media. Ongoing evaluation documents our experiences in establishing, operating, and evaluating this network. Methods: Overall evaluation methods included (1) tracking website use, (2) conducting two member surveys, and (3) soliciting member feedback through focus groups and interviews with those who participated in electronic communities of practice (eCoPs) and other stakeholders. These data have been used to learn about the types of support that seem relevant to network growth. Results: Network growth exceeded all expectations. Members engaged with varying aspects of the network?s virtual technologies, such as teams of professionals sharing a common interest, research teams conducting their work, and instructional webinars open to network members. Members used wikis, blogs, and discussion groups to support professional work, as well as a members? database with contact information and areas of interest. The database is accessed approximately 10 times per day. InspireNet public blog posts are accessed roughly 500 times each. At the time of writing, 21 research teams conduct their work virtually using the InspireNet platform; 10 topic-based Action Teams meet to address issues of mutual concern. Nursing and other health professionals, even those who rated themselves as computer literate, required significant mentoring and support in their efforts to adopt their practice to a virtual environment. There was a steep learning curve for professionals to learn to work in a virtual environment and to benefit from the available technologies. Conclusions: Virtual professional networks can be positioned to make a significant contribution to ongoing professional practice and to creating environments supportive of information sharing, mentoring, and learning across geographical boundaries. Nonetheless, creation of a Web 2.0 and social media platform is not sufficient, in and of itself, to attract or sustain a vibrant community of professionals interested in improving their practice. Essential support includes instruction in the use of Web-based activities and time management, a biweekly e-Newsletter, regular communication from leaders, and an annual face-to-face conference. UR - http://www.jmir.org/2014/2/e49/ UR - http://dx.doi.org/10.2196/jmir.3018 UR - http://www.ncbi.nlm.nih.gov/pubmed/24566806 ID - info:doi/10.2196/jmir.3018 ER - TY - JOUR AU - Kahlon, Maninder AU - Yuan, Leslie AU - Daigre, John AU - Meeks, Eric AU - Nelson, Katie AU - Piontkowski, Cynthia AU - Reuter, Katja AU - Sak, Rachael AU - Turner, Brian AU - Weber, M. Griffin AU - Chatterjee, Anirvan PY - 2014/02/07 TI - The Use and Significance of a Research Networking System JO - J Med Internet Res SP - e46 VL - 16 IS - 2 KW - social networking KW - search engine KW - information seeking behavior KW - interprofessional relations KW - multidisciplinary communication N2 - Background: Universities have begun deploying public Internet systems that allow for easy search of their experts, expertise, and intellectual networks. Deployed first in biomedical schools but now being implemented more broadly, the initial motivator of these research networking systems was to enable easier identification of collaborators and enable the development of teams for research. Objective: The intent of the study was to provide the first description of the usage of an institutional research ?social networking? system or research networking system (RNS). Methods: Number of visits, visitor location and type, referral source, depth of visit, search terms, and click paths were derived from 2.5 years of Web analytics data. Feedback from a pop-up survey presented to users over 15 months was summarized. Results: RNSs automatically generate and display profiles and networks of researchers. Within 2.5 years, the RNS at the University of California, San Francisco (UCSF) achieved one-seventh of the monthly visit rate of the main longstanding university website, with an increasing trend. Visitors came from diverse locations beyond the institution. Close to 75% (74.78%, 208,304/278,570) came via a public search engine and 84.0% (210 out of a sample of 250) of these queried an individual?s name that took them directly to the relevant profile page. In addition, 20.90% (214 of 1024) visits went beyond the page related to a person of interest to explore related researchers and topics through the novel and networked information provided by the tool. At the end of the period analyzed, more than 2000 visits per month traversed 5 or more links into related people and topics. One-third of visits came from returning visitors who were significantly more likely to continue to explore networked people and topics (P<.001). Responses to an online survey suggest a broad range of benefits of using the