TY - JOUR AU - Mueller, Julia AU - Jay, Caroline AU - Harper, Simon AU - Davies, Alan AU - Vega, Julio AU - Todd, Chris PY - 2017/06/13 TI - Web Use for Symptom Appraisal of Physical Health Conditions: A Systematic Review JO - J Med Internet Res SP - e202 VL - 19 IS - 6 KW - Online health information KW - health information seeking KW - Internet KW - symptom appraisal KW - Web search KW - search strategies N2 - Background: The Web has become an important information source for appraising symptoms. We need to understand the role it currently plays in help seeking and symptom evaluation to leverage its potential to support health care delivery. Objective: The aim was to systematically review the literature currently available on Web use for symptom appraisal. Methods: We searched PubMed, EMBASE, PsycINFO, ACM Digital Library, SCOPUS, and Web of Science for any empirical studies that addressed the use of the Web by lay people to evaluate symptoms for physical conditions. Articles were excluded if they did not meet minimum quality criteria. Study findings were synthesized using a thematic approach. Results: A total of 32 studies were included. Study designs included cross-sectional surveys, qualitative studies, experimental studies, and studies involving website/search engine usage data. Approximately 35% of adults engage in Web use for symptom appraisal, but this proportion varies between 23% and 75% depending on sociodemographic and disease-related factors. Most searches were symptom-based rather than condition-based. Users viewed only the top search results and interacted more with results that mentioned serious conditions. Web use for symptom appraisal appears to impact on the decision to present to health services, communication with health professionals, and anxiety. Conclusions: Web use for symptom appraisal has the potential to influence the timing of help seeking for symptoms and the communication between patients and health care professionals during consultations. However, studies lack suitable comparison groups as well as follow-up of participants over time to determine whether Web use results in health care utilization and diagnosis. Future research should involve longitudinal follow-up so that we can weigh the benefits of Web use for symptom appraisal (eg, reductions in delays to diagnosis) against the disadvantages (eg, unnecessary anxiety and health care use) and relate these to health care costs. UR - http://www.jmir.org/2017/6/e202/ UR - http://dx.doi.org/10.2196/jmir.6755 UR - http://www.ncbi.nlm.nih.gov/pubmed/28611017 ID - info:doi/10.2196/jmir.6755 ER - TY - JOUR AU - Michie, Susan AU - Yardley, Lucy AU - West, Robert AU - Patrick, Kevin AU - Greaves, Felix PY - 2017/06/29 TI - Developing and Evaluating Digital Interventions to Promote Behavior Change in Health and Health Care: Recommendations Resulting From an International Workshop JO - J Med Internet Res SP - e232 VL - 19 IS - 6 KW - health behavior KW - psychological theory KW - mobile applications KW - behavioral medicine KW - mHealth KW - eHealth UR - http://www.jmir.org/2017/6/e232/ UR - http://dx.doi.org/10.2196/jmir.7126 UR - http://www.ncbi.nlm.nih.gov/pubmed/28663162 ID - info:doi/10.2196/jmir.7126 ER - TY - JOUR AU - Lutz, Wolfgang AU - Arndt, Alice AU - Rubel, Julian AU - Berger, Thomas AU - Schröder, Johanna AU - Späth, Christina AU - Meyer, Björn AU - Greiner, Wolfgang AU - Gräfe, Viola AU - Hautzinger, Martin AU - Fuhr, Kristina AU - Rose, Matthias AU - Nolte, Sandra AU - Löwe, Bernd AU - Hohagen, Fritz AU - Klein, Philipp Jan AU - Moritz, Steffen PY - 2017/06/09 TI - Defining and Predicting Patterns of Early Response in a Web-Based Intervention for Depression JO - J Med Internet Res SP - e206 VL - 19 IS - 6 KW - patterns of early change KW - depression KW - web interventions KW - psychotherapy research N2 - Background: Web-based interventions for individuals with depressive disorders have been a recent focus of research and may be an effective adjunct to face-to-face psychotherapy or pharmacological treatment. Objective: The aim of our study was to examine the early change patterns in Web-based interventions to identify differential effects. Methods: We applied piecewise growth mixture modeling (PGMM) to identify different latent classes of early change in individuals with mild-to-moderate depression (n=409) who underwent a CBT-based web intervention for depression. Results: Overall, three latent classes were identified (N=409): Two early response classes (n=158, n=185) and one early deterioration class (n=66). Latent classes differed in terms of outcome (P<.001) and adherence (P=.03) in regard to the number of modules (number of modules with a duration of at least 10 minutes) and the number of assessments (P<.001), but not in regard to the overall amount of time using the system. Class membership significantly improved outcome prediction by 24.8% over patient intake characteristics (P<.001) and significantly added to the prediction of adherence (P=.04). Conclusions: These findings suggest that in Web-based interventions outcome and adherence can be predicted by patterns of early change, which can inform treatment decisions and potentially help optimize the allocation of scarce clinical resources. UR - http://www.jmir.org/2017/6/e206/ UR - http://dx.doi.org/10.2196/jmir.7367 UR - http://www.ncbi.nlm.nih.gov/pubmed/28600278 ID - info:doi/10.2196/jmir.7367 ER - TY - JOUR AU - Kramer, Jan-Niklas AU - Kowatsch, Tobias PY - 2017/06/02 TI - Using Feedback to Promote Physical Activity: The Role of the Feedback Sign JO - J Med Internet Res SP - e192 VL - 19 IS - 6 KW - feedback KW - internet KW - physical activity KW - health behavior KW - activity trackers N2 - Background: Providing feedback is a technique to promote health behavior that is emphasized by behavior change theories. However, these theories make contradicting predictions regarding the effect of the feedback sign?that is, whether the feedback signals success or failure. Thus, it is unclear whether positive or negative feedback leads to more favorable behavior change in a health behavior intervention. Objective: The aim of this study was to examine the effect of the feedback sign in a health behavior change intervention. Methods: Data from participants (N=1623) of a 6-month physical activity intervention was used. Participants received a feedback email at the beginning of each month. Feedback was either positive or negative depending on the participants? physical activity in the previous month. In an exploratory analysis, change in monthly step count averages was used to evaluate the feedback effect. Results: The feedback sign did not predict the change in monthly step count averages over the course of the intervention (b=?84.28, P=.28). Descriptive differences between positive and negative feedback can be explained by regression to the mean. Conclusions: The feedback sign might not influence the effect of monthly feedback emails sent out to participants of a large-scale physical activity intervention. However, randomized studies are needed to further support this conclusion. Limitations as well as opportunities for future research are discussed. UR - http://www.jmir.org/2017/6/e192/ UR - http://dx.doi.org/10.2196/jmir.7012 UR - http://www.ncbi.nlm.nih.gov/pubmed/28576757 ID - info:doi/10.2196/jmir.7012 ER - TY - JOUR AU - van Rosmalen-Nooijens, Karin AU - Lo Fo Wong, Sylvie AU - Prins, Judith AU - Lagro-Janssen, Toine PY - 2017/06/12 TI - Young People, Adult Worries: Randomized Controlled Trial and Feasibility Study of the Internet-Based Self-Support Method ?Feel the ViBe? for Adolescents and Young Adults Exposed to Family Violence JO - J Med Internet Res SP - e204 VL - 19 IS - 6 KW - domestic violence KW - child abuse KW - exposure to violence KW - adolescent KW - young adult KW - telemedicine KW - peer group KW - peer influence KW - Internet KW - feasibility studies KW - randomized controlled trial KW - delivery of health care N2 - Background: Adolescents and young adults (AYAs) are of special interest in a group of children exposed to family violence (FV). Past-year prevalence of exposure to FV is known to be highest in AYAs and has severe consequences. Peer support is an effective approach to behavior change and the Internet is considered suitable as a mode of delivery. Objective: The study aimed to evaluate both effectiveness and feasibility of a randomized controlled trial (RCT) and feasibility study of the Internet-based self-support method ?Feel the ViBe? (FtV) using mixed-methods approach to fully understand the strengths and weaknesses of a new intervention. Methods: AYAs aged 12-25 years and exposed to FV were randomized in an intervention group (access to FtV + usual care) and a control group (minimally enhanced usual care) after they self-registered themselves. From June 2012 to July 2014, participants completed the Impact of Event Scale (IES) and Depression (DEP) and Anxiety (ANX) subscales of the Symptom CheckList-90-R (SCL-90) every 6 weeks. The Web Evaluation Questionnaire was completed after 12 weeks. Quantitative usage data were collected using Google analytics and content management system (CMS) logs and data files. A univariate analysis of variance (UNIANOVA) and mixed model analysis (intention-to-treat [ITT], complete case) were used to compare groups. Pre-post t tests were used to find within-group effects. Feasibility measures structurally address the findings. The CONsolidated Standards Of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth (CONSORT-EHEALTH) checklist was closely followed. Results: In total, 31 out of 46 participants in the intervention group and 26 out of 47 participants in the control group started FtV. Seventeen participants (intervention: n=8, control: n=9) completed all questionnaires. Mixed model analysis showed significant differences between groups on the SCL-90 DEP (P=.04) and ANX (P=.049) subscales between 6 and 12 weeks after participation started. UNIANOVA showed no significant differences. Pre-post paired sample t tests showed significant improvements after 12 weeks for the SCL-90 DEP (P=.03) and ANX (P=.046) subscales. Reported mean Web-based time per week was 2.83 with a session time of 36 min. FtV was rated a mean 7.47 (1-10 Likert scale) with a helpfulness score of 3.16 (1-5 Likert scale). All participants felt safe. Two-thirds of the intervention participants started regular health care. Conclusions: No changes on the IES were found. SCL-90 DEP and ANX showed promising results; however, the calculated sample size was not reached (n=18). FtV functions best as a first step for adolescents and young adults in an early stage of change. FtV can be easily implemented without extensive resources and fits best in the field of public health care or national governmental care. Trial Registration: Netherlands National Trial Register (NTR): NTR3692; http://www.trialregister.nl/trialreg/admin/ rctview.asp?TC=3692 (Archived by WebCite at http://www.webcitation.org/6qIeKyjA4) UR - http://www.jmir.org/2017/6/e204/ UR - http://dx.doi.org/10.2196/jmir.6004 UR - http://www.ncbi.nlm.nih.gov/pubmed/28606893 ID - info:doi/10.2196/jmir.6004 ER - TY - JOUR AU - Beiwinkel, Till AU - Eißing, Tabea AU - Telle, Nils-Torge AU - Siegmund-Schultze, Elisabeth AU - Rössler, Wulf PY - 2017/06/15 TI - Effectiveness of a Web-Based Intervention in Reducing Depression and Sickness Absence: Randomized Controlled Trial JO - J Med Internet Res SP - e213 VL - 19 IS - 6 KW - Internet KW - depression KW - absenteeism KW - cognitive therapy KW - randomized controlled trial N2 - Background: Depression is highly prevalent in the working population and is associated with significant loss of workdays; however, access to evidence-based treatment is limited. Objective: This study evaluated the effectiveness of a Web-based intervention in reducing mild to moderate depression and sickness absence. Methods: In an open-label randomized controlled trial, participants were recruited from a large-scale statutory health insurance and were assigned to two groups. The intervention group had access to a 12 week Web-based program consisting of structured interactive sessions and therapist support upon request. The wait-list control group had access to unguided Web-based psycho-education. Depressive symptoms were self-assessed at baseline, post-treatment, and follow-up (12 weeks after treatment) using the Patient Health Questionnaire (PHQ-9) and Beck Depression Inventory (BDI-II) as primary outcome measures. Data on sickness absence was retrieved from health insurance records. Intention-to-treat (ITT) analysis and per-protocol (PP) analysis were performed. Results: Of the 180 participants who were randomized, 88 completed the post-assessment (retention rate: 48.8%, 88/180). ITT analysis showed a significant between-group difference in depressive symptoms during post-treatment in favor of the intervention group, corresponding to a moderate effect size (PHQ-9: d=0.55, 95% CI 0.25-0.85, P<.001, and BDI-II: d=0.41, CI 0.11-0.70, P=.004). PP analysis partially supported this result, but showed a non-significant effect on one primary outcome (PHQ-9: d=0.61, 95% CI 0.15-1.07, P=.04, and BDI-II: d=0.25 95% CI ?0.18 to 0.65, P=.37). Analysis of clinical significance using reliable change index revealed that significantly more participants who used the Web-based intervention (63%, 63/100) responded to the treatment versus the control group (33%, 27/80; P<.001). The number needed to treat (NNT) was 4.08. Within both groups, there was a reduction in work absence frequency (IG: ?67.23%, P<.001, CG: ?82.61%, P<.001), but no statistical difference in sickness absence between groups was found (P=.07). Conclusions: The Web-based intervention was effective in reducing depressive symptoms among adults with sickness absence. As this trial achieved a lower power than calculated, its results should be replicated in a larger sample. Further validation of health insurance records as an outcome measure for eHealth trials is needed. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 02446836; http://www.isrctn.com/ISRCTN02446836 (Archived by WebCite at http://www.webcitation.org/6jx4SObnw) UR - http://www.jmir.org/2017/6/e213/ UR - http://dx.doi.org/10.2196/jmir.6546 UR - http://www.ncbi.nlm.nih.gov/pubmed/28619701 ID - info:doi/10.2196/jmir.6546 ER - TY - JOUR AU - Cheung, Long Kei AU - Wijnen, Ben AU - de Vries, Hein PY - 2017/06/23 TI - A Review of the Theoretical Basis, Effects, and Cost Effectiveness of Online Smoking Cessation Interventions in the Netherlands: A Mixed-Methods Approach JO - J Med Internet Res SP - e230 VL - 19 IS - 6 KW - Smoking cessation KW - telemedicine KW - review KW - online intervention KW - Internet-based intervention KW - behavioral change techniques KW - Netherlands N2 - Background: Tobacco smoking is a worldwide public health problem. In 2015, 26.3% of the Dutch population aged 18 years and older smoked, 74.4% of them daily. More and more people have access to the Internet worldwide; approximately 94% of the Dutch population have online access. Internet-based smoking cessation interventions (online cessation interventions) provide an opportunity to tackle the scourge of tobacco. Objective: The goal of this paper was to provide an overview of online cessation interventions in the Netherlands, while exploring their effectivity, cost effectiveness, and theoretical basis. Methods: A mixed-methods approach was used to identify Dutch online cessation interventions, using (1) a scientific literature search, (2) a grey literature search, and (3) expert input. For the scientific literature, the Cochrane review was used and updated by two independent researchers (n=651 identified studies), screening titles, abstracts, and then full-text studies between 2013 and 2016 (CENTRAL, MEDLINE, and EMBASE). For the grey literature, the researchers conducted a Google search (n=100 websites), screening for titles and first pages. Including expert input, this resulted in six interventions identified in the scientific literature and 39 interventions via the grey literature. Extracted data included effectiveness, cost effectiveness, theoretical factors, and behavior change techniques used. Results: Overall, many interventions (45 identified) were offered. Of the 45 that we identified, only six that were included in trials provided data on effectiveness. Four of these were shown to be effective and cost effective. In the scientific literature, 83% (5/6) of these interventions included changing attitudes, providing social support, increasing self-efficacy, motivating smokers to make concrete action plans to prepare their attempts to quit and to cope with challenges, supporting identity change and advising on changing routines, coping, and medication use. In all, 50% (3/6) of the interventions included a reward for abstinence. Interventions identified in the grey literature were less consistent, with inclusion of each theoretical factor ranging from 31% to 67% and of each behavior change technique ranging from 28% to 54%. Conclusions: Although the Internet may provide the opportunity to offer various smoking cessation programs, the user is left bewildered as far as efficacy is concerned, as most of these data are not available nor offered to the smokers. Clear regulations about the effectiveness of these interventions need to be devised to avoid disappointment and failed quitting attempts. Thus, there is a need for policy regulations to regulate the proliferation of these interventions and to foster their quality in the Netherlands. UR - http://www.jmir.org/2017/6/e230/ UR - http://dx.doi.org/10.2196/jmir.7209 UR - http://www.ncbi.nlm.nih.gov/pubmed/28645889 ID - info:doi/10.2196/jmir.7209 ER - TY - JOUR AU - Sorgente, Angela AU - Pietrabissa, Giada AU - Manzoni, Mauro Gian AU - Re, Federica AU - Simpson, Susan AU - Perona, Sara AU - Rossi, Alessandro AU - Cattivelli, Roberto AU - Innamorati, Marco AU - Jackson, B. Jeffrey AU - Castelnuovo, Gianluca PY - 2017/06/26 TI - Web-Based Interventions for Weight Loss or Weight Loss Maintenance in Overweight and Obese People: A Systematic Review of Systematic Reviews JO - J Med Internet Res SP - e229 VL - 19 IS - 6 KW - Internet KW - review KW - delivery of health care KW - obesity KW - overweight KW - telemedicine KW - weight loss KW - body weight maintenance KW - treatment outcome N2 - Background: Weight loss is challenging and maintenance of weight loss is problematic. Web-based programs offer good potential for delivery of interventions for weight loss or weight loss maintenance. However, the precise impact of Web-based weight management programs is still unclear. Objective: The purpose of this meta-systematic review was to provide a comprehensive summary of the efficacy of Web-based interventions for weight loss and weight loss maintenance. Methods: Electronic databases were searched for systematic reviews and meta-analyses that included at least one study investigating the effect of a Web-based intervention on weight loss and/or weight loss maintenance among samples of overweight and/or obese individuals. Twenty identified reviews met the inclusion criteria. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was used to assess methodological quality of reviews. All included reviews were of sufficient methodological quality (R-AMSTAR score ?22). Key methodological and outcome data were extracted from each review. Results: Web-based interventions for both weight loss and weight loss maintenance were more effective than minimal or control conditions. However, when contrasted with comparable non-Web-based interventions, results were less consistent across reviews. Conclusions: Overall, the efficacy of weight loss maintenance interventions was stronger than the efficacy of weight loss interventions, but further evidence is needed to more clearly understand the efficacy of both types of Web-based interventions. Trial Registration: PROSPERO 2015: CRD42015029377; http://www.crd.york.ac.uk/PROSPERO/display_record.asp? ID=CRD42015029377 (Archived by WebCite at http://www.webcitation.org/6qkSafdCZ) UR - http://www.jmir.org/2017/6/e229/ UR - http://dx.doi.org/10.2196/jmir.6972 UR - http://www.ncbi.nlm.nih.gov/pubmed/28652225 ID - info:doi/10.2196/jmir.6972 ER - TY - JOUR AU - Radtke, Theda AU - Ostergaard, Mathias AU - Cooke, Richard AU - Scholz, Urte PY - 2017/06/28 TI - Web-Based Alcohol Intervention: Study of Systematic Attrition of Heavy Drinkers JO - J Med Internet Res SP - e217 VL - 19 IS - 6 KW - attrition KW - dropout KW - alcohol drinking KW - intervention study KW - Internet KW - surveys and questionnaires KW - university student drinking KW - motivation N2 - Background: Web-based alcohol interventions are a promising way to reduce alcohol consumption because of their anonymity and the possibility of reaching a high numbers of individuals including heavy drinkers. However, Web-based interventions are often characterized by high rates of attrition. To date, very few studies have investigated whether individuals with higher alcohol consumption show higher attrition rates in Web-based alcohol interventions as compared with individuals with lower alcohol consumption. Objectives: The aim of this study was to examine the attrition rate and predictors of attrition in a Web-based intervention study on alcohol consumption. Methods: The analysis of the predictors of attrition rate was performed on data collected in a Web-based randomized control trial. Data collection took place at the University of Konstanz, Germany. A total of 898 people, which consisted of 46.8% males (420/898) and 53.2% females (478/898) with a mean age of 23.57 years (SD 5.19), initially volunteered to participate in a Web-based intervention study to reduce alcohol consumption. Out of the sample, 86.9% (781/898) were students. Participants were classified as non-completers (439/898, 48.9%) if they did not complete the Web-based intervention. Potential predictors of attrition were self-reported: alcohol consumption in the last seven days, per week, from Monday to Thursday, on weekends, excessive drinking behavior measured with the Alcohol Use Disorder Identification Test (AUDIT), and drinking motives measured by the Drinking Motive Questionnaire (DMQ-R SF). Results: Significant differences between completers and non-completers emerged regarding alcohol consumption in the last seven days (B=?.02, P=.05, 95% CI [0.97-1.00]), on weekends (B=?.05, P=.003, 95% CI [0.92-0.98]), the AUDIT (B=?.06, P=.007, 95% CI [0.90-0.98], and the status as a student (B=.72, P=.001, 95% CI [1.35-3.11]). Most importantly, non-completers had a significantly higher alcohol consumption compared with completers. Conclusions: Hazardous alcohol consumption appears to be a key factor of the dropout rate in a Web-based alcohol intervention study. Thus, it is important to develop strategies to keep participants who are at high risk in Web-based interventions. UR - http://www.jmir.org/2017/6/e217/ UR - http://dx.doi.org/10.2196/jmir.6780 UR - http://www.ncbi.nlm.nih.gov/pubmed/28659251 ID - info:doi/10.2196/jmir.6780 ER - TY - JOUR AU - Hargreaves, Sarah AU - Hawley, S. Mark AU - Haywood, Annette AU - Enderby, M. Pamela PY - 2017/06/28 TI - Informing the Design of ?Lifestyle Monitoring? Technology for the Detection of Health Deterioration in Long-Term Conditions: A Qualitative Study of People Living With Heart Failure JO - J Med Internet Res SP - e231 VL - 19 IS - 6 KW - independent living KW - human activities KW - heart failure KW - biomedical technology N2 - Background: Health technologies are being developed to help people living at home manage long-term conditions. One such technology is ?lifestyle monitoring? (LM), a telecare technology based on the idea that home activities may be monitored unobtrusively via sensors to give an indication of changes in health-state. However, questions remain about LM technology: how home activities change when participants experience differing health-states; and how sensors might capture clinically important changes to inform timely interventions. Objective: The objective of this paper was to report the findings of a study aimed at identifying changes in activity indicative of important changes in health in people with long-term conditions, particularly changes indicative of exacerbation, by exploring the relationship between home activities and health among people with heart failure (HF). We aimed to add to the knowledge base informing the development of home monitoring technologies designed to detect health deterioration in order to facilitate early intervention and avoid hospital admissions. Methods: This qualitative study utilized semistructured interviews to explore everyday activities undertaken during the three health-states of HF: normal days, bad days, and exacerbations. Potential recruits were identified by specialist nurses and attendees at an HF support group. The sample was purposively selected to include a range of experience of living with HF. Results: The sample comprised a total of 20 people with HF aged 50 years and above, and 11 spouses or partners of the individuals with HF. All resided in Northern England. Participant accounts revealed that home activities are in part shaped by the degree of intrusion from HF symptoms. During an exacerbation, participants undertook activities specifically to ease symptoms, and detailed activity changes were identified. Everyday activity was also influenced by a range of factors other than health. Conclusions: The study highlights the importance of careful development of LM technology to identify changes in activities that occur during clinically important changes in health. These detailed activity changes need to be considered by developers of LM sensors, platforms, and algorithms intended to detect early signs of deterioration. Results suggest that for LM to move forward, sensor set-up should be personalized to individual circumstances and targeted at individual health conditions. LM needs to take account of the uncertainties that arise from placing technology within the home, in order to inform sensor set-up and data interpretation. This targeted approach is likely to yield more clinically meaningful data and address some of the ethical issues of remote monitoring. UR - http://www.jmir.org/2017/6/e231/ UR - http://dx.doi.org/10.2196/jmir.6931 UR - http://www.ncbi.nlm.nih.gov/pubmed/28659253 ID - info:doi/10.2196/jmir.6931 ER - TY - JOUR AU - King, Elizabeth AU - Kinvig, Karen AU - Steif, Jonathan AU - Qiu, Q. Annie AU - Maan, J. Evelyn AU - Albert, YK Arianne AU - Pick, Neora AU - Alimenti, Ariane AU - Kestler, H. Mary AU - Money, M. Deborah AU - Lester, T. Richard AU - Murray, Margaret Melanie Caroline PY - 2017/06/01 TI - Mobile Text Messaging to Improve Medication Adherence and Viral Load in a Vulnerable Canadian Population Living With Human Immunodeficiency Virus: A Repeated Measures Study JO - J Med Internet Res SP - e190 VL - 19 IS - 6 KW - mHealth KW - HIV KW - medication adherence KW - vulnerable KW - female KW - viral load KW - mobile phone KW - engagement N2 - Background: Combination antiretroviral therapy (cART) as treatment for human immunodeficiency virus (HIV) infection is effective and available, but poor medication adherence limits benefits, particularly in vulnerable populations. In a Kenyan randomized controlled trial, a weekly text-messaging intervention (WelTel) improved cART adherence and HIV viral load (VL). Despite growing evidence for short message service (SMS) text-message interventions in HIV care, there is a paucity of data utilizing these interventions in marginalized or female cohorts. Objective: This study was undertaken to assess whether the standardized WelTel SMS text-message intervention applied to a vulnerable, predominantly female, population improved cART adherence and VL. Methods: We conducted a repeated measures study of the WelTel intervention in high-risk HIV-positive persons by measuring change in VL, CD4 count, and self-reported adherence 12 months