TY - JOUR AU - Musy, N. Sarah AU - Ausserhofer, Dietmar AU - Schwendimann, René AU - Rothen, Ulrich Hans AU - Jeitziner, Marie-Madlen AU - Rutjes, WS Anne AU - Simon, Michael PY - 2018/05/30 TI - Trigger Tool?Based Automated Adverse Event Detection in Electronic Health Records: Systematic Review JO - J Med Internet Res SP - e198 VL - 20 IS - 5 KW - patient safety KW - electronic health records KW - patient harm KW - review, systematic N2 - Background: Adverse events in health care entail substantial burdens to health care systems, institutions, and patients. Retrospective trigger tools are often manually applied to detect AEs, although automated approaches using electronic health records may offer real-time adverse event detection, allowing timely corrective interventions. Objective: The aim of this systematic review was to describe current study methods and challenges regarding the use of automatic trigger tool-based adverse event detection methods in electronic health records. In addition, we aimed to appraise the applied studies? designs and to synthesize estimates of adverse event prevalence and diagnostic test accuracy of automatic detection methods using manual trigger tool as a reference standard. Methods: PubMed, EMBASE, CINAHL, and the Cochrane Library were queried. We included observational studies, applying trigger tools in acute care settings, and excluded studies using nonhospital and outpatient settings. Eligible articles were divided into diagnostic test accuracy studies and prevalence studies. We derived the study prevalence and estimates for the positive predictive value. We assessed bias risks and applicability concerns using Quality Assessment tool for Diagnostic Accuracy Studies-2 (QUADAS-2) for diagnostic test accuracy studies and an in-house developed tool for prevalence studies. Results: A total of 11 studies met all criteria: 2 concerned diagnostic test accuracy and 9 prevalence. We judged several studies to be at high bias risks for their automated detection method, definition of outcomes, and type of statistical analyses. Across all the 11 studies, adverse event prevalence ranged from 0% to 17.9%, with a median of 0.8%. The positive predictive value of all triggers to detect adverse events ranged from 0% to 100% across studies, with a median of 40%. Some triggers had wide ranging positive predictive value values: (1) in 6 studies, hypoglycemia had a positive predictive value ranging from 15.8% to 60%; (2) in 5 studies, naloxone had a positive predictive value ranging from 20% to 91%; (3) in 4 studies, flumazenil had a positive predictive value ranging from 38.9% to 83.3%; and (4) in 4 studies, protamine had a positive predictive value ranging from 0% to 60%. We were unable to determine the adverse event prevalence, positive predictive value, preventability, and severity in 40.4%, 10.5%, 71.1%, and 68.4% of the studies, respectively. These studies did not report the overall number of records analyzed, triggers, or adverse events; or the studies did not conduct the analysis. Conclusions: We observed broad interstudy variation in reported adverse event prevalence and positive predictive value. The lack of sufficiently described methods led to difficulties regarding interpretation. To improve quality, we see the need for a set of recommendations to endorse optimal use of research designs and adequate reporting of future adverse event detection studies. UR - http://www.jmir.org/2018/5/e198/ UR - http://dx.doi.org/10.2196/jmir.9901 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jmir.9901 ER - TY - JOUR AU - Grande, W. Stuart AU - Sherman, D. Ledric PY - 2018/05/14 TI - Too Important to Ignore: Leveraging Digital Technology to Improve Chronic Illness Management Among Black Men JO - J Med Internet Res SP - e182 VL - 20 IS - 5 KW - black men KW - digital health KW - chronic illness UR - http://www.jmir.org/2018/5/e182/ UR - http://dx.doi.org/10.2196/jmir.9434 UR - http://www.ncbi.nlm.nih.gov/pubmed/29759956 ID - info:doi/10.2196/jmir.9434 ER - TY - JOUR AU - Ahmadvand, Alireza AU - Gatchel, Robert AU - Brownstein, John AU - Nissen, Lisa PY - 2018/05/18 TI - The Biopsychosocial-Digital Approach to Health and Disease: Call for a Paradigm Expansion JO - J Med Internet Res SP - e189 VL - 20 IS - 5 KW - digital health KW - digital technologies KW - Biopsychosocial Model to Health and Disease KW - human resources for health UR - http://www.jmir.org/2018/5/e189/ UR - http://dx.doi.org/10.2196/jmir.9732 UR - http://www.ncbi.nlm.nih.gov/pubmed/29776900 ID - info:doi/10.2196/jmir.9732 ER - TY - JOUR AU - Tanaka, Rika AU - Nolan, P. Robert PY - 2018/05/11 TI - Psychobehavioral Profiles to Assist Tailoring of Interventions for Patients With Hypertension: Latent Profile Analysis JO - J Med Internet Res SP - e149 VL - 20 IS - 5 KW - hypertension KW - depression KW - health behavior KW - lifestyle KW - counseling N2 - Background: Practice guidelines advocate combining pharmacotherapy with lifestyle counseling for patients with hypertension. To allow for appropriate tailoring of interventions to meet individual patient needs, a comprehensive understanding of baseline patient characteristics is essential. However, few studies have empirically assessed behavioral profiles of hypertensive patients in Web-based lifestyle counseling programs. Objective: The objectives of this study were to (1) specify baseline psychobehavioral profiles of patients with hypertension who were enrolled in a Web-based lifestyle counseling trial, and (2) examine mean differences among the identified profile groups in demographics, psychological distress, self-reported self-care behaviors, physiological outcomes, and program engagement to determine prognostic implications. Methods: Participants (N=264; mean age 57.5 years; 154/264, 58.3% female; 193/264, 73.1% white) were recruited into a longitudinal, double-blind, randomized controlled trial, designed to evaluate an online lifestyle intervention for hypertensive patients. A series of latent profile analyses identified psychobehavioral profiles, indicated by baseline measures of mood, motivation, and health behaviors. Mean differences between profile groups were then explored. Results: A 2-class solution provided the best model fit (the Bayesian information criterion (BIC) is 10,133.11; sample-size adjusted BIC is 10,006.54; Lo-Mendell-Rubin likelihood ratio test is 65.56, P=.001). The 2 profile groups were (1) adaptive adjustment, marked by low distress, high motivation, and somewhat satisfactory engagement in health behaviors and (2) affectively distressed, marked by clinically significant distress. At baseline, on average, affectively distressed patients had lower income, higher body mass index, and endorsed higher stress compared with their adaptive adjustment counterparts. At 12-months post intervention, treatment effects were sustained for systolic blood pressure and Framingham risk index in the adaptive adjustment group, and those in the adaptive adjustment group were 2.4 times more likely to complete the 12-month intervention study, compared with their affectively distressed counterparts. Conclusions: Interventions for patients who are adaptively adjusted may differ in focus from those designed for the affectively distressed patients. As such, this study underscores the importance of identifying psychobehavioral profiles, as they allow for evidence-based tailoring of lifestyle counseling programs for patients with hypertension. Trial Registration: ClinicalTrials.gov NCT01541540; https://clinicaltrials.gov/ct2/show/NCT01541540 (Archived by WebCite at http://www.webcitation.org/6yzZYZcWF) UR - http://www.jmir.org/2018/5/e149/ UR - http://dx.doi.org/10.2196/jmir.8757 UR - http://www.ncbi.nlm.nih.gov/pubmed/29752248 ID - info:doi/10.2196/jmir.8757 ER - TY - JOUR AU - Berg, Marie AU - Linden, Karolina AU - Adolfsson, Annsofie AU - Sparud Lundin, Carina AU - Ranerup, Agneta PY - 2018/05/02 TI - Web-Based Intervention for Women With Type 1 Diabetes in Pregnancy and Early Motherhood: Critical Analysis of Adherence to Technological Elements and Study Design JO - J Med Internet Res SP - e160 VL - 20 IS - 5 KW - randomized controlled trial KW - eHealth KW - mHealth KW - case study N2 - Background: Numerous Web-based interventions have been implemented to promote health and health-related behaviors in persons with chronic conditions. Using randomized controlled trials to evaluate such interventions creates a range of challenges, which in turn can influence the study outcome. Applying a critical perspective when evaluating Web-based health interventions is important. Objective: The objective of this study was to critically analyze and discuss the challenges of conducting a Web-based health intervention as a randomized controlled trial. Method: The MODIAB-Web study was critically examined using an exploratory case study methodology and the framework for analysis offered through the Persuasive Systems Design model. Focus was on technology, study design, and Web-based support usage, with special focus on the forum for peer support. Descriptive statistics and qualitative content analysis were used. Results: The persuasive content and technological elements in the design of