RNS in supporting the research and clinical mission. Conclusions: Returning visitors in an ever-increasing pool of visitors to an RNS are among those that display behavior consistent with using the tool to identify new collaborators or research topics. Through direct user feedback we know that some visits do result in research-enhancing outcomes, although we cannot address the scale of impact. With the rapid pace of acquiring visitors searching for individual names, the RNS is evolving into a new kind of gateway for the university. UR - http://www.jmir.org/2014/2/e46/ UR - http://dx.doi.org/10.2196/jmir.3137 UR - http://www.ncbi.nlm.nih.gov/pubmed/24509520 ID - info:doi/10.2196/jmir.3137 ER - TY - JOUR AU - Mathew, Deepa AU - McKibbon, Ann K. AU - Lokker, Cynthia AU - Colquhoun, Heather PY - 2014/01/21 TI - Engaging With a Wiki Related to Knowledge Translation: A Survey of WhatisKT Wiki Users JO - J Med Internet Res SP - e21 VL - 16 IS - 1 KW - knowledge translation KW - wiki KW - usability N2 - Background: In 2008, WhatisKT wiki was launched as a collaborative platform for knowledge translation (KT) researchers and stakeholders to debate the use and definitions of KT-related terms. The wiki has definitions for over 110 terms from disciplines including health care, information technology, education, accounting, and business. WhatisKT wiki has over 115 registered users. Approximately 73,000 unique visitors have visited the wiki since 2008. Despite annual increases in visitors and regular maintenance of the wiki, no visitors have contributed content or started a discussion. Objective: We surveyed wiki users to gain an understanding of the perceived value of the website, reasons for not engaging in the wiki, and suggestions to facilitate collaboration and improve the usability of the wiki. Methods: We surveyed three cohorts: KT Canada members who were previously invited to join the wiki, registered wiki members, and unregistered visitors. The first two cohorts completed a Web-based survey that included the System Usability Scale (SUS) questionnaire to assess usability; additionally 3 participants were interviewed. Unregistered wiki visitors were surveyed with polls posted on the wiki. The study received ethics approval from the McMaster University Faculty of Health Sciences Research Ethics Board. Results: Twenty-three participants completed the Web-based and SUS surveys; 15 participants indicated that they would collaborate on the wiki. The mean SUS score of 67 (95% CI 56-77) indicated that the wiki could be considered for design improvements. Study participants indicated that the wiki could be improved by email notification regarding new terms, better grouping of terms, user friendly interface, and training for users interested in editing content. Conclusions: The findings from this survey will be used to enhance the design and content of WhatisKT wiki. Further feedback from participants will be used to make the wiki an ideal collaboration platform for KT researchers interested in terminology. UR - http://www.jmir.org/2014/1/e21/ UR - http://dx.doi.org/10.2196/jmir.3001 UR - http://www.ncbi.nlm.nih.gov/pubmed/24449712 ID - info:doi/10.2196/jmir.3001 ER - TY - JOUR AU - Archambault, M. Patrick AU - van de Belt, H. Tom AU - Grajales III, J. Francisco AU - Faber, J. Marjan AU - Kuziemsky, E. Craig AU - Gagnon, Susie AU - Bilodeau, Andrea AU - Rioux, Simon AU - Nelen, LDM Willianne AU - Gagnon, Marie-Pierre AU - Turgeon, F. Alexis AU - Aubin, Karine AU - Gold, Irving AU - Poitras, Julien AU - Eysenbach, Gunther AU - Kremer, AM Jan AU - Légaré, France PY - 2013/10/08 TI - Wikis and Collaborative Writing Applications in Health Care: A Scoping Review JO - J Med Internet Res SP - e210 VL - 15 IS - 10 KW - collaborative writing applications KW - collaborative authoring KW - knowledge management KW - crowdsourcing KW - medical informatics KW - ehealth KW - Internet KW - Wiki KW - Wikipedia KW - Google Docs KW - Google Knol KW - Web 2.0 KW - knowledge translation KW - evidence-based medicine KW - participatory med N2 - Background: Collaborative writing applications (eg, wikis and Google Documents) hold the potential to improve the use of evidence in both public health and health care. The rapid rise in their use has created the need for a systematic synthesis of the evidence of their impact as knowledge translation (KT) tools in the health care sector and for an inventory of the factors that affect their use. Objective: Through the Levac six-stage methodology, a scoping review was undertaken to explore the depth and breadth of evidence about the effective, safe, and ethical use of wikis and collaborative writing applications (CWAs) in health care. Methods: Multiple strategies were used to locate studies. Seven