before and 12 months after the WelTel intervention was introduced. Inclusion criteria included VL ?200 copies/mL, indication for treatment, and meeting vulnerability criteria. Participants were given a mobile phone with unlimited texting (where required), and weekly check-in text messages were sent for one year from the WelTel computer platform. Clinical data were collected for control and intervention years. Participants were followed by a multidisciplinary team in a clinical setting. Outcomes were assessed using Wilcoxon signed ranks tests for change in CD4 and VL from control year to study end and mixed-effects logistic regressions for change in cART adherence and appointment attendance. A secondary analysis was conducted to assess the effect of response rate on the outcome by modeling final log10 VL by number of responses while controlling for mean log10 VL in the control year. Results: Eighty-five participants enrolled in the study, but 5 withdrew (final N=80). Participants were predominantly female (90%, 72/80) with a variety of vulnerabilities. Mean VL decreased from 1098 copies/mL in the control year to 439 copies/mL at study end (P=.004). Adherence to cART significantly improved (OR 1.14, IQR 1.10-1.18; P<.001), whereas appointment attendance decreased slightly with the intervention (OR 0.81, IQR 0.67-0.99; P=.03). A response was received for 46.57% (1753/3764) of messages sent and 9.62% (362/3764) of text messages sent were replied to with a problem. An outcome analysis examining relationship between reply rate and VL did not meet statistical significance (P=.07), but may be worthy of investigating further in a larger study. Conclusions: WelTel may be an effective tool for improving cART adherence and reducing VLs among high-risk, vulnerable HIV-positive persons. Trial Registration: Clinicaltrials.gov NCT02603536; https://clinicaltrials.gov/ct2/show/NCT02603536 (Archived by WebCite at http://www.webcitation.org/6qK57zCwv) UR - http://www.jmir.org/2017/6/e190/ UR - http://dx.doi.org/10.2196/jmir.6631 UR - http://www.ncbi.nlm.nih.gov/pubmed/28572079 ID - info:doi/10.2196/jmir.6631 ER - TY - JOUR AU - Holmen, Heidi AU - Wahl, Klopstad Astrid AU - Cvancarova Småstuen, Milada AU - Ribu, Lis PY - 2017/06/23 TI - Tailored Communication Within Mobile Apps for Diabetes Self-Management: A Systematic Review JO - J Med Internet Res SP - e227 VL - 19 IS - 6 KW - diabetes mellitus (MeSH) KW - communication (MeSH) KW - mobile apps KW - self-management KW - systematic review KW - mHealth N2 - Background: The prevalence of diabetes is increasing and with the requirements for self-management and risk of late complications, it remains a challenge for the individual and society. Patients can benefit from support from health care personnel in their self-management, and the traditional communication between patients and health care personnel is changing. Smartphones and apps offer a unique platform for communication, but apps with integrated health care personnel communication based on patient data are yet to be investigated to provide evidence of possible effects. Objective: Our goal was to systematically review studies that aimed to evaluate integrated communication within mobile apps for tailored feedback between patients with diabetes and health care personnel in terms of (1) study characteristics, (2) functions, (3) study outcomes, (4) effects, and (5) methodological quality. Methods: A systematic literature search was conducted following our International Prospective Register of Systematic Reviews (PROSPERO) protocol, searching for apps with integrated communication for persons with diabetes tested in a controlled trial in the period 2008 to 2016. We searched the databases PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central, Excerpta Medica database (EMBASE), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform. The search was closed in September 2016. Reference lists of primary articles and review papers were assessed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and we applied the Cochrane risk of bias tool to assess methodological quality. Results: We identified 2822 citations and after duplicate removal, we assessed 1128 citations. A total of 6 papers were included in this systematic review, reporting on data from 431 persons participating in small trials of short duration. The integrated communication features were mostly individualized as written non?real-time feedback. The number of functions varied from 2 to 9, and blood glucose tracking was the most common. HbA1c was the most common primary outcome, but the remaining reported outcomes were not standardized and comparable. Because of both the heterogeneity of the included trials and the poor methodological quality of the studies, a meta-analysis was not possible. A statistically significant improvement in the primary measure of outcome was found in 3 of the 6 included studies, of which 2 were HbA1c and 1 was mean daytime ambulatory blood pressure. Participants in the included trials reported positive usability or feasibility postintervention in 5 out of 6 trials. The overall methodological quality of the trials was, however, scored as an uncertain risk of bias. Conclusions: This systematic review highlights the need for more trials of higher methodological quality. Few studies offer an integrated function for communication and feedback from health care personnel, and the research field represents an area of heterogeneity with few studies of highly rigorous methodological quality. This, in combination with a low number of participants and a short follow-up, is making it difficult to provide reliable evidence of effects for stakeholders. UR - http://www.jmir.org/2017/6/e227/ UR - http://dx.doi.org/10.2196/jmir.7045 UR - http://www.ncbi.nlm.nih.gov/pubmed/28645890 ID - info:doi/10.2196/jmir.7045 ER - TY - JOUR AU - Grundy, Quinn AU - Held, P. Fabian AU - Bero, A. Lisa PY - 2017/06/28 TI - Tracing the Potential Flow of Consumer Data: A Network Analysis of Prominent Health and Fitness Apps JO - J Med Internet Res SP - e233 VL - 19 IS - 6 KW - mobile health KW - smartphone KW - privacy N2 - Background: A great deal of consumer data, collected actively through consumer reporting or passively through sensors, is shared among apps. Developers increasingly allow their programs to communicate with other apps, sensors, and Web-based services, which are promoted as features to potential users. However, health apps also routinely pose risks related to information leaks, information manipulation, and loss of information. There has been less investigation into the kinds of user data that developers are likely to collect, and who might have access to it. Objective: We sought to describe how consumer data generated from mobile health apps might be distributed and reused. We also aimed to outline risks to individual privacy and security presented by this potential for aggregating and combining user data across apps. Methods: We purposively sampled prominent health and fitness apps available in the United States, Canada, and Australia Google Play and iTunes app stores in November 2015. Two independent coders extracted data from app promotional materials on app and developer characteristics, and the developer-reported collection and sharing of user data. We conducted a descriptive analysis of app, developer, and user data collection characteristics. Using structural equivalence analysis, we conducted a network analysis of sampled apps? self-reported sharing of user-generated data. Results: We included 297 unique apps published by 231 individual developers, which requested 58 different permissions (mean 7.95, SD 6.57). We grouped apps into 222 app families on the basis of shared ownership. Analysis of self-reported data sharing revealed a network of 359 app family nodes, with one connected central component of 210 app families (58.5%). Most (143/222, 64.4%) of the sampled app families did not report sharing any data and were therefore isolated from each other and from the core network. Fifteen app families assumed more central network positions as gatekeepers on the shortest paths that data would have to travel between other app families. Conclusions: This cross-sectional analysis highlights the possibilities for user data collection and potential paths that data is able to travel among a sample of prominent health and fitness apps. While individual apps may not collect personally identifiable information, app families and the partners with which they share data may be able to aggregate consumer data, thus achieving a much more comprehensive picture of the individual consumer. The organizations behind the centrally connected app families represent diverse industries, including apparel manufacturers and social media platforms that are not traditionally involved in health or fitness. This analysis highlights the potential for anticipated and voluntary but also possibly unanticipated and involuntary sharing of user data, validating privacy and security concerns in mobile health. UR - http://www.jmir.org/2017/6/e233/ UR - http://dx.doi.org/10.2196/jmir.7347 UR - http://www.ncbi.nlm.nih.gov/pubmed/28659254 ID - info:doi/10.2196/jmir.7347 ER - TY - JOUR AU - Allot, Alexis AU - Chennen, Kirsley AU - Nevers, Yannis AU - Poidevin, Laetitia AU - Kress, Arnaud AU - Ripp, Raymond AU - Thompson, Dawn Julie AU - Poch, Olivier AU - Lecompte, Odile PY - 2017/06/16 TI - MyGeneFriends: A Social Network Linking Genes, Genetic Diseases, and Researchers JO - J Med Internet Res SP - e212 VL - 19 IS - 6 KW - health care KW - social media KW - genetic variation KW - hereditary disease N2 - Background: The constant and massive increase of biological data offers unprecedented opportunities to decipher the function and evolution of genes and their roles in human diseases. However, the multiplicity of sources and flow of data mean that efficient access to useful information and knowledge production has become a major challenge. This challenge can be addressed by taking inspiration from Web 2.0 and particularly social networks, which are at the forefront of big data exploration and human-data interaction. Objective: MyGeneFriends is a Web platform inspired by social networks, devoted to genetic disease analysis, and organized around three types of proactive agents: genes, humans, and genetic diseases. The aim of this study was to improve exploration and exploitation of biological, postgenomic era big data. Methods: MyGeneFriends leverages conventions popularized by top social networks (Facebook, LinkedIn, etc), such as networks of friends, profile pages, friendship recommendations, affinity scores, news feeds, content recommendation, and data visualization. Results: MyGeneFriends provides simple and intuitive interactions with data through evaluation and visualization of connections (friendships) between genes, humans, and diseases. The platform suggests new friends and publications and allows agents to follow the activity of their friends. It dynamically personalizes information depending on the user?s specific interests and provides an efficient way to share information with collaborators. Furthermore, the user?s behavior itself generates new information that constitutes an added value integrated in the network, which can be used to discover new connections between biological agents. Conclusions: We have developed MyGeneFriends, a Web platform leveraging conventions from popular social networks to redefine the relationship between humans and biological big data and improve human processing of biomedical data. MyGeneFriends is available at lbgi.fr/mygenefriends. UR - http://www.jmir.org/2017/6/e212/ UR - http://dx.doi.org/10.2196/jmir.6676 UR - http://www.ncbi.nlm.nih.gov/pubmed/28623182 ID - info:doi/10.2196/jmir.6676 ER - TY - JOUR AU - Zhang, Ni AU - Campo, Shelly AU - Yang, Jingzhen AU - Eckler, Petya AU - Snetselaar, Linda AU - Janz, Kathleen AU - Leary, Emily PY - 2017/06/22 TI - What Motivates Young Adults to Talk About Physical Activity on Social Network Sites? JO - J Med Internet Res SP - e226 VL - 19 IS - 6 KW - physical activity KW - social marketing KW - social media N2 - Background: Electronic word-of-mouth on social network sites has been used successfully in marketing. In social marketing, electronic word-of-mouth about products as health behaviors has the potential to be more effective and reach more young adults than health education through traditional mass media. However, little is known about what motivates people to actively initiate electronic word-of-mouth about health behaviors on their personal pages or profiles on social network sites, thus potentially reaching all their contacts on those sites. Objective: This study filled the gap by applying a marketing theoretical model to explore the factors associated with electronic word-of-mouth on social network sites about leisure-time physical activity. Methods: A Web survey link was sent to undergraduate students at one of the Midwestern universities and 439 of them completed the survey. Results: The average age of the 439 participants was 19 years (SD=1 year, range: 18-24). Results suggested that emotional engagement with leisure-time physical activity (ie, affective involvement in leisure-time physical activity) predicted providing relevant opinions or information on social network sites. Social network site users who perceived stronger ties with all their contacts were more likely to provide and seek leisure-time physical activity opinions and information. People who provided leisure-time physical activity opinions and information were more likely to seek opinions and information, and people who forwarded information about leisure-time physical activity were more likely to chat about it. Conclusions: This study shed light on the application of the electronic word-of-mouth theoretical framework in promoting health behaviors. The findings can also guide the development of future social marketing interventions using social network sites to promote