the randomized controlled trial included all four categories of the Persuasive Systems Design model, but not all design principles were implemented. The study duration was extended to a period of four and a half years. Of 81 active participants in the intervention group, a maximum of 36 women were simultaneously active. User adherence varied greatly with a median of 91 individual log-ins. The forum for peer support was used by 63 participants. Although only about one-third of the participants interacted in the forum, there was a fairly rich exchange of experiences and advice between them. Thus, adherence in terms of social interactions was negatively affected by limited active participation due to prolonged recruitment process and randomization effects. Lessons learned from this critical analysis are that technology and study design matter and might mutually influence each other. In Web-based interventions, the use of design theories enables utilization of the full potential of technology and promotes adherence. The randomization element in a randomized controlled trial design can become a barrier to achieving a critical mass of user interactions in Web-based interventions, especially when social support is included. For extended study periods, the technology used may need to be adapted in line with newly available technical options to avoid the risk of becoming outdated in the user realm, which in turn might jeopardize study validity in terms of randomized controlled trial designs. Conclusions: On the basis of lessons learned in this randomized controlled trial, we give recommendations to consider when designing and evaluating Web-based health interventions. UR - http://www.jmir.org/2018/5/e160/ UR - http://dx.doi.org/10.2196/jmir.9665 UR - http://www.ncbi.nlm.nih.gov/pubmed/29720365 ID - info:doi/10.2196/jmir.9665 ER - TY - JOUR AU - Mol, Mayke AU - Dozeman, Els AU - Provoost, Simon AU - van Schaik, Anneke AU - Riper, Heleen AU - Smit, H. Johannes PY - 2018/05/03 TI - Behind the Scenes of Online Therapeutic Feedback in Blended Therapy for Depression: Mixed-Methods Observational Study JO - J Med Internet Res SP - e174 VL - 20 IS - 5 KW - cognitive behavioral therapy KW - eHealth KW - depressive disorder N2 - Background: In Internet-delivered cognitive behavioral therapies (iCBT), written feedback by therapists is a substantial part of therapy. However, it is not yet known how this feedback should be given best and which specific therapist behaviors and content are most beneficial for patients. General instructions for written feedback are available, but the uptake and effectiveness of these instructions in iCBT have not been studied yet. Objective: This study aimed to identify therapist behaviors in written online communication with patients in blended CBT for adult depression in routine secondary mental health care, to identify the extent to which the therapists adhere to feedback instructions, and to explore whether therapist behaviors and adherence to feedback instructions are associated with patient outcome. Methods: Adults receiving blended CBT (10 online sessions in combination with 5 face-to-face sessions) for depression in routine mental health care were recruited in the context of the European implementation project MasterMind. A qualitative content analysis was used to identify therapist behaviors in online written feedback messages, and a checklist for the feedback instruction adherence of the therapists was developed. Correlations were explored between the therapist behaviors, therapist instruction adherence, and patient outcomes (number of completed online sessions and symptom change scores). Results: A total of 45 patients (73%, 33/45 female, mean age 35.9 years) received 219 feedback messages given by 19 therapists (84%, 16/19 female). The most frequently used therapist behaviors were informing, encouraging, and affirming. However, these were not related to patient outcomes. Although infrequently used, confronting was positively correlated with session completion (?=.342, P=.02). Therapists adhered to most of the feedback instructions. Only 2 feedback aspects were correlated with session completion: the more therapists adhere to instructions containing structure (limiting to 2 subjects and sending feedback within 3 working days) and readability (short sentences and short paragraphs), the less online sessions were completed (?=?.340, P=.02 and ?=?.361, P=.02, respectively). No associations were found with depression symptom change scores. Conclusions: The therapist behaviors found in this study are comparable to previous research. The findings suggest that online feedback instructions for therapists provide sufficient guidance to communicate in a supportive and positive manner with patients. However, the instructions might be improved by adding more therapeutic techniques besides the focus on style and form. UR - http://www.jmir.org/2018/5/e174/ UR - http://dx.doi.org/10.2196/jmir.9890 UR - http://www.ncbi.nlm.nih.gov/pubmed/29724708 ID - info:doi/10.2196/jmir.9890 ER - TY - JOUR AU - Shen, Ying AU - Wang, Fengbin AU - Zhang, Xing AU - Zhu, Xiaorou AU - Sun, Qiudan AU - Fisher, Edwin AU - Sun, Xinying PY - 2018/05/07 TI - Effectiveness of Internet-Based Interventions on Glycemic Control in Patients With Type 2 Diabetes: Meta-Analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e172 VL - 20 IS - 5 KW - internet KW - type 2 diabetes mellitus KW - HbA1c KW - randomized controlled trial KW - meta-analysis N2 - Background: The popularity of internet as an area of research has grown manifold over the years. Given its rapid development and increasing coverage worldwide, internet-based interventions seem to offer a promising option to ameliorate huge burdens brought by type 2 diabetes mellitus. However, studies conducted by different researchers have provided contradictory results on the effect of internet-based interventions in glycemic control. Objective: This meta-analysis aims to summarize currently available evidence and evaluate the overall impact of internet-based interventions on glycemic management of type 2 diabetic patients. Methods: A systematic literature search was performed in PubMed, ScienceDirect, and Web of Science. Randomized controlled trials that used glycosylated hemoglobin values as the outcome measure of glycemic control were considered. Risk of bias and publication bias were evaluated. Results: Of the 492 studies, 35 were included in meta-analysis, and results indicated that the weighted mean difference (WMD) between usual care and internet-based interventions at endpoint was ?0.426% (95% CI ?0.540 to ?0.312; P<.001). Subgroup analyses revealed that intervention duration ?3 months yielded optimal performance (WMD ?0.51%; 95% CI ?0.71 to ?0.31; P<.001). Combined mobile and website interventions were substantially superior to solely Web-based and mobile-based interventions in glycemic control (combined WMD ?0.77%, 95% CI ?1.07 to ?0.47; P<.001; Web only: WMD ?0.48%; 95% CI ?0.71 to ?0.24, P<.001; mobile only WMD ?0.31%, 95% CI ?0.49 to ?0.14; P<.001). Furthermore, the effect of interventions with automated feedbacks was similar to those with manual feedbacks, and studies with internet-based educational contents were more effective in glycemic control. The assessment revealed a low risk of bias. Conclusions: In conclusion, utilization of internet-based intervention is beneficial for patients with type 2 diabetes mellitus, and taking full advantage of this type of intervention may substantially reduce the incidence of complications and improve quality of life. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO): CRD42017058032; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=58032 (Archived by WebCite at http://www.webcitation.org/6yY7eQNHr) UR - http://www.jmir.org/2018/5/e172/ UR - http://dx.doi.org/10.2196/jmir.9133 UR - http://www.ncbi.nlm.nih.gov/pubmed/29735475 ID - info:doi/10.2196/jmir.9133 ER - TY - JOUR AU - Walsh, MJ Deirdre AU - Moran, Kieran AU - Cornelissen, Véronique AU - Buys, Roselien AU - Cornelis, Nils AU - Woods, Catherine PY - 2018/05/08 TI - Electronic Health Physical Activity Behavior Change Intervention to Self-Manage Cardiovascular Disease: Qualitative Exploration of Patient and Health Professional Requirements JO - J Med Internet Res SP - e163 VL - 20 IS - 5 KW - telemedicine KW - exercise KW - cardiovascular diseases KW - rehabilitation N2 - Background: Cardiovascular diseases are a leading cause of premature death worldwide. International guidelines recommend routine delivery of all phases of cardiac rehabilitation. Uptake of traditional cardiac rehabilitation remains suboptimal, as attendance at formal hospital-based cardiac rehabilitation programs is low, with community-based cardiac rehabilitation rates and individual long-term exercise maintenance even lower. Home-based cardiac rehabilitation programs have been shown to be equally effective in clinical and health-related quality of life outcomes and yet are not readily available. Objective: Given the potential that home-based cardiac rehabilitation programs have, it is important to explore how to appropriately design any such intervention in conjunction with key stakeholders. The aim of this study was to engage with individuals with cardiovascular disease and other professionals within the health ecosystem to (1) understand the personal, social, and physical factors that inhibit or promote their capacity to engage with physical activity and (2) explore their technology competencies, needs, and wants in relation to an eHealth intervention. Methods: Fifty-four semistructured interviews were conducted across two countries. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Barriers to the implementation of PATHway were also explored specifically in relation to physical capability and safety as well as technology readiness and further mapped onto the COM-B model for future intervention design. Results: Key recommendations included collection of patient data and use of measurements, harnessing hospital based social connections, and advice to utilize a patient-centered approach with personalization and tailoring to facilitate optimal engagement. Conclusions: In summary, a multifaceted, personalizable intervention with an inclusively designed interface was deemed desirable for use among cardiovascular disease patients both by end users and key stakeholders. In-depth understanding of core needs of the population can aid intervention development and acceptability. UR - http://www.jmir.org/2018/5/e163/ UR - http://dx.doi.org/10.2196/jmir.9181 UR - http://www.ncbi.nlm.nih.gov/pubmed/29739740 ID - info:doi/10.2196/jmir.9181 ER - TY - JOUR AU - Jonas, Benjamin AU - Tensil, Marc-Dennan AU - Tossmann, Peter AU - Strüber, Evelin PY - 2018/05/08 TI - Effects of Treatment Length and Chat-Based Counseling in a Web-Based Intervention for Cannabis Users: Randomized Factorial Trial JO - J Med Internet Res SP - e166 VL - 20 IS - 5 KW - cannabis KW - Internet KW - counseling KW - random allocation N2 - Background: Digital interventions show promise in reducing problematic cannabis use. However, little is known about the effect of moderators in such interventions. The therapist-guided internet intervention Quit the Shit provides 50 days of chat-based (synchronous) and time-lagged (asynchronous) counseling. Objective: In the study, we examined whether the effectiveness of Quit the Shit is reduced by shortening the program or by removing the chat-based counseling option. Methods: We conducted a purely Web-based randomized experimental trial using a two-factorial design (factor 1: real-time-counseling via text-chat: yes vs no; factor 2: intervention duration: 50 days vs 28 days). Participants were recruited on the Quit the Shit website. Follow-ups were conducted 3, 6, and 12 months after randomization. Primary outcome was cannabis-use days during the past 30 days using a Timeline Followback procedure. Secondary outcomes were cannabis quantity, cannabis-use events, cannabis dependency (Severity of Dependence Scale), treatment satisfaction (Client Satisfaction Questionnaire), and working alliance (Working Alliance Inventory-short revised). Results: In total, 534 participants were included in the trial. Follow-up rates were 47.2% (252/534) after 3 months, 38.2% (204/534) after 6 months, and 25.3% (135/534) after 12 months. Provision of real-time counseling (factor 1) was not significantly associated with any cannabis-related outcome but with higher treatment satisfaction (P=.001, d=0.34) and stronger working alliance (P=.008, d=0.22). In factor 2, no significant differences were found in any outcome. The reduction of cannabis use among all study participants was strong (P<.001, d?1.13). Conclusions: The reduction of program length and the waiver of synchronous communication have no meaningful impact on the effectiveness of Quit the Shit. It therefore seems tenable to abbreviate the program and to offer a self-guided start into Quit the Shit. Due to its positive impact on treatment satisfaction and working alliance, chat-based counseling nevertheless should be provided in Quit the Shit. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN99818059; http://www.isrctn.com/ISRCTN99818059 (Archived by WebCite at http://www.webcitation.org/6uVDeJjfD) UR - http://www.jmir.org/2018/5/e166/ UR - http://dx.doi.org/10.2196/jmir.9579 UR - http://www.ncbi.nlm.nih.gov/pubmed/29739738 ID - info:doi/10.2196/jmir.9579 ER - TY - JOUR AU - Larsen, Britta AU - Benitez, Tanya AU - Cano, Mayra AU - Dunsiger, S. Shira AU - Marcus, H. Bess AU - Mendoza-Vasconez, Andrea AU - Sallis, F. James AU - Zive, Michelle PY - 2018/05/09 TI - Web-Based Physical Activity Intervention for Latina Adolescents: Feasibility, Acceptability, and Potential Efficacy of the Niñas Saludables Study JO - J Med Internet Res SP - e170 VL - 20 IS - 5 KW - exercise KW - health behavior KW - internet KW - eHealth KW - telemedicine N2 - Background: Physical activity is markedly low in Latina adolescents, yet few physical activity interventions have been attempted in this population. Web-based interventions can incorporate theory-based components, be appealing to adolescents, and have potential for low-cost dissemination. Objective: This study aimed to assess the feasibility, acceptability, and potential efficacy of a Web-based physical activity intervention for Latina adolescents in a single-arm pilot trial. Methods: A total of 21 Latina adolescents (aged 12-18 years) who could read and write in English and were underactive (<90 min/week) participated in a 12-week, theory-informed Web-based physical activity intervention. The intervention website was modified from a previous Web-based intervention for Latina adults. Web content was individually tailored based on the responses to monthly questionnaires. Feasibility was measured by recruitment, retention, and adherence/engagement, and acceptability was measured by satisfaction surveys. Physical activity was measured at baseline and follow-up (12 weeks) using the 7-day physical activity recall (PAR) interview and accelerometers. Results: Baseline activity as measured by the 7-day PAR and accelerometers was 24.7 (SD 26.11) and 24.8 (SD 38.3) min/week, respectively. At 12 weeks, 19 participants (90%, 19/21) returned. Adherence and engagement with materials were low, but 72% (15/21) of the participants indicated that they were satisfied with the intervention. Activity at 12 weeks increased by 58.8 (SD 11.33) min/week measured by the 7-day PAR (P<.001). Accelerometer-measured activity did not increase. Activities reported at follow-up were more varied than at baseline, including some activities measured poorly by accelerometers (eg, biking and swimming). Participants suggested simplifying the website and incorporating other technologies. Conclusions: Good retention and increases in self-reported activity suggest a promising approach to delivering a physical activity intervention to Latina adolescents. Incorporating other technologies, such as smartphone apps, could make the intervention more engaging, acceptable, and effective. UR - http://www.jmir.org/2018/5/e170/ UR - http://dx.doi.org/10.2196/jmir.9206 UR - http://www.ncbi.nlm.nih.gov/pubmed/29743151 ID - info:doi/10.2196/jmir.9206 ER - TY - JOUR AU - Lawford, J. Belinda AU - Hinman, S. Rana AU - Kasza, Jessica AU - Nelligan, Rachel AU - Keefe, Francis AU - Rini, Christine AU - Bennell, L. Kim PY - 2018/05/09 TI - Moderators of Effects of Internet-Delivered Exercise and Pain Coping Skills Training for People With Knee Osteoarthritis: Exploratory Analysis of the IMPACT Randomized Controlled Trial JO - J Med Internet Res SP - e10021 VL - 20 IS - 5 KW - telerehabilitation KW - moderators KW - osteoarthritis KW - exercise N2 - Background: Internet-delivered exercise, education, and pain coping skills training is effective for people with knee osteoarthritis, yet it is not clear whether this treatment is better suited to particular subgroups of patients. Objective: The aim was to explore demographic and clinical moderators of the effect of an internet-delivered intervention on changes in pain and physical function in people with knee osteoarthritis. Methods: Exploratory analysis of data from 148 people with knee osteoarthritis who participated in a randomized controlled trial comparing internet-delivered exercise, education, and pain coping skills training to internet-delivered education alone. Primary outcomes were changes in knee pain while walking (11-point Numerical Rating Scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index function subscale) at 3 and 9 months. Separate regression models were fit with moderator variables (age, gender, expectations of outcomes, self-efficacy [pain], education, employment status, pain catastrophizing, body mass index) and study group as covariates, including an interaction between the two. Results: Participants in the intervention group who were currently employed had significantly greater reductions in pain at 3 months than similar participants in the control group (between-group difference: mean 2.38, 95% CI 1.52-3.23 Numerical Rating Scale units; interaction P=.02). Additionally, within the intervention group, pain at 3 months reduced by mean 0.53 (95% CI 0.28-0.78) Numerical Rating Scale units per unit increase in baseline self-efficacy for managing pain compared to mean 0.11 Numerical Rating Scale units (95% CI ?0.13 to 0.35; interaction P=.02) for the control group. Conclusions: People who were employed and had higher self-efficacy at baseline were more likely to experience greater improvements in pain at 3 months after an internet-delivered exercise, education, and pain coping skills training program. There was no evidence of a difference in the effect across gender, educational level, expectation of treatment outcome, or across age, body mass index, or tendency to catastrophize pain. Findings support the effectiveness of internet-delivered care for a wide range of people with knee osteoarthritis, but future confirmatory research is needed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000243617; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365812&isReview=true (Archived by WebCite at http://www.webcitation.org/6z466oTPs) UR - http://www.jmir.org/2018/5/e10021/ UR - http://dx.doi.org/10.2196/10021 UR - http://www.ncbi.nlm.nih.gov/pubmed/29743149 ID - info:doi/10.2196/10021 ER - TY - JOUR AU - Mascarenhas, Nina Maya AU - Chan, Maylin June AU - Vittinghoff, Eric AU - Van Blarigan, Lynn Erin AU - Hecht, Frederick PY - 2018/05/18 TI - Increasing Physical Activity in Mothers Using Video Exercise Groups and Exercise Mobile Apps: Randomized Controlled Trial JO - J Med Internet Res SP - e179 VL - 20 IS - 5 KW - mobile applications KW - videoconferencing KW - Internet KW - health promotion KW - exercise KW - social support KW - mothers KW - randomized controlled trial N2 - Background: Women significantly decrease their activity levels in the transition to motherhood. Digital health technologies are low cost, scalable, and can provide an effective delivery mechanism for behavior change. This is the first study that examines the use of videoconferencing and mobile apps to create exercise groups for mothers. Objective: The aim of the study was to test the feasibility, acceptability, and effectiveness of an individually adaptive and socially supportive physical activity intervention incorporating videoconferencing and mobile apps for mothers. Methods: The Moms Online Video Exercise Study was an 8-week, 2-armed, Web-based randomized trial comparing the effectiveness of a group exercise intervention with a waitlist control. Healthy mothers with at least 1 child under the age of 12 years were recruited through Facebook and email listservs. Intervention participants joined exercise groups using videoconferencing (Google Hangouts) every morning on weekdays and exercised together in real time, guided by exercise mobile apps (eg, Nike+, Sworkit) of their choice. Waitlist control participants had access to recommended mobile apps and an invitation to join an exercise group after the 8-week study period. Main outcomes assessed included changes in self-reported moderate, vigorous, and moderate to vigorous physical activity (MVPA) minutes per week in aggregate and stratified by whether women met Centers for Disease Control and Prevention guidelines for sufficient aerobic activity at baseline. Outcomes were measured through self-assessed Web-based questionnaires at baseline and 8 weeks. Results: The intervention was effective at increasing exercise for inactive women and proved to be feasible and acceptable to all participants. A total of 64 women were randomized, 30 to intervention and 34 to control. Women attended 2.8 sessions per week. There was a strong, but not statistically significant, trend toward increasing moderate, vigorous, and MVPA minutes for all women. As hypothesized, in the prespecified stratum of women who were inactive at baseline (n=51), intervention participants significantly increased their activity by an average of 50 (95% CI 4.0-95.9, P=.03) MVPA minutes per week more than control participants. They had a corresponding statistically significant net increase of 19 (95% CI 3.2-34.8, P=.02) minutes of vigorous activity. Inactive women in the intervention arm also experienced promising reductions in depression, reporting a statistically significant net decrease in their depression score (?3.8, 95% CI ?7.0 to ?0.6; P=.02). Conclusions: We found that a group exercise intervention using videoconferencing and mobile apps was a feasible and acceptable way to deliver a physical activity intervention to mothers. The intervention increased physical activity in inactive mothers. Further studies are needed to better establish how long these changes in physical activity can be maintained and whether these findings can be reproduced in a more diverse population. Trial Registration: ClinicalTrials.gov NCT02805140; https://clinicaltrials.gov/ct2/show/NCT02805140 (Archived by WebCite at http://www.webcitation.org/6yYZwRveg) UR - http://www.jmir.org/2018/5/e179/ UR - http://dx.doi.org/10.2196/jmir.9310 UR - http://www.ncbi.nlm.nih.gov/pubmed/29776899 ID - info:doi/10.2196/jmir.9310 ER - TY - JOUR AU - Lunde, Pernille AU - Nilsson, Blakstad Birgitta AU - Bergland, Astrid AU - Kværner, Jorunn Kari AU - Bye, Asta PY - 2018/05/04 TI - The Effectiveness of Smartphone Apps for Lifestyle Improvement in Noncommunicable Diseases: Systematic Review and Meta-Analyses JO - J Med Internet Res SP - e162 VL - 20 IS - 5 KW - smartphone KW - telemedicine KW - noncommunicable diseases KW - lifestyle KW - diet KW - exercise N2 - Background: Noncommunicable diseases (NCDs) account for 70% of all deaths in a year globally. The four main NCDs are cardiovascular diseases, cancers, chronic pulmonary diseases, and diabetes mellitus. Fifty percent of persons with NCD do not adhere to prescribed treatment; in fact, adherence to lifestyle interventions is especially considered as a major challenge. Smartphone apps permit structured monitoring of health parameters, as well as the opportunity to receive feedback. Objective: The aim of this study was to review and assess the effectiveness of app-based interventions, lasting at least 3 months, to promote lifestyle changes in patients with NCDs. Methods: In February 2017, a literature search in five databases (EMBASE, MEDLINE, CINAHL, Academic Research Premier, and Cochrane Reviews and Trials) was conducted. Inclusion criteria was quantitative study designs including randomized and nonrandomized controlled trials that included patients aged 18 years and older diagnosed with any of the four main NCDs. Lifestyle outcomes were physical activity, physical fitness, modification of dietary habits, and quality of life. All included studies were assessed for risk of bias using the Cochrane Collaboration`s risk of bias tool. Meta-analyses were conducted for one of the outcomes (glycated hemoglobin, HbA1c) by using the estimate of effect of mean post treatment with SD or CI. Heterogeneity was tested using the I2 test. All studies included in the meta-analyses were graded. Results: Of the 1588 records examined, 9 met the predefined criteria. Seven studies included diabetes patients only, one study included heart patients only, and another study included both diabetes and heart patients. Statistical significant effect was shown in HbA1c in 5 of 8 studies, as well in body weight in one of 5 studies and in waist circumference in one of 3 studies evaluating these outcomes. Seven of the included studies were included in the meta-analyses and demonstrated significantly overall effect on HbA1c on a short term (3-6 months; P=.02) with low heterogeneity (I2=41%). In the long term (10-12 months), the overall effect on HbA1c was statistical significant (P=.009) and without heterogeneity (I2=0%). The quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation was low for short term and moderate for long term. Conclusions: Our review demonstrated limited research of the use of smartphone apps for NCDs other than diabetes with a follow-up of at least 3 months. For diabetes, the use of apps seems to improve lifestyle factors, especially to decrease HbA1c. More research with long-term follow-up should be performed to assess the effect of smartphone apps for NCDs other than diabetes. UR - http://www.jmir.org/2018/5/e162/ UR - http://dx.doi.org/10.2196/jmir.9751 UR - http://www.ncbi.nlm.nih.gov/pubmed/29728346 ID - info:doi/10.2196/jmir.9751 ER - TY - JOUR AU - Kordzadeh, Nima AU - Young, K. Diana PY - 2018/05/16 TI - Exploring Hospitals? Use of Facebook: Thematic Analysis JO - J Med Internet Res SP - e190 VL - 20 IS - 5 KW - social media KW - qualitative research KW - social networking KW - health care providers N2 - Background: Although health care organizations such as hospitals and clinics have widely embraced social media as a means to educate the community on health topics and increase patient loyalty and satisfaction, little is known about the content these organizations actually share when using social media channels. Objective: This study aimed to explore the types of content US hospitals post on their Facebook pages and how hospitals? Facebook activities differ with regard to content types. Methods: We collected and thematically analyzed more than 1700 Facebook posts made over a 3-month period by 17 US hospitals. During the first phase, the 2 researchers coded a set of 159 posts and created an initial thematic web of content. During the second phase, the researchers coded the remaining posts and then