scientific databases and 6 grey literature sources were queried for articles on wikis and CWAs published between 2001 and September 16, 2011. In total, 4436 citations and 1921 grey literature items were screened. Two reviewers independently reviewed citations, selected eligible studies, and extracted data using a standardized form. We included any paper presenting qualitative or quantitative empirical evidence concerning health care and CWAs. We defined a CWA as any technology that enables the joint and simultaneous editing of a webpage or an online document by many end users. We performed qualitative content analysis to identify the factors that affect the use of CWAs using the Gagnon framework and their effects on health care using the Donabedian framework. Results: Of the 111 studies included, 4 were experimental, 5 quasi-experimental, 5 observational, 52 case studies, 23 surveys about wiki use, and 22 descriptive studies about the quality of information in wikis. We classified them by theme: patterns of use of CWAs (n=26), quality of information in existing CWAs (n=25), and CWAs as KT tools (n=73). A high prevalence of CWA use (ie, more than 50%) is reported in 58% (7/12) of surveys conducted with health care professionals and students. However, we found only one longitudinal study showing that CWA use is increasing in health care. Moreover, contribution rates remain low and the quality of information contained in different CWAs needs improvement. We identified 48 barriers and 91 facilitators in 4 major themes (factors related to the CWA, users? knowledge and attitude towards CWAs, human environment, and organizational environment). We also found 57 positive and 23 negative effects that we classified into processes and outcomes. Conclusions: Although we found some experimental and quasi-experimental studies of the effectiveness and safety of CWAs as educational and KT interventions, the vast majority of included studies were observational case studies about CWAs being used by health professionals and patients. More primary research is needed to find ways to address the different barriers to their use and to make these applications more useful for different stakeholders. UR - http://www.jmir.org/2013/10/e210/ UR - http://dx.doi.org/10.2196/jmir.2787 UR - http://www.ncbi.nlm.nih.gov/pubmed/24103318 ID - info:doi/10.2196/jmir.2787 ER - TY - JOUR AU - Jeffery, Rebecca AU - Navarro, Tamara AU - Lokker, Cynthia AU - Haynes, Brian R. AU - Wilczynski, L. Nancy AU - Farjou, George PY - 2012/12/10 TI - How Current Are Leading Evidence-Based Medical Textbooks? An Analytic Survey of Four Online Textbooks JO - J Med Internet Res SP - e175 VL - 14 IS - 6 KW - databases, bibliographic KW - medical informatics KW - evidence-based medicine N2 - Background: The consistency of treatment recommendations of evidence-based medical textbooks with more recently published evidence has not been investigated to date. Inconsistencies could affect the quality of medical care. Objective: To determine the frequency with which topics in leading online evidence-based medical textbooks report treatment recommendations consistent with more recently published research evidence. Methods: Summarized treatment recommendations in 200 clinical topics (ie, disease states) covered in four evidence-based textbooks?UpToDate, Physicians? Information Education Resource (PIER), DynaMed, and Best Practice?were compared with articles identified in an evidence rating service (McMaster Premium Literature Service, PLUS) since the date of the most recent topic updates in each textbook. Textbook treatment recommendations were compared with article results to determine if the articles provided different, new conclusions. From these findings, the proportion of topics which potentially require updating in each textbook was calculated. Results: 478 clinical topics were assessed for inclusion to find 200 topics that were addressed by all four textbooks. The proportion of topics for which there was 1 or more recently published articles found in PLUS with evidence that differed from the textbooks? treatment recommendations was 23% (95% CI 17-29%) for DynaMed, 52% (95% CI 45-59%) for UpToDate, 55% (95% CI 48-61%) for PIER, and 60% (95% CI 53-66%) for Best Practice (?23=65.3, P<.001). The time since the last update for each textbook averaged from 170 days (range 131-209) for DynaMed, to 488 days (range 423-554) for PIER (P<.001 across all textbooks). Conclusions: In online evidence-based textbooks, the proportion of topics with potentially outdated treatment recommendations varies substantially. UR - http://www.jmir.org/2012/6/e175/ UR - http://dx.doi.org/10.2196/jmir.2105 UR - http://www.ncbi.nlm.nih.gov/pubmed/23220465 ID - info:doi/10.2196/jmir.2105 ER - TY - JOUR AU - Stewart, Alan Samuel AU - Abidi, Raza Syed Sibte PY - 2012/12/04 TI - Applying Social Network Analysis to Understand the Knowledge Sharing Behaviour of Practitioners in a Clinical Online Discussion Forum JO - J Med Internet Res SP - e170 VL - 14 IS - 6 KW - Web 2.0 KW - health knowledge KW - attitudes KW - practice KW - knowledge management KW - information dissemination KW - pain KW - pediatrics KW - pediatric hospitals KW - education KW - professional KW - electronic mail N2 - Background: Knowledge Translation (KT) plays a vital role in the modern health care community, facilitating the incorporation of new evidence into practice. Web 2.0 tools provide a useful mechanism for establishing an online KT environment in which health practitioners share their practice-related knowledge and experiences with an online community of practice. We have implemented a Web 2.0 based KT environment?an online discussion forum?for pediatric pain practitioners across seven different hospitals in Thailand. The online discussion forum enabled the pediatric pain practitioners to share and translate their experiential knowledge to help improve the management of pediatric pain in hospitals. Objective: The goal of this research is to investigate the knowledge sharing dynamics of a community of practice through an online discussion forum. We evaluated the communication patterns of the community members using statistical and social network analysis methods in order to better understand how the online community engages to share experiential knowledge. Methods: Statistical analyses and visualizations provide a broad overview of the communication patterns within the discussion forum. Social network analysis provides the tools to delve deeper into the social network, identifying the most active members of the community, reporting the overall health of the social network, isolating the potential core members of the social network, and exploring the inter-group relationships that exist across institutions and professions. Results: The statistical analyses revealed a network dominated by a single institution and a single profession, and found a varied relationship between reading and posting content to the discussion forum. The social network analysis discovered a healthy network with strong communication patterns, while identifying which users are at the center of the community in terms of facilitating communication. The group-level analysis suggests that there is strong interprofessional and interregional communication, but a dearth of non-nurse participants has been identified as a shortcoming. Conclusions: The results of the analysis suggest that the discussion forum is active and healthy, and that, though few, the interprofessional and interinstitutional ties are strong. UR - http://www.jmir.org/2012/6/e170/ UR - http://dx.doi.org/10.2196/jmir.1982 UR - http://www.ncbi.nlm.nih.gov/pubmed/23211783 ID - info:doi/10.2196/jmir.1982 ER - TY - JOUR AU - Archambault, Michel Patrick AU - Bilodeau, Andrea AU - Gagnon, Marie-Pierre AU - Aubin, Karine AU - Lavoie, André AU - Lapointe, Jean AU - Poitras, Julien AU - Croteau, Sylvain AU - Pham-Dinh, Martin AU - Légaré, France PY - 2012/04/19 TI - Health Care Professionals? Beliefs About Using Wiki-Based Reminders to Promote Best Practices in Trauma Care JO - J Med Internet Res SP - e49 VL - 14 IS - 2 KW - Wiki KW - Collaborative writing applications KW - Web 2.0 KW - traumatic brain injury KW - interprofessional collaboration KW - reminders KW - computerized clinical decision-support system KW - knowledge translation KW - evidence-based medicine KW - theory of planned behavior N2 - Background : Wikis are knowledge translation tools that could help health professionals implement best practices in acute care. Little is known about the factors influencing professionals? use of wikis. Objectives : To identify and compare the beliefs of emergency physicians (EPs) and allied health professionals (AHPs) about using a wiki-based reminder that promotes evidence-based care for traumatic brain injuries. Methods : Drawing on the theory of planned behavior, we conducted semistructured interviews to elicit EPs? and AHPs? beliefs about using a wiki-based reminder. Previous studies suggested a sample of 25 EPs and 25 AHPs. We purposefully selected participants from three trauma centers in Quebec, Canada, to obtain a representative sample. Using univariate analyses, we assessed whether our participants? gender, age, and level of experience were similar to those of all eligible individuals. Participants viewed a video showing a clinician using a wiki-based reminder, and we interviewed participants about their behavioral, control, and normative beliefs?that is, what they saw as