leisure-time physical activity. UR - http://www.jmir.org/2017/6/e226/ UR - http://dx.doi.org/10.2196/jmir.7017 UR - http://www.ncbi.nlm.nih.gov/pubmed/28642215 ID - info:doi/10.2196/jmir.7017 ER - TY - JOUR AU - Fairburn, G. Christopher AU - Allen, Elizabeth AU - Bailey-Straebler, Suzanne AU - O'Connor, E. Marianne AU - Cooper, Zafra PY - 2017/06/16 TI - Scaling Up Psychological Treatments: A Countrywide Test of the Online Training of Therapists JO - J Med Internet Res SP - e214 VL - 19 IS - 6 KW - psychotherapy KW - training KW - dissemination KW - Internet KW - eating disorders KW - cognitive behavior therapy N2 - Background: A major barrier to the widespread dissemination of psychological treatments is the way that therapists are trained. The current method is not scalable. Objective: Our objective was to conduct a proof-of-concept study of Web-centered training, a scalable online method for training therapists. Methods: The Irish Health Service Executive identified mental health professionals across the country whom it wanted to be trained in a specific psychological treatment for eating disorders. These therapists were given access to a Web-centered training program in transdiagnostic cognitive behavior therapy for eating disorders. The training was accompanied by a scalable form of support consisting of brief encouraging telephone calls from a nonspecialist. The trainee therapists completed a validated measure of therapist competence before and after the training. Results: Of 102 therapists who embarked upon the training program, 86 (84.3%) completed it. There was a substantial increase in their competence scores following the training (mean difference 5.84, 95% Cl ?6.62 to ?5.05; P<.001) with 42.5% (34/80) scoring above a predetermined cut-point indicative of a good level of competence. Conclusions: Web-centered training proved feasible and acceptable and resulted in a marked increase in therapist competence scores. If these findings are replicated, Web-centered training would provide a means of simultaneously training large numbers of geographically dispersed trainees at low cost, thereby overcoming a major obstacle to the widespread dissemination of psychological treatments. UR - http://www.jmir.org/2017/6/e214/ UR - http://dx.doi.org/10.2196/jmir.7864 UR - http://www.ncbi.nlm.nih.gov/pubmed/28623184 ID - info:doi/10.2196/jmir.7864 ER - TY - JOUR AU - Metwally, Omar AU - Blumberg, Seth AU - Ladabaum, Uri AU - Sinha, R. Sidhartha PY - 2017/06/07 TI - Using Social Media to Characterize Public Sentiment Toward Medical Interventions Commonly Used for Cancer Screening: An Observational Study JO - J Med Internet Res SP - e200 VL - 19 IS - 6 KW - Twitter KW - sentiment analysis KW - cancer screening KW - colonoscopy KW - mammography KW - Pap smear KW - Papanicolaou test KW - social media KW - early detection of cancer N2 - Background: Although cancer screening reduces morbidity and mortality, millions of people worldwide remain unscreened. Social media provide a unique platform to understand public sentiment toward tools that are commonly used for cancer screening. Objective: The objective of our study was to examine public sentiment toward colonoscopy, mammography, and Pap smear and how this sentiment spreads by analyzing discourse on Twitter. Methods: In this observational study, we classified 32,847 tweets (online postings on Twitter) related to colonoscopy, mammography, or Pap smears using a naive Bayes algorithm as containing positive, negative, or neutral sentiment. Additionally, we characterized the spread of sentiment on Twitter using an established model to study contagion. Results: Colonoscopy-related tweets were more likely to express negative than positive sentiment (negative to positive ratio 1.65, 95% CI 1.51-1.80, P<.001), in contrast to the more positive sentiment expressed regarding mammography (negative to positive ratio 0.43, 95% CI 0.39-0.47, P<.001). The proportions of negative versus positive tweets about Pap smear were not significantly different (negative to positive ratio 0.95, 95% CI 0.87-1.04, P=.18). Positive and negative tweets tended to share lexical features across screening modalities. Positive tweets expressed resonance with the benefits of early detection. Fear and pain were the principal lexical features seen in negative tweets. Negative sentiment for colonoscopy and mammography spread more than positive sentiment; no correlation with sentiment and spread was seen for Pap smear. Conclusions: Analysis of social media data provides a unique, quantitative framework to better understand the public?s perception of medical interventions that are commonly used for cancer screening. Given the growing use of social media, public health interventions to improve cancer screening should use the health perceptions of the population as expressed in social network postings about tests that are frequently used for cancer screening, as well as other people they may influence with such postings. UR - http://www.jmir.org/2017/6/e200/ UR - http://dx.doi.org/10.2196/jmir.7485 UR - http://www.ncbi.nlm.nih.gov/pubmed/28592395 ID - info:doi/10.2196/jmir.7485 ER - TY - JOUR AU - Huesch, Marco AU - Chetlen, Alison AU - Segel, Joel AU - Schetter, Susann PY - 2017/06/09 TI - Frequencies of Private Mentions and Sharing of Mammography and Breast Cancer Terms on Facebook: A Pilot Study JO - J Med Internet Res SP - e201 VL - 19 IS - 6 KW - Facebook KW - online social network KW - social media KW - breast cancer screening KW - mammography KW - user comments KW - websites KW - links N2 - Background: The most popular social networking site in the United States is Facebook, an online forum where circles of friends create, share, and interact with each other?s content in a nonpublic way. Objective: Our objectives were to understand (1) the most commonly used terms and phrases relating to breast cancer screening, (2) the most commonly shared website links that other women interacted with, and (3) the most commonly shared website links, by age groups. Methods: We used a novel proprietary tool from Facebook to analyze all of the more than 1.7 million unique interactions (comments on stories, reshares, and emoji reactions) and stories associated with breast cancer screening keywords that were generated by more than 1.1 million unique female Facebook users over the 1 month between November 15 and December 15, 2016. We report frequency distributions of the most popular shared Web content by age group and keywords. Results: On average, each of 59,000 unique stories during the month was reshared 1.5 times, commented on nearly 8 times, and reacted to more than 20 times by other users. Posted stories were most often authored by women aged 45-54 years. Users shared, reshared, commented on, and reacted to website links predominantly to e-commerce sites (12,200/1.7 million, 36% of all the most popular links), celebrity news (n=8800, 26%), and major advocacy organizations (n=4900, 15%; almost all accounted for by the American Cancer Society breast cancer site). Conclusions: On Facebook, women shared and reacted to links to commercial and informative websites regarding breast cancer and screening. This information could inform patient outreach regarding breast cancer screening, indirectly through better understanding of key issues, and directly through understanding avenues for paid messaging to women authoring and reacting to content in this space. UR - http://www.jmir.org/2017/6/e201/ UR - http://dx.doi.org/10.2196/jmir.7508 UR - http://www.ncbi.nlm.nih.gov/pubmed/28600279 ID - info:doi/10.2196/jmir.7508 ER - TY - JOUR AU - van Lent, GG Liza AU - Sungur, Hande AU - Kunneman, A. Florian AU - van de Velde, Bob AU - Das, Enny PY - 2017/06/13 TI - Too Far to Care? Measuring Public Attention and Fear for Ebola Using Twitter JO - J Med Internet Res SP - e193 VL - 19 IS - 6 KW - psychological theory KW - epidemics KW - fear KW - distance perception KW - social media N2 - Background: In 2014, the world was startled by a sudden outbreak of Ebola. Although Ebola infections and deaths occurred almost exclusively in Guinea, Sierra Leone, and Liberia, few potential Western cases, in particular, caused a great stir among the public in Western countries. Objective: This study builds on the construal level theory to examine the relationship between psychological distance to an epidemic and public attention and sentiment expressed on Twitter. Whereas previous research has shown the potential of social media to assess real-time public opinion and sentiment, generalizable insights that further the theory development lack. Methods: Epidemiological data (number of Ebola infections and fatalities) and media data (tweet volume and key events reported in the media) were collected for the 2014 Ebola outbreak, and Twitter content from the Netherlands was coded for (1) expressions of fear for self or fear for others and (2) psychological distance of the outbreak to the tweet source. Longitudinal relations were compared using vector error correction model (VECM) methodology. Results: Analyses based on 4500 tweets revealed that increases in public attention to Ebola co-occurred with severe world events related to the epidemic, but not all severe events evoked fear. As hypothesized, Web-based public attention and expressions of fear responded mainly to the psychological distance of the epidemic. A chi-square test showed a significant positive relation between proximity and fear: ?22=103.2 (P<.001). Public attention and fear for self in the Netherlands showed peaks when Ebola became spatially closer by crossing the Mediterranean Sea and Atlantic Ocean. Fear for others was mostly predicted by the social distance to the affected parties. Conclusions: Spatial and social distance are important predictors of public attention to worldwide crisis such as epidemics. These factors need to be taken into account when communicating about human tragedies. UR - http://www.jmir.org/2017/6/e193/ UR - http://dx.doi.org/10.2196/jmir.7219 UR - http://www.ncbi.nlm.nih.gov/pubmed/28611015 ID - info:doi/10.2196/jmir.7219 ER - TY - JOUR AU - Mueller, Julia AU - Jay, Caroline AU - Harper, Simon AU - Todd, Chris PY - 2017/06/08 TI - The Role of Web-Based Health Information in Help-Seeking Behavior Prior to a Diagnosis of Lung Cancer: A Mixed-Methods Study JO - J Med Internet Res SP - e189 VL - 19 IS - 6 KW - help seeking KW - online health information KW - health information seeking KW - lung cancer KW - symptom appraisal N2 - Background: Delays to diagnosis in lung cancer can lead to reduced chance of survival, and patients often wait for several months before presenting symptoms. The time between first symptom recognition until diagnosis has been theorized into three intervals: symptom appraisal, help-seeking, and diagnostic interval (here: ?pathway to diagnosis?). Interventions are needed to reduce delays to diagnosis in lung cancer. The Web has become an important lay health information source and could potentially play a role in this pathway to diagnosis. Objective: Our overall aim was to gain a preliminary insight into whether Web-based information plays a role in the pathway to diagnosis in lung cancer in order to assess whether it may be possible to leverage this information source to reduce delays to diagnosis. Methods: Patients diagnosed with lung cancer in the 6 months before study entry completed a survey about whether (and how, if yes) they had used the Web to appraise their condition prior to diagnosis. Based on survey responses, we purposively sampled patients and their next-of-kin for semistructured interviews (24 interviews; 33 participants). Interview data were analyzed qualitatively using Framework Analysis in the context of the pathway to diagnosis model. Results: A total of 113 patients completed the survey (age: mean 67.0, SD 8.8 years). In all, 20.4% (23/113) reported they or next-of-kin had researched their condition online before the diagnosis. The majority of searches (20/23, 87.0%) were conducted by or with the help of next-of-kin. Interview results suggest that patients and next-of-kin perceived an impact of the information found online on all three intervals in the time to diagnosis. In the appraisal interval, participants used online information to evaluate symptoms and possible causes. In the help-seeking interval, the Web was used to inform the decision of whether to present to health services. In the diagnostic interval, it was used to evaluate health care professionals? advice, to support requests for further investigation of symptoms, and to understand medical jargon. Within this interval, we identified two distinct subintervals (before/after relevant diagnostic tests were initiated), in which the Web reportedly played different roles. Conclusions: Because only 20.4% of the sample reported prediagnosis Web searches, it seems the role of the Web before diagnosis of lung cancer is at present still limited, but this proportion is likely to increase in the future, when barriers such as unfamiliarity with technology and unwillingness to be informed about one?s own health are likely to decrease. Participants? perceptions suggest that the Web can have an impact on all three intervals in the pathway to diagnosis. Thus, the Web may hold the potential to reduce delays in the diagnostic process, and this should be explored in future research and interventions. Our results also suggest a division of the diagnostic interval into two subintervals may be useful. UR - http://www.jmir.org/2017/6/e189/ UR - http://dx.doi.org/10.2196/jmir.6336 UR - http://www.ncbi.nlm.nih.gov/pubmed/28596146 ID - info:doi/10.2196/jmir.6336 ER - TY - JOUR AU - Lee, Kenneth AU - Hoti, Kreshnik AU - Hughes, David Jeffery AU - Emmerton, Lynne PY - 2017/06/14 TI - Dr Google Is Here to Stay but Health Care Professionals Are Still Valued: An Analysis of Health Care Consumers? Internet Navigation Support Preferences JO - J Med Internet Res SP - e210 VL - 19 IS - 6 KW - health care KW - information seeking behavior KW - Internet KW - chronic disease KW - patients KW - surveys N2 - Background: The Internet offers great opportunities for consumers to be informed about their health. However, concerns have been raised regarding its impact on the traditional health consumer-health professional relationship. Our recent survey of 400 Australian adults identified that over half of consumers required some form of navigational support in locating appropriate Web-based health information. We propose that support provided by health professionals would be preferred by consumers; this preference is regardless of whether consumers have a need for navigational support. Secondary analysis of the survey dataset is presented here to quantify consumer-reported support preferences and barriers when navigating Web-based health information. Objective: We aimed to quantitatively identify consumers? support preferences for locating Web-based health information and their barriers when navigating Web-based health information. We also aimed to compare such preferences and barriers between consumers identified as needing and not needing support when locating Web-based health information. Methods: Chi-square (?2) tests identified whether each listed support preference differed between subgroups of consumers classified as needing (n=205, 51.3%) or not needing (n=195, 48.8%) navigational support; degree of association, via phi coefficient (?) tests, were also considered to ascertain the likely practical significance of any differences. This was repeated for each listed barrier. Free-text responses regarding additional support preferences were descriptively analyzed and compared with the quantitative findings to provide a richer understanding of desired support for health information searches. Results: Of the 400 respondents, the most preferred mode of navigational support was involvement of health professionals; this was reported by participants identified as needing and not needing navigational support. While there was a significant difference between groups, the degree of association was small (?21 [N=400]=13.2; P<.001; ?