revised, refined, and validated the initial web of content accordingly. Coding consensus was achieved on 1184 of the 1548 analyzable sampled posts (76.49%). Results: We identified a list of 13 unique health social media post themes and classified those themes into 3 thematic groups that included announcing, sharing, and recognizing activities. The most frequently used theme was sharing health information, which appeared in 35.81% (424/1184) of the posts analyzed. Such posts sought to provide health tips and advice to community members. Recognizing special days and recognizing employees were the second and third most frequently used themes, respectively, with 14.95% (177/1184) and 11.82% (140/1184) of the posts containing those themes. The frequency of these themes was surprising as the content was geared more toward stakeholders internal to the organization, although most previous literature has focused on social media as a tool to connect with external stakeholders. In addition, we found many of the posts involved more than one theme, and selected sets of themes co-occurred frequently. For example, 25.4% (45/177) of the posts recognizing special days also included content to share health information, and approximately 38% (32/85) of the posts announcing research activities also included content to share health information. Finally, we found similarities and differences between the sampled hospitals in terms of the types of content they posted more frequently on their Facebook pages. Conclusions: Hospitals use Facebook as an inexpensive way to educate people on health and wellness topics and to communicate different types of information and news to the public audience. Hospitals and clinics that are expanding their social media activities or are starting to embark on social media strategies can use the results of this study to better formulate their activities on Facebook. UR - http://www.jmir.org/2018/5/e190/ UR - http://dx.doi.org/10.2196/jmir.9549 UR - http://www.ncbi.nlm.nih.gov/pubmed/29769173 ID - info:doi/10.2196/jmir.9549 ER - TY - JOUR AU - Ospina-Pinillos, Laura AU - Davenport, A. Tracey AU - Ricci, S. Cristina AU - Milton, C. Alyssa AU - Scott, M. Elizabeth AU - Hickie, B. Ian PY - 2018/05/28 TI - Developing a Mental Health eClinic to Improve Access to and Quality of Mental Health Care for Young People: Using Participatory Design as Research Methodologies JO - J Med Internet Res SP - e188 VL - 20 IS - 5 KW - mental health KW - community-based participatory research KW - eHealth N2 - Background: Each year, many young Australians aged between 16 and 25 years experience a mental health disorder, yet only a small proportion access services and even fewer receive timely and evidence-based treatments. Today, with ever-increasing access to the Internet and use of technology, the potential to provide all young people with access (24 hours a day, 7 days a week) to the support they require to improve their mental health and well-being is promising. Objective: The aim of this study was to use participatory design (PD) as research methodologies with end users (young people aged between 16 and 25 years and youth health professionals) and our research team to develop the Mental Health eClinic (a Web-based mental health clinic) to improve timely access to, and better quality, mental health care for young people across Australia. Methods: A research and development (R&D) cycle for the codesign and build of the Mental Health eClinic included several iterative PD phases: PD workshops; translation of knowledge and ideas generated during workshops to produce mockups of webpages either as hand-drawn sketches or as wireframes (simple layout of a webpage before visual design and content is added); rapid prototyping; and one-on-one consultations with end users to assess the usability of the alpha build of the Mental Health eClinic. Results: Four PD workshops were held with 28 end users (young people n=18, youth health professionals n=10) and our research team (n=8). Each PD workshop was followed by a knowledge translation session. At the conclusion of this cycle, the alpha prototype was built, and one round of one-on-one end user consultation sessions was conducted (n=6; all new participants, young people n=4, youth health professionals n=2). The R&D cycle revealed the importance of five key components for the Mental Health eClinic: a home page with a visible triage system for those requiring urgent help; a comprehensive online physical and mental health assessment; a detailed dashboard of results; a booking and videoconferencing system to enable video visits; and the generation of a personalized well-being plan that includes links to evidence-based, and health professional?recommended, apps and etools. Conclusions: The Mental Health eClinic provides health promotion, triage protocols, screening, assessment, a video visit system, the development of personalized well-being plans, and self-directed mental health support for young people. It presents a technologically advanced and clinically efficient system that can be adapted to suit a variety of settings in which there is an opportunity to connect with young people. This will enable all young people, and especially those currently not able or willing to connect with face-to-face services, to receive best practice clinical services by breaking down traditional barriers to care and making health care more personalized, accessible, affordable, and available. UR - http://www.jmir.org/2018/5/e188/ UR - http://dx.doi.org/10.2196/jmir.9716 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jmir.9716 ER - TY - JOUR AU - Seidl, Stefanie AU - Schuster, Barbara AU - Rüth, Melvin AU - Biedermann, Tilo AU - Zink, Alexander PY - 2018/05/02 TI - What Do Germans Want to Know About Skin Cancer? A Nationwide Google Search Analysis From 2013 to 2017 JO - J Med Internet Res SP - e10327 VL - 20 IS - 5 KW - skin cancer KW - melanoma KW - nonmelanoma skin cancer (NMSC) KW - Google KW - search analysis KW - population N2 - Background: Experts worldwide agree that skin cancer is a global health issue, but only a few studies have reported on world populations? interest in skin cancer. Internet search data can reflect the interest of a population in different topics and thereby identify what the population wants to know. Objective: Our aim was to assess the interest of the German population in nonmelanoma skin cancer and melanoma. Methods: Google AdWords Keyword Planner was used to identify search terms related to nonmelanoma skin cancer and melanoma in Germany from November 2013 to October 2017. The identified search terms were assessed descriptively using SPSS version 24.0. In addition, the search terms were qualitatively categorized. Results: A total of 646 skin cancer-related search terms were identified with 19,849,230 Google searches in the period under review. The search terms with the highest search volume were ?skin cancer? (n=2,388,500, 12.03%), ?white skin cancer? (n=2,056,900, 10.36%), ?basalioma? (n=907,000, 4.57%), and ?melanoma? (n=717,800, 3.62%). The most searched localizations of nonmelanoma skin cancer were ?nose? (n=93,370, 38.99%) and ?face? (n=53,270, 22.24%), and the most searched of melanoma were ?nails? (n=46,270, 70.61%) and ?eye? (n=10,480, 15.99%). The skin cancer?related category with the highest search volume was ?forms of skin cancer? (n=10,162,540, 23.28%) followed by ?skin alterations? (n=4,962,020, 11.36%). Conclusions: Our study provides insight into terms and fields of interest related to skin cancer relevant to the German population. Furthermore, temporal trends and courses are shown. This information could aid in the development and implementation of effective and sustainable awareness campaigns by developing information sources targeted to the population?s broad interest or by implementing new Internet campaigns. UR - http://www.jmir.org/2018/5/e10327/ UR - http://dx.doi.org/10.2196/10327 UR - http://www.ncbi.nlm.nih.gov/pubmed/29698213 ID - info:doi/10.2196/10327 ER - TY - JOUR AU - Huang, Ming AU - ElTayeby, Omar AU - Zolnoori, Maryam AU - Yao, Lixia PY - 2018/05/08 TI - Public Opinions Toward Diseases: Infodemiological Study on News Media Data JO - J Med Internet Res SP - e10047 VL - 20 IS - 5 KW - news KW - Reuters KW - public policy KW - text mining KW - sentiment analysis KW - topic modeling KW - unmet medical need KW - research priority N2 - Background: Society always has limited resources to expend on health care, or anything else. What are the unmet medical needs? How do we allocate limited resources to maximize the health and welfare of the people? These challenging questions might be re-examined systematically within an infodemiological frame on a much larger scale, leveraging the latest advancement in information technology and data science. Objective: We expanded our previous work by investigating news media data to reveal the coverage of different diseases and medical conditions, together with their sentiments and topics in news articles over three decades. We were motivated to do so since news media plays a significant role in politics and affects the public policy making. Methods: We analyzed over 3.5 million archive news articles from