advantages, disadvantages, barriers, and facilitators to their use of a reminder, and how they felt important referents would perceive their use of a reminder. Two reviewers independently analyzed the content of the interview transcripts. We considered the 75% most frequently mentioned beliefs as salient. We retained some less frequently mentioned beliefs as well. Results : Of 66 eligible EPs and 444 eligible AHPs, we invited 55 EPs and 39 AHPs to participate, and 25 EPs and 25 AHPs (15 nurses, 7 respiratory therapists, and 3 pharmacists) accepted. Participating AHPs had more experience than eligible AHPs (mean 14 vs 11 years; P = .04). We noted no other significant differences. Among EPs, the most frequently reported advantage of using a wiki-based reminder was that it refreshes the memory (n = 14); among AHPs, it was that it provides rapid access to protocols (n = 16). Only 2 EPs mentioned a disadvantage (the wiki added stress). The most frequently reported favorable referent was nurses for EPs (n = 16) and EPs for AHPs (n = 19). The most frequently reported unfavorable referents were people resistant to standardized care for EPs (n = 8) and people less comfortable with computers for AHPs (n = 11). The most frequent facilitator for EPs was ease of use (n = 19); for AHPs, it was having a bedside computer (n = 20). EPs? most frequently reported barrier was irregularly updated wiki-based reminders (n = 18); AHPs? was undetermined legal responsibility (n = 10). Conclusions : We identified EPs? and AHPs? salient beliefs about using a wiki-based reminder. We will draw on these beliefs to construct a questionnaire to measure the importance of these determinants to EPs? and AHPs? intention to use a wiki-based reminder promoting evidence-based care for traumatic brain injuries. UR - http://www.jmir.org/2012/2/e49/ UR - http://dx.doi.org/10.2196/jmir.1983 UR - http://www.ncbi.nlm.nih.gov/pubmed/22515985 ID - info:doi/10.2196/jmir.1983 ER - TY - JOUR AU - Ketchum, M. Andrea AU - Saleh, A. Ahlam AU - Jeong, Kwonho PY - 2011/02/18 TI - Type of Evidence Behind Point-of-Care Clinical Information Products: A Bibliometric Analysis JO - J Med Internet Res SP - e21 VL - 13 IS - 1 KW - Databases, Factual KW - Bibliometrics KW - Medical Informatics KW - Evidence-based Medicine N2 - Background: Point-of-care (POC) products are widely used as information reference tools in the clinical setting. Although usability, scope of coverage, ability to answer clinical questions, and impact on health outcomes have been studied, no comparative analysis of the characteristics of the references, the evidence for the content, in POC products is available. Objective: The objective of this study was to compare the type of evidence behind five POC clinical information products. Methods: This study is a comparative bibliometric analysis of references cited in monographs in POC products. Five commonly used products served as subjects for the study: ACP PIER, Clinical Evidence, DynaMed, FirstCONSULT, and UpToDate. The four clinical topics examined to identify content in the products were asthma, hypertension, hyperlipidemia, and carbon monoxide poisoning. Four indicators were measured: distribution of citations, type of evidence, product currency, and citation overlap. The type of evidence was determined based primarily on the publication type found in the MEDLINE bibliographic record, as well as the Medical Subject Headings (MeSH), both assigned by the US National Library of Medicine. MeSH is the controlled vocabulary used for indexing articles in MEDLINE/PubMed. Results: FirstCONSULT had the greatest proportion of references with higher levels of evidence publication types such as systematic review and randomized controlled trial (137/153, 89.5%), although it contained the lowest total number of references (153/2330, 6.6%). DynaMed had the largest total number of references (1131/2330, 48.5%) and the largest proportion of current (2007-2009) references (170/1131, 15%). The distribution of references cited for each topic varied between products. For example, asthma had the most references listed in DynaMed, Clinical Evidence, and FirstCONSULT, while hypertension had the most references in UpToDate and ACP PIER. An unexpected finding was that the rate of citation overlap was less than 1% for each topic across all five products. Conclusions: Differences between POC products are revealed by examining the references cited in the monographs themselves. Citation analysis extended to include key content indicators can be used to compare the evidence levels of the literature supporting the content found in POC products. UR - http://www.jmir.org/2011/1/e21/ UR - http://dx.doi.org/10.2196/jmir.1539 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jmir.1539 ER -