=.18). Qualitative data from the free-text responses supported consumers? desire for health professional involvement. The two most commonly reported barriers when navigating desired Web-based health information were (1) volume of available information and (2) inconsistency of information between sources; these were reported by participants with and without a need for navigational support. While participants identified with a need for navigational support were more likely to report volume (?21 [N=387]= 4.40; P=.04; ?=.11) and inconsistency of information (?21 [N=387]= 16.10, P<.001, ?=.20) as barriers, the degrees of association were small to moderate. Conclusions: Despite concerns in the literature that the popularity of the Internet could compromise the health consumer-health professional relationship, our findings suggest the contrary. Our findings showed that health professionals were found to be the most commonly preferred mode of navigational support, even among consumers classified as not needing navigational support. Further research into how health professionals could assist consumers with Web-based health information seeking could strengthen the health consumer-health professional relationship amidst the growing use of ?Dr Google.? UR - http://www.jmir.org/2017/6/e210/ UR - http://dx.doi.org/10.2196/jmir.7489 UR - http://www.ncbi.nlm.nih.gov/pubmed/28615156 ID - info:doi/10.2196/jmir.7489 ER - TY - JOUR AU - Guo, Haihong AU - Na, Xu AU - Hou, Li AU - Li, Jiao PY - 2017/06/20 TI - Classifying Chinese Questions Related to Health Care Posted by Consumers Via the Internet JO - J Med Internet Res SP - e220 VL - 19 IS - 6 KW - classification KW - natural language processing KW - hypertension KW - consumer health information N2 - Background: In question answering (QA) system development, question classification is crucial for identifying information needs and improving the accuracy of returned answers. Although the questions are domain-specific, they are asked by non-professionals, making the question classification task more challenging. Objective: This study aimed to classify health care?related questions posted by the general public (Chinese speakers) on the Internet. Methods: A topic-based classification schema for health-related questions was built by manually annotating randomly selected questions. The Kappa statistic was used to measure the interrater reliability of multiple annotation results. Using the above corpus, we developed a machine-learning method to automatically classify these questions into one of the following six classes: Condition Management, Healthy Lifestyle, Diagnosis, Health Provider Choice, Treatment, and Epidemiology. Results: The consumer health question schema was developed with a four-hierarchical-level of specificity, comprising 48 quaternary categories and 35 annotation rules. The 2000 sample questions were coded with 2000 major codes and 607 minor codes. Using natural language processing techniques, we expressed the Chinese questions as a set of lexical, grammatical, and semantic features. Furthermore, the effective features were selected to improve the question classification performance. From the 6-category classification results, we achieved an average precision of 91.41%, recall of 89.62%, and F1 score of 90.24%. Conclusions: In this study, we developed an automatic method to classify questions related to Chinese health care posted by the general public. It enables Artificial Intelligence (AI) agents to understand Internet users? information needs on health care. UR - http://www.jmir.org/2017/6/e220/ UR - http://dx.doi.org/10.2196/jmir.7156 UR - http://www.ncbi.nlm.nih.gov/pubmed/28634156 ID - info:doi/10.2196/jmir.7156 ER - TY - JOUR AU - Bauermeister, Jose AU - Giguere, Rebecca AU - Leu, Cheng-Shiun AU - Febo, Irma AU - Cranston, Ross AU - Mayer, Kenneth AU - Carballo-Diéguez, Alex PY - 2017/06/09 TI - Interactive Voice Response System: Data Considerations and Lessons Learned During a Rectal Microbicide Placebo Adherence Trial for Young Men Who Have Sex With Men JO - J Med Internet Res SP - e207 VL - 19 IS - 6 KW - user-computer interface KW - speech recognition software KW - HIV KW - survey methodology N2 - Background: Rectal microbicides, if proven effective, may aid in reducing human immunodeficiency virus (HIV) incidence; however, demonstration of efficacy and effectiveness is contingent on accurate measurement of product adherence. Delays in self-report, in particular, may affect the accuracy of behavioral data. Objective: The aim of this study was to capitalize on mobile phone use by young men who have sex with men (YMSM), and examine the use of an interactive voice response system (IVRS) by YMSM aged 18-30 years enrolled in a multisite, 12-week microbicide safety and acceptability trial. Methods: YMSM (N=95) enrolled across 3 sites (Boston, Pittsburgh, and San Juan) were asked to report their use of an applicator applied placebo rectal gel product during receptive anal intercourse (RAI) using the IVRS. IVRS was available in Spanish and English. After the 12-week trial, we examined whether IVRS problems were associated with YMSM?s sociodemographic characteristics (eg, age, race and ethnicity, and education), sexual behavior, or recruitment site. We used a multinomial logistic regression to compare YMSM who experienced no IVRS problems (n=40) with those who reported one IVRS problem (n=25) or two or more IVRS problems (n=30). Results: We recorded 1494 IVRS calls over 12 weeks. Over half of the participants (55/95; 58%) experienced challenges using the IVRS during the 12-week trial. YMSM reporting greater RAI occasions during the trial were more likely to experience one (odds ratio [OR]=1.08, 95% CI (1.02-1.14); P ?.01) or more (OR=1.10, 95% CI (1.03-1.16); P ?.001) IVRS challenges. Greater educational attainment was associated with multiple IVRS challenges (OR=7.08, 95% CI (1.6-31.6); P ?.01). Participants in the Puerto Rico site were most likely to report multiple IVRS problems. Conclusions: Although IVRS was a useful data collection technology in our trial, several challenges experienced by English and Spanish speaking YMSM diminish its overall acceptability. We discuss strategies to optimize future development of IVRS data quality protocols based on lessons learned. UR - http://www.jmir.org/2017/6/e207/ UR - http://dx.doi.org/10.2196/jmir.7682 UR - http://www.ncbi.nlm.nih.gov/pubmed/28600275 ID - info:doi/10.2196/jmir.7682 ER - TY - JOUR AU - Villanti, C. Andrea AU - Johnson, L. Amanda AU - Ilakkuvan, Vinu AU - Jacobs, A. Megan AU - Graham, L. Amanda AU - Rath, M. Jessica PY - 2017/06/07 TI - Social Media Use and Access to Digital Technology in US Young Adults in 2016 JO - J Med Internet Res SP - e196 VL - 19 IS - 6 KW - social media KW - technology KW - young adults N2 - Background: In 2015, 90% of US young adults with Internet access used social media. Digital and social media are highly prevalent modalities through which young adults explore identity formation, and by extension, learn and transmit norms about health and risk behaviors during this developmental life stage. Objective: The purpose of this study was to provide updated estimates of social media use from 2014 to 2016 and correlates of social media use and access to digital technology in data collected from a national sample of US young adults in 2016. Methods: Young adult participants aged 18-24 years in Wave 7 (October 2014, N=1259) and Wave 9 (February 2016, N=989) of the Truth Initiative Young Adult Cohort Study were asked about use frequency for 11 social media sites and access to digital devices, in addition to sociodemographic characteristics. Regular use was defined as using a given social media site at least weekly. Weighted analyses estimated the prevalence of use of each social media site, overlap between regular use of specific sites, and correlates of using a greater number of social media sites regularly. Bivariate analyses identified sociodemographic correlates of access to specific digital devices. Results: In 2014, 89.42% (weighted n, 1126/1298) of young adults reported regular use of at least one social media site. This increased to 97.5% (weighted n, 965/989) of young adults in 2016. Among regular users of social media sites in 2016, the top five sites were Tumblr (85.5%), Vine (84.7%), Snapchat (81.7%), Instagram (80.7%), and LinkedIn (78.9%). Respondents reported regularly using an average of 7.6 social media sites, with 85% using 6 or more sites regularly. Overall, 87% of young adults reported access or use of a smartphone with Internet access, 74% a desktop or laptop computer with Internet access, 41% a tablet with Internet access, 29% a smart TV or video game console with Internet access, 11% a cell phone without Internet access, and 3% none of these. Access to all digital devices with Internet was lower in those reporting a lower subjective financial situation; there were also significant differences in access to specific digital devices with Internet by race, ethnicity, and education. Conclusions: The high mean number of social media sites used regularly and the substantial overlap in use of multiple social media sites reflect the rapidly changing social media environment. Mobile devices are a primary channel for social media, and our study highlights disparities in access to digital technologies with Internet access among US young adults by race/ethnicity, education, and subjective financial status. Findings from this study may guide the development and implementation of future health interventions for young adults delivered via the Internet or social media sites. UR - http://www.jmir.org/2017/6/e196/ UR - http://dx.doi.org/10.2196/jmir.7303 UR - http://www.ncbi.nlm.nih.gov/pubmed/28592394 ID - info:doi/10.2196/jmir.7303 ER - TY - JOUR AU - Ghweeba, Mayada AU - Lindenmeyer, Antje AU - Shishi, Sobhi AU - Abbas, Mostafa AU - Waheed, Amani AU - Amer, Shaymaa PY - 2017/06/22 TI - What Predicts Online Health Information-Seeking Behavior Among Egyptian Adults? A Cross-Sectional Study JO - J Med Internet Res SP - e216 VL - 19 IS - 6 KW - Internet KW - information-seeking behavior KW - computer literacy KW - surveys and questionnaires KW - Egypt N2 - Background: Over the last decade, the Internet has become an important source of health-related information for a wide range of users worldwide. Yet, little is known about the personal characteristics of Egyptian Internet users who search for online health information (OHI). Objective: The aim of the study was to identify the personal characteristics of Egyptian OHI seekers and to determine any associations between their personal characteristics and their health information-seeking behavior. Methods:  This cross-sectional questionnaire study was conducted from June to October 2015. A Web-based questionnaire was sent to Egyptian users aged 18 years and older (N=1400) of a popular Arabic-language health information website. The questionnaire included (1) demographic characteristics; (2) self-reported general health status; and (3) OHI-seeking behavior that included frequency of use, different topics sought, and self-reported impact of obtained OHI on health behaviors. Data were analyzed using descriptive statistics and multiple regression analysis. Results: A total of 490 participants completed the electronic questionnaire with a response rate equivalent to 35.0% (490/1400). Regarding personal characteristics, 57.1% (280/490) of participants were females, 63.4% (311/490) had a university level qualification, and 37.1% (182/490) had a chronic health problem. The most commonly sought OHI by the participants was nutrition-related. Results of the multiple regression analysis showed that 31.0% of the variance in frequency of seeking OHI among Egyptian adults can be predicted by personal characteristics. Participants who sought OHI more frequently were likely to be female, of younger age, had higher education