Reuters media during the periods of 1996/1997, 2008 and 2016, using summary statistics, sentiment analysis, and topic modeling. Summary statistics illustrated the coverage of various diseases and medical conditions during the last 3 decades. Sentiment analysis and topic modeling helped us automatically detect the sentiments of news articles (ie, positive versus negative) and topics (ie, a series of keywords) associated with each disease over time. Results: The percentages of news articles mentioning diseases and medical conditions were 0.44%, 0.57% and 0.81% in the three time periods, suggesting that news media or the public has gradually increased its interests in medicine since 1996. Certain diseases such as other malignant neoplasm (34%), other infectious diseases (20%), and influenza (11%) represented the most covered diseases. Two hundred and twenty-six diseases and medical conditions (97.8%) were found to have neutral or negative sentiments in the news articles. Using topic modeling, we identified meaningful topics on these diseases and medical conditions. For instance, the smoking theme appeared in the news articles on other malignant neoplasm only during 1996/1997. The topic phrases HIV and Zika virus were linked to other infectious diseases during 1996/1997 and 2016, respectively. Conclusions: The multi-dimensional analysis of news media data allows the discovery of focus, sentiments and topics of news media in terms of diseases and medical conditions. These infodemiological discoveries could shed light on unmet medical needs and research priorities for future and provide guidance for the decision making in public policy. UR - http://www.jmir.org/2018/5/e10047/ UR - http://dx.doi.org/10.2196/10047 UR - http://www.ncbi.nlm.nih.gov/pubmed/29739741 ID - info:doi/10.2196/10047 ER - TY - JOUR AU - Seabrook, M. Elizabeth AU - Kern, L. Margaret AU - Fulcher, D. Ben AU - Rickard, S. Nikki PY - 2018/05/08 TI - Predicting Depression From Language-Based Emotion Dynamics: Longitudinal Analysis of Facebook and Twitter Status Updates JO - J Med Internet Res SP - e168 VL - 20 IS - 5 KW - automated text analysis KW - depression KW - Facebook KW - Twitter KW - emotions KW - variability KW - instability N2 - Background: Frequent expression of negative emotion words on social media has been linked to depression. However, metrics have relied on average values, not dynamic measures of emotional volatility. Objective: The aim of this study was to report on the associations between depression severity and the variability (time-unstructured) and instability (time-structured) in emotion word expression on Facebook and Twitter across status updates. Methods: Status updates and depression severity ratings of 29 Facebook users and 49 Twitter users were collected through the app MoodPrism. The average proportion of positive and negative emotion words used, within-person variability, and instability were computed. Results: Negative emotion word instability was a significant predictor of greater depression severity on Facebook (rs(29)=.44, P=.02, 95% CI 0.09-0.69), even after controlling for the average proportion of negative emotion words used (partial rs(26)=.51, P=.006) and within-person variability (partial rs(26)=.49, P=.009). A different pattern emerged on Twitter where greater negative emotion word variability indicated lower depression severity (rs(49)=?.34, P=.01, 95% CI ?0.58 to 0.09). Differences between Facebook and Twitter users in their emotion word patterns and psychological characteristics were also explored. Conclusions: The findings suggest that negative emotion word instability may be a simple yet sensitive measure of time-structured variability, useful when screening for depression through social media, though its usefulness may depend on the social media platform. UR - http://www.jmir.org/2018/5/e168/ UR - http://dx.doi.org/10.2196/jmir.9267 UR - http://www.ncbi.nlm.nih.gov/pubmed/29739736 ID - info:doi/10.2196/jmir.9267 ER - TY - JOUR AU - Alvarez-Mon, Angel Miguel AU - Asunsolo del Barco, Angel AU - Lahera, Guillermo AU - Quintero, Javier AU - Ferre, Francisco AU - Pereira-Sanchez, Victor AU - Ortuño, Felipe AU - Alvarez-Mon, Melchor PY - 2018/05/28 TI - Increasing Interest of Mass Communication Media and the General Public in the Distribution of Tweets About Mental Disorders: Observational Study JO - J Med Internet Res SP - e205 VL - 20 IS - 5 KW - Twitter KW - social media KW - psychiatry KW - mental health N2 - Background: The contents of traditional communication media and new internet social media reflect the interests of society. However, certain barriers and a lack of attention towards mental disorders have been previously observed. Objective: The objective of this study is to measure the relevance of influential American mainstream media outlets for the distribution of psychiatric information and the interest generated in these topics among their Twitter followers. Methods: We investigated tweets generated about mental health conditions and diseases among 15 mainstream general communication media outlets in the United States of America between January 2007 and December 2016. Our study strategy focused on identifying several psychiatric terms of primary interest. The number of retweets generated from the selected tweets was also investigated. As a control, we examined tweets generated about the main causes of death in the United States of America, the main chronic neurological degenerative diseases, and HIV. Results: In total, 13,119 tweets about mental health disorders sent by the American mainstream media outlets were analyzed. The results showed a heterogeneous distribution but preferential accumulation for a select number of conditions. Suicide and gender dysphoria accounted for half of the number of tweets sent. Variability in the number of tweets related to each control disease was also found (5998). The number of tweets sent regarding each different psychiatric or organic disease analyzed was significantly correlated with the number of retweets generated by followers (1,030,974 and 424,813 responses to mental health disorders and organic diseases, respectively). However, the probability of a tweet being retweeted differed significantly among the conditions and diseases analyzed. Furthermore, the retweeted to tweet ratio was significantly higher for psychiatric diseases than for the control diseases (odds ratio 1.11, CI 1.07-1.14; P<.001). Conclusions: American mainstream media outlets and the general public demonstrate a preferential interest for psychiatric diseases on Twitter. The heterogeneous weights given by the media outlets analyzed to the different mental health disorders and conditions are reflected in the responses of Twitter followers. UR - http://www.jmir.org/2018/5/e205/ UR - http://dx.doi.org/10.2196/jmir.9582 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jmir.9582 ER - TY - JOUR AU - El Sherif, Reem AU - Pluye, Pierre AU - Thoër, Christine AU - Rodriguez, Charo PY - 2018/05/04 TI - Reducing Negative Outcomes of Online Consumer Health Information: Qualitative Interpretive Study with Clinicians, Librarians, and Consumers JO - J Med Internet Res SP - e169 VL - 20 IS - 5 KW - consumer health information KW - internet KW - professional-patient relations KW - qualitative research N2 - Background: There has been an exponential increase in the general population?s usage of the internet and of information accessibility; the current demand for online consumer health information (OCHI) is unprecedented. There are multiple studies on internet access and usage, quality of information, and information needs. However, few studies explored negative outcomes of OCHI in detail or from different perspectives, and none examined how these negative outcomes could be reduced. Objective: The aim of this study was to describe negative outcomes associated with OCHI use in primary care and identify potential preventive strategies from consumers?, health practitioners?, and health librarians? perspectives. Methods: This included a two-stage interpretive qualitative study. In the first stage, we recruited through a social media survey, a purposeful sample of 19 OCHI users who had experienced negative outcomes associated with OCHI. We conducted semistructured interviews and performed a deductive-inductive thematic analysis. The results also informed the creation of vignettes that were used in the next stage. In the second stage, we interviewed a convenient sample of 10 key informants: 7 health practitioners (3 family physicians, 2 nurses, and 2 pharmacists) and 3 health librarians. With the support of the vignettes, we asked participants to elaborate on (1) their experience with patients who have used OCHI and experienced negative outcomes and (2) what strategies they suggest to reduce these outcomes. We performed a deductive-inductive thematic analysis. Results: We found that negative outcomes of OCHI may occur at three levels: internal (such as increased worrying), interpersonal (such as a tension in the patient-clinician relationship), and service-related (such as postponing a clinical encounter). Participants also proposed three types of strategies to reduce the occurrence of these