levels, and good self-reported general health. Conclusions: Our results provide insights into personal characteristics and OHI-seeking behaviors of Egyptian OHI users. This will contribute to better recognize their needs, highlight ways to increase the availability of appropriate OHI, and may lead to the provision of tools allowing Egyptian OHI users to navigate to the highest-quality health information. UR - http://www.jmir.org/2017/6/e216/ UR - http://dx.doi.org/10.2196/jmir.6855 UR - http://www.ncbi.nlm.nih.gov/pubmed/28642216 ID - info:doi/10.2196/jmir.6855 ER - TY - JOUR AU - Wongkoblap, Akkapon AU - Vadillo, A. Miguel AU - Curcin, Vasa PY - 2017/06/29 TI - Researching Mental Health Disorders in the Era of Social Media: Systematic Review JO - J Med Internet Res SP - e228 VL - 19 IS - 6 KW - mental health KW - mental disorders KW - social networking KW - artificial intelligence KW - machine learning KW - public health informatics KW - depression KW - anxiety KW - infodemiology N2 - Background: Mental illness is quickly becoming one of the most prevalent public health problems worldwide. Social network platforms, where users can express their emotions, feelings, and thoughts, are a valuable source of data for researching mental health, and techniques based on machine learning are increasingly used for this purpose. Objective: The objective of this review was to explore the scope and limits of cutting-edge techniques that researchers are using for predictive analytics in mental health and to review associated issues, such as ethical concerns, in this area of research. Methods: We performed a systematic literature review in March 2017, using keywords to search articles on data mining of social network data in the context of common mental health disorders, published between 2010 and March 8, 2017 in medical and computer science journals. Results: The initial search returned a total of 5386 articles. Following a careful analysis of the titles, abstracts, and main texts, we selected 48 articles for review. We coded the articles according to key characteristics, techniques used for data collection, data preprocessing, feature extraction, feature selection, model construction, and model verification. The most common analytical method was text analysis, with several studies using different flavors of image analysis and social interaction graph analysis. Conclusions: Despite an increasing number of studies investigating mental health issues using social network data, some common problems persist. Assembling large, high-quality datasets of social media users with mental disorder is problematic, not only due to biases associated with the collection methods, but also with regard to managing consent and selecting appropriate analytics techniques. UR - http://www.jmir.org/2017/6/e228/ UR - http://dx.doi.org/10.2196/jmir.7215 UR - http://www.ncbi.nlm.nih.gov/pubmed/28663166 ID - info:doi/10.2196/jmir.7215 ER - TY - JOUR AU - Greenberg, J. Alexandra AU - Falisi, L. Angela AU - Finney Rutten, J. Lila AU - Chou, Sylvia Wen-Ying AU - Patel, Vaishali AU - Moser, P. Richard AU - Hesse, W. Bradford PY - 2017/06/02 TI - Access to Electronic Personal Health Records Among Patients With Multiple Chronic Conditions: A Secondary Data Analysis JO - J Med Internet Res SP - e188 VL - 19 IS - 6 KW - electronic personal health information KW - electronic health records KW - patient engagement KW - multiple chronic conditions N2 - Background: In the United States, national incentives for offering access to electronic personal health records (ePHRs) through electronic means are geared toward creating a culture of patient engagement. One group of patients who stand to benefit from online access to ePHRs is the growing population with multiple chronic conditions (MCC). However, little is known about the current availability and use of ePHRs and patient portals among those managing MCC. Objective: The aim was to determine the associations between number of chronic conditions and sociodemographic characteristics and usage of ePHRs, and to assess how the public?s use of ePHRs varies across subpopulations, including those with MCC. Methods: This study used data collected from the 2014 Health Information National Trends Survey (HINTS), and assessed differences in use of ePHRs between those with and without MCC (N=3497) using multiple logistic regression techniques. Variables associated with health care systems (insurance status, having a regular provider) and patient-reported self-efficacy were included in the statistical models. Results: Those with MCC (n=1555) had significantly higher odds of accessing their records three or more times in the past year compared to those reporting no chronic conditions (n=1050; OR 2.46, 95% CI 1.37-4.45), but the overall percentage of those with MCC using ePHRs remained low (371 of 1529 item respondents, 25.63% weighted). No difference in odds of accessing their records was found between those reporting one chronic condition (n=892) and those reporting none (n=1050; OR 1.02, 95% CI 0.66-1.58). Significant differences in odds of accessing ePHRs were seen between income and age groups (P<.001 and P=.05, respectively), and by whether respondents had a regular provider (P=.03). Conclusions: We conclude that ePHRs provide a unique opportunity to enhance MCC patient self-management, but additional effort is needed to ensure that these patients are able to access their ePHRs. An increase in availability of patient access to their ePHRs may provide an opportunity to increase patient engagement and support self-management for all patients and especially those with MCC. UR - http://www.jmir.org/2017/6/e188/ UR - http://dx.doi.org/10.2196/jmir.7417 UR - http://www.ncbi.nlm.nih.gov/pubmed/28576755 ID - info:doi/10.2196/jmir.7417 ER - TY - JOUR AU - Denneson, M. Lauren AU - Cromer, Risa AU - Williams, B. Holly AU - Pisciotta, Maura AU - Dobscha, K. Steven PY - 2017/06/14 TI - A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship JO - J Med Internet Res SP - e208 VL - 19 IS - 6 KW - eHealth KW - physician-patient relations KW - mental health KW - patient-centered care N2 - Background: As part of the national OpenNotes initiative, the Veterans Health Administration (VHA) provides veterans online access to their clinical progress notes, raising concern in mental health settings. Objective: The aim of this study was to examine the perspectives and experiences of mental health clinicians with OpenNotes to better understand how OpenNotes may be affecting mental health care. Methods: We conducted individual semi-structured interviews with 28 VHA mental health clinicians and nurses. Transcripts were analyzed using a thematic analysis approach, which allows for both inductive and deductive themes to be explored using an iterative, constant comparative coding process. Results: OpenNotes is changing VHA mental health care in ways that mental health clinicians perceive as both challenging and beneficial. At the heart of these changes is a shifting power distribution within the patient-clinician relationship. Some clinicians view OpenNotes as an opportunity to better partner with patients, whereas others feel that it has the potential to undo the therapeutic relationship. Many clinicians are uncomfortable with OpenNotes, but acknowledge that this discomfort could both improve and diminish care and documentation practices. Specifically, we found that (1) OpenNotes is empowering patients, (2) OpenNotes is affecting how clinicians build and maintain the therapeutic relationship, and (3) mental health clinicians are adjusting their practices to protect patients and themselves from adverse consequences of OpenNotes. Conclusions: Our findings suggest that future research should monitor whether OpenNotes notes facilitates stronger patient-clinician relationships, enhancing patient-centered mental health care, or diminishes the quality of mental health care through disruptions in the therapeutic relationship and reduced documentation. UR - http://www.jmir.org/2017/6/e208/ UR - http://dx.doi.org/10.2196/jmir.6915 UR - http://www.ncbi.nlm.nih.gov/pubmed/28615152 ID - info:doi/10.2196/jmir.6915 ER - TY - JOUR AU - Mira, Joaquín José AU - Carrillo, Irene AU - Guilabert, Mercedes AU - Lorenzo, Susana AU - Pérez-Pérez, Pastora AU - Silvestre, Carmen AU - Ferrús, Lena AU - PY - 2017/06/08 TI - The Second Victim Phenomenon After a Clinical Error: The Design and Evaluation of a Website to Reduce Caregivers? Emotional Responses After a Clinical Error JO - J Med Internet Res SP - e203 VL - 19 IS - 6 KW - patient safety KW - professionals KW - hospital KW - primary care KW - second victims KW - clinical error KW - e-learning N2 - Background: Adverse events (incidents that harm a patient) can also produce emotional hardship for the professionals involved (second victims). Although a few international pioneering programs exist that aim to facilitate the recovery of the second victim, there are no known initiatives that aim to raise awareness in the professional community about this issue and prevent the situation from worsening. Objective: The aim of this study was to design and evaluate an online program directed at frontline hospital and primary care health professionals that raises awareness and provides information about the second victim phenomenon. Methods: The design of the Mitigating Impact in Second Victims (MISE) online program was based on a literature review, and its contents were selected by a group of 15 experts on patient safety with experience in both clinical and academic settings. The website hosting MISE was subjected to an accreditation process by an external quality agency that specializes in evaluating health websites. The MISE structure and content were evaluated by 26 patient safety managers at hospitals and within primary care in addition to 266 frontline health care professionals who followed the program, taking into account its comprehension, usefulness of the information, and general adequacy. Finally, the amount of knowledge gained from the program was assessed with three objective measures (pre- and posttest design). Results: The website earned Advanced Accreditation for health websites after fulfilling required standards. The comprehension and practical value of the MISE content were positively assessed by 88% (23/26) and 92% (24/26) of patient safety managers, respectively. MISE was positively evaluated by health care professionals, who awarded it 8.8 points out of a maximum 10. Users who finished MISE improved their knowledge on patient safety terminology, prevalence and impact of adverse events and clinical errors, second victim support models, and recommended actions following a severe adverse event (P<.001). Conclusions: The MISE program differs from existing intervention initiatives by its preventive nature in relation to the second victim phenomenon. Its online nature makes it an easily accessible tool for the professional community. This program has shown to increase user?s knowledge on this issue and it helps them correct their approach. Furthermore, it is one of the first initiatives to attempt to bring the second victim phenomenon closer to primary care. UR - http://www.jmir.org/2017/6/e203/ UR - http://dx.doi.org/10.2196/jmir.7840 UR - http://www.ncbi.nlm.nih.gov/pubmed/28596148 ID - info:doi/10.2196/jmir.7840 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 - Kooij, Laura AU - Groen, G. Wim AU - van Harten, H. Wim PY - 2017/06/22 TI - The Effectiveness of Information Technology-Supported Shared Care for Patients With Chronic Disease: A Systematic Review JO - J Med Internet Res SP - e221 VL - 19 IS - 6 KW - review KW - integrated healthcare systems KW - health information systems KW - chronic disease N2 - Background: In patients with chronic disease, many health care professionals are involved during treatment and follow-up. This leads to fragmentation that in turn may lead to suboptimal care. Shared care is a means to improve the integration of care delivered by various providers, specifically primary care physicians (PCPs) and specialty care professionals, for patients with chronic disease. The use of information technology (IT) in this field seems promising. Objective: Our aim was to systematically review the literature regarding the effectiveness of IT-supported shared care interventions in chronic disease in terms of provider or professional, process, health or clinical and financial outcomes. Additionally, our aim was to provide an inventory of the IT applications' characteristics that support such interventions. Methods: PubMed, Scopus, and EMBASE were searched from 2006 to 2015 to identify relevant studies using search terms related to shared care, chronic disease, and IT. Eligible studies were in the English language, and the randomized controlled trials (RCTs), controlled trials, or single group pre-post studies used reported on the effects of IT-supported shared care in patients with chronic disease and cancer. The interventions had to involve providers from both primary and specialty health care. Intervention and IT characteristics and effectiveness?in terms of provider or professional (proximal), process (intermediate), health or clinical and financial (distal) outcomes?were extracted. Risk of bias of (cluster) RCTs was assessed using the Cochrane tool. Results: The initial search yielded 4167 results. Thirteen publications were used, including 11 (cluster) RCTs, a controlled trial, and a pre-post feasibility study. Four main categories of IT applications were identified: (1) electronic decision support tools, (2) electronic platform with a call-center, (3) electronic health records, and (4) electronic communication applications. Positive effects were found for decision support-based interventions on financial and health outcomes, such as physical activity. Electronic health record use improved PCP visits and reduced rehospitalization. Electronic platform use resulted in fewer readmissions and better clinical outcomes?for example, in terms of body mass index (BMI) and dyspnea. The use of electronic communication applications using text-based information transfer between professionals had a positive effect on the number of PCPs contacting hospitals, PCPs? satisfaction, and confidence. Conclusions: IT-supported shared care can improve proximal outcomes, such as confidence and satisfaction of PCPs, especially in using electronic communication applications. Positive effects on intermediate and distal outcomes were also reported but were mixed. Surprisingly, few studies were found that substantiated these anticipated benefits. Studies showed a large heterogeneity in the included populations, outcome measures, and IT applications used. Therefore, a firm conclusion cannot be drawn. As IT applications are developed and implemented rapidly, evidence is needed to test the specific added value of IT in shared care interventions. This is expected to require innovative research methods. UR - http://www.jmir.org/2017/6/e221/ UR - http://dx.doi.org/10.2196/jmir.7405 UR - http://www.ncbi.nlm.nih.gov/pubmed/28642218 ID - info:doi/10.2196/jmir.7405 ER - TY - JOUR AU - Sbaffi, Laura AU - Rowley, Jennifer PY - 2017/06/19 TI - Trust and Credibility in Web-Based Health Information: A Review and Agenda for Future Research JO - J Med Internet Res SP - e218 VL - 19 IS - 6 KW - literature review KW - trust KW - health information KW - information retrieval KW - web N2 - Background: Internet sources are becoming increasingly important in seeking health information, such that they may have a significant effect on health care decisions and outcomes. Hence, given the wide range of different sources of Web-based health information (WHI) from different organizations and individuals, it is important to understand how information seekers evaluate and select the sources that they use, and more specifically, how they assess their credibility and trustworthiness. Objective: The aim of this study was to review empirical studies on trust and credibility in the use of WHI. The article seeks to present a profile of the research conducted on trust and credibility in WHI seeking, to identify the factors that impact judgments of trustworthiness and credibility, and to explore the role of demographic factors affecting trust formation. On this basis, it aimed to identify the gaps in current knowledge and to propose an agenda for future research. Methods: A systematic literature review was conducted. Searches were conducted using a variety of combinations of the terms WHI, trust, credibility, and their variants in four multi-disciplinary and four health-oriented databases. Articles selected were published in English from 2000 onwards; this process generated 3827 unique records. After the application of the exclusion criteria, 73 were analyzed fully. Results: Interest in this topic has persisted over the last 15 years, with articles being published in medicine, social science, and computer science and originating mostly from the United States and the United Kingdom. Documents in the final dataset fell into 3 categories: (1) those using trust or credibility as a dependent variable, (2) those using trust or credibility as an independent variable, and (3) studies of the demographic factors that influence the role of trust or credibility in WHI seeking. There is a consensus that website design, clear layout, interactive features, and the authority of the owner have a positive effect on trust or credibility, whereas advertising has a negative effect. With regard to content features, authority of the author, ease of use, and content have a positive effect on trust or credibility formation. Demographic factors influencing trust formation are age, gender, and perceived health status. Conclusions: There is considerable scope for further research. This includes increased clarity of the interaction between the variables associated with health information seeking, increased consistency on the measurement of trust and credibility, a greater focus on specific WHI sources, and enhanced understanding of the impact of demographic variables on trust and credibility judgments. UR - http://www.jmir.org/2017/6/e218/ UR - http://dx.doi.org/10.2196/jmir.7579 UR - http://www.ncbi.nlm.nih.gov/pubmed/28630033 ID - info:doi/10.2196/jmir.7579 ER - TY - JOUR AU - Golder, Su AU - Ahmed, Shahd AU - Norman, Gill AU - Booth, Andrew PY - 2017/06/06 TI - Attitudes Toward the Ethics of Research Using Social Media: A Systematic Review JO - J Med Internet Res SP - e195 VL - 19 IS - 6 KW - review literature as topic KW - social media KW - ethics KW - research design KW - qualitative research N2 - Background: Although primarily used for social networking and often used for social support and dissemination, data on social media platforms are increasingly being used to facilitate research. However, the ethical challenges in conducting social media research remain of great concern. Although much debated in the literature, it is the views of the public that are most pertinent to inform future practice. Objective: The aim of our study was to ascertain attitudes on the ethical considerations of using social media as a data source for research as expressed by social media users and researchers. Methods: A systematic review was conducted, wherein 16 databases and 2 Internet search engines were searched in addition to handsearching, reference checking, citation searching, and contacting authors and experts. Studies that conducted any qualitative methods to collect data on attitudes on the ethical implications of research using social media were included. Quality assessment was conducted using the quality of reporting tool (QuaRT) and findings analyzed using inductive thematic synthesis. Results: In total, 17 studies met the inclusion criteria. Attitudes varied from overly positive with people expressing the views about the essential nature of such research for the public good, to very concerned with views that social media research should not happen. Underlying reasons for this variation related to issues such as the purpose and quality of the research, the researcher affiliation, and the potential harms. The methods used to conduct the research were also important. Many respondents were positive about social media research while adding caveats such as the need for informed consent or use restricted to public platforms only. Conclusions: Many conflicting issues contribute to the complexity of good ethical practice in social media research. However, this should not deter researchers from conducting social media research. Each Internet research project requires an individual assessment of its own ethical issues. Guidelines on ethical conduct should be based on current evidence and standardized to avoid discrepancies between, and duplication across, different institutions, taking into consideration different jurisdictions. UR - http://www.jmir.org/2017/6/e195/ UR - http://dx.doi.org/10.2196/jmir.7082 UR - http://www.ncbi.nlm.nih.gov/pubmed/28588006 ID - info:doi/10.2196/jmir.7082 ER - TY - JOUR AU - Brinker, Josef Titus AU - Owczarek, Dawid Andreas AU - Seeger, Werner AU - Groneberg, Alexander David AU - Brieske, Martin Christian AU - Jansen, Philipp AU - Klode, Joachim AU - Stoffels, Ingo AU - Schadendorf, Dirk AU - Izar, Benjamin AU - Fries, Norbert Fabian AU - Hofmann, Johannes Felix PY - 2017/06/06 TI - A Medical Student-Delivered Smoking Prevention Program, Education Against Tobacco, for Secondary Schools in Germany: Randomized Controlled Trial JO - J Med Internet Res SP - e199 VL - 19 IS - 6 KW - medical students KW - tobacco prevention KW - secondary schools KW - smoking cessation KW - adolescents KW - school-based prevention N2 - Background: More than 8.5 million Germans suffer from chronic diseases attributable to smoking. Education Against Tobacco (EAT) is a multinational network of medical students who volunteer for school-based prevention in the classroom setting, amongst other activities. EAT has been implemented in 28 medical schools in Germany and is present in 13 additional countries around the globe. A recent quasi-experimental study showed significant short-term smoking cessation effects on 11-to-15-year-old adolescents. Objective: The aim of this study was to provide the first randomized long-term evaluation of the optimized 2014 EAT curriculum involving a photoaging software for its effectiveness in reducing the smoking prevalence among 11-to-15-year-old pupils in German secondary schools. Methods: A randomized controlled trial was undertaken with 1504 adolescents from 9 German secondary schools, aged 11-15 years in grades 6-8, of which 718 (47.74%) were identifiable for the prospective sample at the 12-month follow-up. The experimental study design included measurements at baseline (t1), 6 months (t2), and 12 months postintervention (t3), via questionnaire. The study groups consisted of 40 randomized classes that received the standardized EAT intervention (two medical student-led interactive modules taking 120 minutes total) and 34 control classes within the same schools (no intervention). The primary endpoint was the difference in smoking prevalence from t1 to t3 in the control group versus the difference from t1 to t3 in the intervention group. The differences in smoking behavior (smoking onset, quitting) between the two groups, as well as gender-specific effects, were studied as secondary outcomes. Results: None of the effects were significant due to a high loss-to-follow-up effect (52.26%, 786/1504). From baseline to the two follow-up time points, the prevalence of smoking increased from 3.1% to 5.2% to 7.2% in the control group and from 3.0% to 5.4% to 5.8% in the intervention group (number needed to treat [NNT]=68). Notable differences were observed between the groups for the female gender (4.2% to 9.5% for control vs 4.0% to 5.2% for intervention; NNT=24 for females vs NNT=207 for males), low educational background (7.3% to 12% for control vs 6.1% to 8.7% for intervention; NNT=30), and migrational background (students who claimed that at least one parent was not born in Germany) at the 12-month follow-up. The intervention appears to prevent smoking onset (NNT=63) but does not appear to initiate quitting. Conclusions: The intervention appears to prevent smoking, especially in females and students with a low educational background. UR - http://www.jmir.org/2017/6/e199/ UR - http://dx.doi.org/10.2196/jmir.7906 UR - http://www.ncbi.nlm.nih.gov/pubmed/28588007 ID - info:doi/10.2196/jmir.7906 ER - TY - JOUR AU - Spreco, Armin AU - Eriksson, Olle AU - Dahlström, Örjan AU - Cowling, John Benjamin AU - Timpka, Toomas PY - 2017/06/15 TI - Integrated Detection and Prediction of Influenza Activity for Real-Time Surveillance: Algorithm Design JO - J Med Internet Res SP - e211 VL - 19 IS - 6 KW - human influenza KW - algorithms KW - epidemiological surveillance KW - public health surveillance KW - evaluation research KW - epidemiological methods N2 - Background: Influenza is a viral respiratory disease capable of causing epidemics that represent a threat to communities worldwide. The rapidly growing availability of electronic ?big data? from diagnostic and prediagnostic sources in health care and public health settings permits advance of a new generation of methods for local detection and prediction of winter influenza seasons and influenza pandemics. Objective: The aim of this study was to present a method for integrated detection and prediction of influenza virus activity in local settings using electronically available surveillance data and to evaluate its performance by retrospective application on authentic data from a Swedish county. Methods: An integrated detection and prediction method was formally defined based on a design rationale for influenza detection and prediction methods adapted for local surveillance. The novel method was retrospectively applied on data from the winter influenza season 2008-09 in a Swedish county (population 445,000). Outcome data represented individuals who met a clinical case definition for influenza (based on International Classification of Diseases version 10 [ICD-10] codes) from an electronic health data repository. Information from calls to a telenursing service in the county was used as syndromic data source. Results: The novel integrated detection and prediction method is based on nonmechanistic statistical models and is designed for integration in local health information systems. The method is divided into separate modules for detection and prediction of local influenza virus activity. The function of the detection module is to alert for an upcoming period of increased load of influenza cases on local health care (using influenza-diagnosis data), whereas the function of the prediction module is to predict the timing of the activity peak (using syndromic data) and its intensity (using influenza-diagnosis data). For detection modeling, exponential regression was used based on the assumption that the beginning of a winter influenza season has an exponential growth of infected individuals. For prediction modeling, linear regression was applied on 7-day periods at the time in order to find the peak timing, whereas a derivate of a normal distribution density function was used to find the peak intensity. We found that the integrated detection and prediction method detected the 2008-09 winter influenza season on its starting day (optimal timeliness 0 days), whereas the predicted peak was estimated to occur 7 days ahead of the factual peak and the predicted peak intensity was estimated to be 26% lower than the factual intensity (6.3 compared with 8.5 influenza-diagnosis cases/100,000). Conclusions: Our detection and prediction method is one of the first integrated methods specifically designed for local application on influenza data electronically available for surveillance. The performance of the method in a retrospective study indicates that further prospective evaluations of the methods are justified. UR - http://www.jmir.org/2017/6/e211/ UR - http://dx.doi.org/10.2196/jmir.7101 UR - http://www.ncbi.nlm.nih.gov/pubmed/28619700 ID - info:doi/10.2196/jmir.7101 ER - TY - JOUR AU - Prescott, Julie AU - Mackie, Lynn PY - 2017/6/2 TI - ?You Sort of Go Down a Rabbit Hole...You?re Just Going to Keep on Searching?: A Qualitative Study of Searching Online for Pregnancy-Related Information During Pregnancy JO - J Med Internet Res SP - e194 VL - 19 IS - 6 KW - pregnancy KW - information seeking behavior KW - qualitative research N2 - Background: The Web is becoming increasingly popular for gaining information on medical or health issues; with women in particular likely to search online for this type of information and support. Despite the increased use of the Web for health-related information, we need to question whether the Web and the ease of seeking health information that it provides leads to more (patient) empowerment. As well as being a time of joy and expectations, pregnancy can be a worrying time for women, especially first time mums-to-be, with unfamiliar experiences and symptoms and concerns for the baby as well as the self. Objective: Our aim was to explore how and why pregnant women use the Web to gain information and support during pregnancy and what they consider a reliable source. Methods: To meet the objectives of the study, a qualitative approach was required to gather information on the experiences of currently pregnant women who use the Web to gain information and support during their pregnancy. Sixteen pregnant women took part in a semistructured interview, either face-to-face or via telephone. The interviews took place from January to March 2016, all participants were from England, and the health professionals are all employed by the National Health Service (NHS). Qualitative analytical procedures were employed using inductive thematic analysis supported by NVivo software (QSR International). Results: Pregnant women found reassurance from the experiences of others. This reassurance resulted in them feeling less alone, as well as enabling them to normalize any symptoms or experiences they were undergoing. The women understood that caution was needed at times while reading the stories of others, acknowledging the potential for extreme cases or worst case scenarios. This is particularly pertinent to the Web, as this wide range of stories may not be as easily accessible if stories where confined to those in a woman?s offline social circle. The interviews provide insights into how and why pregnant women search online for information and perhaps more so, support while pregnant. Conclusions: Searching for health information and advice online during pregnancy is viewed as quick, easy, and accessible. The affordances of the Web have provided women the opportunity to go online as a first port of call. Knowing they were not alone and reading the experiences or symptoms of other pregnant women enabled women to normalize their experience and was ultimately reassuring for pregnant women. UR - http://www.jmir.org/2017/19/e194/ UR - http://dx.doi.org/10.2196/jmir.6302 UR - http://www.ncbi.nlm.nih.gov/pubmed/28583906 ID - info:doi/10.2196/jmir.6302 ER - TY - JOUR AU - Brady, John Christopher AU - Mudie, Iluka Lucy AU - Wang, Xueyang AU - Guallar, Eliseo AU - Friedman, Steven David PY - 2017/06/20 TI - Improving Consensus Scoring of Crowdsourced Data Using the Rasch Model: Development and Refinement of a Diagnostic Instrument JO - J Med Internet Res SP - e222 VL - 19 IS - 6 KW - crowdsourcing KW - diabetic retinopathy KW - Rasch analysis KW - Amazon Mechanical Turk N2 - Background: Diabetic retinopathy (DR) is a leading cause of vision loss in working age individuals worldwide. While screening is effective and cost effective, it remains underutilized, and novel methods are needed to increase detection of DR. This clinical validation study compared diagnostic gradings of retinal fundus photographs provided by volunteers on the Amazon Mechanical Turk (AMT) crowdsourcing marketplace with expert-provided gold-standard grading and explored whether determination of the consensus of crowdsourced classifications could be improved beyond a simple majority vote (MV) using regression methods. Objective: The aim of our study was to determine whether regression methods could be used to improve the consensus grading of data collected by crowdsourcing. Methods: A total of 1200 retinal images of individuals with diabetes mellitus from the Messidor public dataset were posted to AMT. Eligible crowdsourcing workers had at least 500 previously approved tasks with an approval rating of 99% across their prior submitted work. A total of 10 workers were recruited to classify each image as normal or abnormal. If half or more workers judged the image to be abnormal, the MV consensus grade was recorded as abnormal. Rasch analysis was then used to calculate worker ability scores in a random 50% training set, which were then used as weights in a regression model in the remaining 50% test set to determine if a more accurate consensus could be devised. Outcomes of interest were the percent correctly classified images, sensitivity, specificity, and area under the receiver operating characteristic (AUROC) for the consensus grade as compared with the expert grading provided with the dataset. Results: Using MV grading, the consensus was correct in 75.5% of images (906/1200), with 75.5% sensitivity, 75.5% specificity, and an AUROC of 0.75 (95% CI 0.73-0.78). A logistic regression model using Rasch-weighted individual scores generated an AUROC of 0.91 (95% CI 0.88-0.93) compared with 0.89 (95% CI 0.86-92) for a model using unweighted scores (chi-square P value<.001). Setting a diagnostic cut-point to optimize sensitivity at 90%, 77.5% (465/600) were graded correctly, with 90.3% sensitivity, 68.5% specificity, and an AUROC of 0.79 (95% CI 0.76-0.83). Conclusions: Crowdsourced interpretations of retinal images provide rapid and accurate results as compared with a gold-standard grading. Creating a logistic regression model using Rasch analysis to weight crowdsourced classifications by worker ability improves accuracy of aggregated grades as compared with simple majority vote. UR - http://www.jmir.org/2017/6/e222/ UR - http://dx.doi.org/10.2196/jmir.7984 UR - http://www.ncbi.nlm.nih.gov/pubmed/28634154 ID - info:doi/10.2196/jmir.7984 ER - TY - JOUR AU - Zwier, Sandra PY - 2017/06/14 TI - ?Click for Closer Care?: A Content Analysis of Community Pharmacy Websites in Four Countries JO - J Med Internet Res SP - e205 VL - 19 IS - 6 KW - community pharmacy services KW - pharmaceutical services KW - online pharmacies KW - marketing of health services KW - commerce KW - pharmacy ethics N2 - Background: Combinations of professional and commercial communication are typically very controversial, particularly in health care communication on the Internet. Websites of licensed community pharmacies on the other hand tend to raise remarkably little controversy, although they typically contain controversial combinations of clinical and commercial services previously unprecedented in professional health care communication. Objective: The aim of this study was to fill the void of knowledge about the combination of clinical and commercial services presented on the websites of licensed community pharmacies. Methods: A content analysis of clinical and commercial services presented in a random sample of 200 licensed community pharmacy websites from Great Britain, the Netherlands, the Canadian provinces British Columbia and Manitoba, and the Australian states New South Wales and Western Australia was conducted. Results: The top five specific services mentioned on the community pharmacy websites were cosmetic products (126/200, 63.0%), medication refill request options (124/200, 62.0%), over-the-counter medicine (115/200, 57.5%), complementary and alternative medicine (107/200, 53.5%), and home medical aids (98/200, 49.0%). On average, 72.5% (145/200) of the community pharmacy websites across the 4 countries included a combination of clinical and commercial services. A combination of clinical and commercial services was more often present on chain pharmacy websites (120/147, 82.8%) than single pharmacy websites (25/53, 47%; P<.001), and most often on the Canadian community pharmacy websites, followed by the Australian, British, and Dutch pharmacy websites, respectively (P<.02). Furthermore, more than half of the pharmacies? homepages contained a combination of clinical and commercial images (107/200, 53.5%), and almost half of the homepage menus contained a combination of clinical and commercial items (99/200, 49.5%). The latter were, again, more common on chain pharmacy than single pharmacy websites (P<.001), with significant differences between countries (P<.001). Conclusions: A considerable share of websites of licensed community pharmacies in Great Britain, the Netherlands, Canada, and Australia combine clinical services with commercial services. Previous research into the presence of a combination of commercial and professional services suggests that such a combination may lead to increased interest in commercial services that may be unnecessary or inappropriate to patients? health. UR - http://www.jmir.org/2017/6/e205/ UR - http://dx.doi.org/10.2196/jmir.6899 UR - http://www.ncbi.nlm.nih.gov/pubmed/28615153 ID - info:doi/10.2196/jmir.6899 ER - TY - JOUR AU - Zhu, Bin AU - Hedman, Anders AU - Feng, Shuo AU - Li, Haibo AU - Osika, Walter PY - 2017/06/14 TI - Designing, Prototyping and Evaluating Digital Mindfulness Applications: A Case Study of Mindful Breathing for Stress Reduction JO - J Med Internet Res SP - e197 VL - 19 IS - 6 KW - respiration KW - biofeedback KW - mindfulness KW - stress KW - device design KW - sound KW - light KW - breathing KW - heart rate KW - relaxation N2 - Background: During the past decade, there has been a rapid increase of interactive apps designed for health and well-being. Yet, little research has been published on developing frameworks for design and evaluation of digital mindfulness facilitating technologies. Moreover, many existing digital mindfulness applications are purely software based. There is room for further exploration and assessment of designs that make more use of physical qualities of artifacts. Objective: The study aimed to develop and test a new physical digital mindfulness prototype designed for stress reduction. Methods: In this case study, we designed, developed, and evaluated HU, a physical digital mindfulness prototype designed for stress reduction. In the first phase, we used vapor and light to support mindful breathing and invited 25 participants through snowball sampling to test HU. In the second phase, we added sonification. We deployed a package of probes such as photos, diaries, and cards to collect data from users who explored HU in their homes. Thereafter, we evaluated our installation using both self-assessed stress levels and heart rate (HR) and heart rate variability (HRV) measures in a pilot study, in order to measure stress resilience effects. After the experiment, we performed a semistructured interview to reflect on HU and investigate the design of digital mindfulness apps for stress reduction. Results: The results of the first phase showed that 22 of 25 participants (88%) claimed vapor and light could be effective ways of promoting mindful breathing. Vapor could potentially support mindful breathing better than light (especially for mindfulness beginners). In addition, a majority of the participants mentioned sound as an alternative medium. In the second phase, we found that participants thought that HU could work well for stress reduction. We compared the effect of silent HU (using light and vapor without sound) and sonified HU on 5 participants. Subjective stress levels were statistically improved with both silent and sonified HU. The mean value of HR using silent HU was significantly lower than resting baseline and sonified HU. The mean value of root mean square of differences (RMSSD) using silent HU was significantly higher than resting baseline. We found that the differences between our objective and subjective assessments were intriguing and prompted us to investigate them further. Conclusions: Our evaluation of HU indicated that HU could facilitate relaxed breathing and stress reduction. There was a difference in outcome between the physiological measures of stress and the subjective reports of stress, as well as a large intervariability among study participants. Our conclusion is that the use of stress reduction tools should be customized and that the design work of mindfulness technology for stress reduction is a complex process, which requires cooperation of designers, HCI (Human-Computer Interaction) experts and clinicians. UR - http://www.jmir.org/2017/6/e197/ UR - http://dx.doi.org/10.2196/jmir.6955 UR - http://www.ncbi.nlm.nih.gov/pubmed/28615157 ID - info:doi/10.2196/jmir.6955 ER - TY - JOUR AU - Kim, Yoonsang AU - Huang, Jidong AU - Emery, Sherry PY - 2017/06/02 TI - The Research Topic Defines ?Noise? in Social Media Data ? a Response from the Authors JO - J Med Internet Res SP - e165 VL - 19 IS - 6 KW - automated tweets, noise, social media data UR - http://www.jmir.org/2017/6/e165/ UR - http://dx.doi.org/10.2196/jmir.6824 UR - http://www.ncbi.nlm.nih.gov/pubmed/28576756 ID - info:doi/10.2196/jmir.6824 ER - TY - JOUR AU - Rau, Hsiao-Hsien AU - Wu, Yi-Syuan AU - Chu, Chi-Ming AU - Wang, Fu-Chung AU - Hsu, Min-Huei AU - Chang, Chi-Wen AU - Chen, Kang-Hua AU - Lee, Yen-Liang AU - Kao, Senyeong AU - Chiu, Yu-Lung AU - Wen, Hsyien-Chia AU - Fuad, Anis AU - Hsu, Chien-Yeh AU - Chiu, Hung-Wen PY - 2017/06/09 TI - Metadata Correction: Importance-Performance Analysis of Personal Health Records in Taiwan: A Web-Based Survey JO - J Med Internet Res SP - e209 VL - 19 IS - 6 UR - http://www.jmir.org/2017/6/e209/ UR - http://dx.doi.org/10.2196/jmir.7944 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578232 ID - info:doi/10.2196/jmir.7944 ER -