negative outcomes, namely, providing consumers with reliable OCHI, educating consumers on how to assess OCHI websites, and helping consumers present and discuss the OCHI they find with a health professional in their social network or a librarian for instance. Conclusions: We examined negative outcomes associated with using OCHI from five complementary perspectives (consumers, family physicians, pharmacists, nurses, and health librarians). We identified a construct of OCHI use?related tension that included and framed all negative outcomes. This construct has three dimensions (three interdependent levels): internal, interpersonal, and service-related tensions. Future research can focus on the implementation and effectiveness of the proposed strategies, which might contribute to reducing these tensions. UR - http://www.jmir.org/2018/5/e169/ UR - http://dx.doi.org/10.2196/jmir.9326 UR - http://www.ncbi.nlm.nih.gov/pubmed/29728350 ID - info:doi/10.2196/jmir.9326 ER - TY - JOUR AU - Lupiáñez-Villanueva, Francisco AU - Anastasiadou, Dimitra AU - Codagnone, Cristiano AU - Nuño-Solinís, Roberto AU - Garcia-Zapirain Soto, Begona Maria PY - 2018/05/03 TI - Electronic Health Use in the European Union and the Effect of Multimorbidity: Cross-Sectional Survey JO - J Med Internet Res SP - e165 VL - 20 IS - 5 KW - multimorbidity KW - eHealth KW - adoption KW - Europe N2 - Background: Multimorbidity is becoming increasingly common and is a leading challenge currently faced by societies with aging populations. The presence of multimorbidity requires patients to coordinate, understand, and use the information obtained from different health care professionals, while simultaneously striving to distinguish the symptoms of different diseases and self-manage their sometimes conflicting health problems. Electronic health (eHealth) tools provide a means to disseminate health information and education for both patients and health professionals and hold promise for more efficient and cost-effective care processes. Objective: The aim of this study was to analyze the use of eHealth tools, taking into account the citizens? sociodemographic and clinical characteristics, and above all, the presence of multimorbidity. Methods: Cross-sectional and exploratory research was conducted using online survey data from July 2011 to August 2011. Participants included a total of 14,000 citizens from 14 European countries aged 16 to 74 years, who had used an eHealth tool in the past 3 months. The variables studied were sociodemographic variables of the participants, the questionnaire items assessing the frequency of using eHealth tools, the degree of morbidity, and the eHealth adoption gradient. Chi-square tests were conducted to examine the relationship between the sociodemographic and clinical variables of participants and the group the participants were assigned to according to their frequency of eHealth use (eHealth user group). A one-way analysis of variance (ANOVA) allowed for assessing the differences in the eHealth adoption gradient average between different groups of individuals according to their morbidity level. A two-way between-groups ANOVA was performed to explore the effects of multimorbidity and age group on the eHealth adoption gradient. Results: According to the eHealth adoption gradient, most participants (68.15%, 9541/14,000) were labeled as rare users, with the majority of them (55.1%, 508/921) being in the age range of 25 to 54 years, with upper secondary education (50.3%, 464/921), currently employed (49.3%, 454/921), and living in medium-sized cities (40.7%, 375/921). Results of the one-way ANOVA showed that the number of health problems significantly affected the use of eHealth tools (F2,13996=11.584; P<.001). The two-way ANOVA demonstrated that there was a statistically significant interaction between the effects of age and number of health problems on the eHealth adoption gradient (F4,11991=7.936; P<.001). Conclusions: The eHealth adoption gradient has proven to be a reliable way to measure different aspects of eHealth use. Multimorbidity is associated with a more intense use of eHealth, with younger Internet users using new technologies for health purposes more frequently than older groups with the same level of morbidity. These findings suggest the need to consider different strategies aimed at making eHealth tools more sensitive to the characteristics of older populations to reduce digital disadvantages. UR - http://www.jmir.org/2018/5/e165/ UR - http://dx.doi.org/10.2196/jmir.7299 UR - http://www.ncbi.nlm.nih.gov/pubmed/29724702 ID - info:doi/10.2196/jmir.7299 ER - TY - JOUR AU - VonHoltz, Houdek Lauren A. AU - Frasso, Rosemary AU - Golinkoff, M. Jesse AU - Lozano, J. Alicia AU - Hanlon, Alexandra AU - Dowshen, Nadia PY - 2018/05/22 TI - Internet and Social Media Access Among Youth Experiencing Homelessness: Mixed-Methods Study JO - J Med Internet Res SP - e184 VL - 20 IS - 5 KW - adolescent KW - homeless youth KW - internet KW - social media KW - smartphone KW - health N2 - Background: Youth experiencing homelessness are at a risk for a variety of adverse outcomes. Given the widespread use of the internet and social media, these new technologies may be used to address their needs and for outreach purposes. However, little is known about how this group uses these resources. Objective: This study investigated how homeless adolescents use these technologies for general and health-related purposes, whether the scope of their use changes with housing status, and their interest in a website dedicated to youth experiencing homelessness. Methods: A convenience sample of youth aged 18 to 21 years was recruited from a youth-specific homeless shelter. All participants completed a 47-item survey, with 10 individuals completing a semistructured interview. Descriptive statistics, exact testing, logistic regression, and generalized estimating equation modeling was performed for quantitative data analysis. Interviews were transcribed verbatim, and NVivo 10 (QSR International) was employed to facilitate double coding and thematic analysis. Results: A total of 87 participants completed the survey with a mean age of 19.4 (SD 1.1) years. While experiencing homelessness, 56% (49/87) accessed the internet at least once a day, with 86% (75/87) accessing once a week. Access to a smartphone was associated with a 3.03 greater odds of accessing the internet and was the most frequently used device (66% of participants, 57/87). While experiencing homelessness, subjects reported a 68% decreased odds in internet access frequency (odds ratio [OR] 0.32, P<.001), 75% decreased odds in spending greater amounts of time on the internet (OR 0.25, P<.001), and an 87% decreased odds of social media use (OR 0.13, P=.01). Ten participants completed the semistructured interview. Several themes were identified, including (1) changes in internet behaviors while experiencing homelessness, (2) health status as a major concern and reason for Internet use, and (3) interest in a website dedicated to youth experiencing homelessness. While experiencing homelessness, participants indicated their behaviors were more goal-oriented and less focused on leisure or entertainment activities. Conclusions: While homeless youth experience changes in the frequency, amount of time, and specific uses of the internet and social media, study participants were able to access the internet regularly. The internet was used to search health-related topics. Given the importance of smartphones in accessing the internet, mobile-optimized websites may be an effective method for reaching this group. UR - http://www.jmir.org/2018/5/e184/ UR - http://dx.doi.org/10.2196/jmir.9306 UR - http://www.ncbi.nlm.nih.gov/pubmed/29789281 ID - info:doi/10.2196/jmir.9306 ER - TY - JOUR AU - Shim, Hyunju AU - Ailshire, Jennifer AU - Zelinski, Elizabeth AU - Crimmins, Eileen PY - 2018/05/25 TI - The Health and Retirement Study: Analysis of Associations Between Use of the Internet for Health Information and Use of Health Services at Multiple Time Points JO - J Med Internet Res SP - e200 VL - 20 IS - 5 KW - health information technology KW - health services KW - disease management KW - chronic disease KW - geriatrics N2 - Background: The use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known. Objective: This study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions. Methods: The study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested. Results: A total of 48.0% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times. Conclusions: The use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions. UR - http://www.jmir.org/2018/5/e200/ UR - http://dx.doi.org/10.2196/jmir.8203 UR - http://www.ncbi.nlm.nih.gov/pubmed/29802088 ID - info:doi/10.2196/jmir.8203 ER - TY - JOUR AU - Wicks, Paul AU - Mack Thorley, Eileen AU - Simacek, Kristina AU - Curran, Christopher AU - Emmas, Cathy PY - 2018/05/07 TI - Scaling PatientsLikeMe via a ?Generalized Platform? for Members with Chronic Illness: Web-Based Survey Study of Benefits Arising JO - J Med Internet Res SP - e175 VL - 20 IS - 5 KW - personal health records KW - personal monitoring KW - technology KW - health care KW - self-help devices KW - personal tracking KW - social support KW - online support group KW - online health community N2 - Background: Launched in 2006 for patients with amyotrophic lateral sclerosis, PatientsLikeMe is an online community offering patient-reported outcomes, symptom tracking, and social features. Every member of the site can see all the data reported by every other member, view aggregated reports, identify ?patients like them,? and learn about treatment options in order to live better with their condition. In previous studies, members reported benefits such as improved condition knowledge, increased medication adherence, and better management of side effects. However, the site evolved in 2011 from condition-specific ?vertical? communities consisting only of people with the same disease to a ?generalized platform,? in which every patient could connect with every other patient regardless of condition and with generic, rather than condition-specific, data tools. Some, but not all, communities received further custom tracking tools. Objective: We aimed to understand (1) whether members of PatientsLikeMe using the generalized platform still reported similar benefits and (2) assess factors associated with benefits, such as community customization, site use, and patient activation. Methods: A cross-sectional retrospective custom survey was fielded to 377,625 members between 2016 and 2017 including the Patient Activation Measure (PAM). A benefit index was developed for comparability across conditions. Results: The invitation was viewed by 26,048 members of whom 11,915 did not respond, 5091 opted out, 1591 provided partial data, and 17 were screened out. Complete responses were received from 7434 participants. Users perceived greatest benefit in understanding how their condition may affect them (4530/6770, 66.91% participants, excluding ?does not apply? answers), understanding what might help them live better with their condition (4247/6750, 62.92%), which treatments were available (4143/6898, 60.06%), understanding treatment side effects (4182/6902, 60.59%), and important factors in making treatment decisions (3919/6813, 57.52%). The benefit index was 29% higher for the ?most activated? patients (PAM level 4 vs PAM level 1; relative risk [RR]=1.29, P<.001), 21% higher for conditions with some community customization versus none (RR=1.21, P<.001), and 11% higher in those using the site most often versus least (RR=1.11, P<.001). Conclusions: Members of the generalized platform reported a range of benefits related to improved knowledge and understanding of their condition and treatment management. Condition-specific customization may improve their experience still further. Future studies will explore longitudinal changes to patient activation. UR - http://www.jmir.org/2018/5/e175/ UR - http://dx.doi.org/10.2196/jmir.9909 UR - http://www.ncbi.nlm.nih.gov/pubmed/29735472 ID - info:doi/10.2196/jmir.9909 ER - TY - JOUR AU - Kooij, Laura AU - Groen, G. Wim AU - van Harten, H. Wim PY - 2018/05/11 TI - Barriers and Facilitators Affecting Patient Portal Implementation from an Organizational Perspective: Qualitative Study. JO - J Med Internet Res SP - e183 VL - 20 IS - 5 KW - patient portals KW - health information technology KW - attitude of health personnel N2 - Background: The number of patient portals is rising, and although portals can have positive effects, their implementation has major impacts on the providing health care institutions. However, little is known about the organizational factors affecting successful implementation. Knowledge of the specific barriers to and facilitators of various stakeholders is likely to be useful for future implementations. Objective: The objective of this study was to identify the barriers to and facilitators of patient portal implementation facing various stakeholders within hospital organizations in the Netherlands. Methods: Purposive sampling was used to select hospitals of various types. A total of 2 university medical centers, 3 teaching hospitals, and 2 general hospitals were included. For each, 3 stakeholders were interviewed: (1) medical professionals, (2) managers, and (3) information technology employees. In total, 21 semistructured interviews were conducted using the Grol and Wensing model, which describes barriers to and facilitators of change in health care practice at 6 levels: (1) innovation; (2) individual professional; (3) patient; (4) social context; (5) organizational context; and (6) economic and political context. Two researchers independently selected and coded quotes by applying this model using a (deductive) directed content approach. Additional factors related to technical and portal characteristics were added using the model of McGinn et al, developed for implementation of electronic health records. Results: In total, we identified 376 quotes, 26 barriers, and 28 facilitators. Thirteen barriers and 12 facilitators were common for all stakeholder groups. The facilitators? perceived usefulness (especially less paperwork) was mentioned by all the stakeholders, followed by subjects? positive attitude. The main barriers were lack of resources (namely, lack of staff and materials), financial difficulties (especially complying with high costs, lack of reimbursements), and guaranteeing privacy and security (eg, strict regulations). Both similarities and differences were found between stakeholder groups and hospital types. For example, managers and information technology employees mainly considered guaranteeing privacy and security as a predominant barrier. Financial difficulties were particularly mentioned by medical professionals and managers. Conclusions: Patient portal implementation is a complex process and is not only a technical process but also affects the organization and its staff. Barriers and facilitators occurred at various levels and differed among hospital types (eg, lack of accessibility) and stakeholder groups (eg, sufficient resources) in terms of several factors. Our findings underscore the importance of involving multiple stakeholders in portal implementations. We identified a set of barriers and facilitators that are likely to be useful in making strategic and efficient implementation plans. UR - http://www.jmir.org/2018/5/e183/ UR - http://dx.doi.org/10.2196/jmir.8989 UR - http://www.ncbi.nlm.nih.gov/pubmed/29752253 ID - info:doi/10.2196/jmir.8989 ER - TY - JOUR AU - Gerard, Macda AU - Chimowitz, Hannah AU - Fossa, Alan AU - Bourgeois, Fabienne AU - Fernandez, Leonor AU - Bell, K. Sigall PY - 2018/05/24 TI - The Importance of Visit Notes on Patient Portals for Engaging Less Educated or Nonwhite Patients: Survey Study JO - J Med Internet Res SP - e191 VL - 20 IS - 5 KW - patient engagement KW - vulnerable populations KW - patient portals KW - electronic health record N2 - Background: OpenNotes, a national initiative to share clinicians? visit notes with patients, can improve patient engagement, but effects on vulnerable populations are not known very well. Objective: Our aim is to examine the importance of visit notes to nonwhite and less educated patients. Methods: Patients at an urban academic medical center with an active patient portal account and ?1 available ambulatory visit note over the prior year were surveyed during June 2016 until September 2016. The survey was designed with patients and families and assessed importance of reading notes (scale 0-10) for (1) understanding health conditions, (2) feeling informed about care, (3) understanding the provider?s thought process, (4) remembering the plan of care, and (5) making decisions about care. We compared the proportion of patients reporting 9-10 (extremely important) for each item stratified by education level, race/ethnicity, and self-reported health. Principal component analysis and correlation measures supported a summary score for the 5 items (Cronbach alpha=.93). We examined factors associated with rating notes as extremely important to engage in care using logistic regression. Results: Of 24,722 patients, 6913 (27.96%) completed the survey. The majority (6736/6913, 97.44%) read at least one note. Among note readers, 74.0% (727/982) of patients with ?high school education, 70.7% (130/184) of black patients, and 69.9% (153/219) of Hispanic/Latino patients reported that notes are extremely important to feel informed about their care. The majority of less educated and nonwhite patients reported notes as extremely important to remember the care plan (62.4%, 613/982 ?high school education; 62.0%, 114/184 black patients; and 61.6%, 135/219 Hispanic/Latino patients) and to make care decisions (62.3%, 612/982; 59.8%, 110/184; and 58.5%, 128/219, respectively, and P<.003 for all comparisons to more educated and white patients, respectively). Among patients with the poorest self-reported health, 65.9% (499/757) found notes extremely important to be informed and to understand the provider. On multivariable modeling, less educated patients were nearly three times as likely to report notes were extremely important to engage in care compared with the most educated patients (odds ratio [OR] 2.9, 95% CI 2.4-3.3). Nonwhite patients were twice as likely to report the same compared with white patients (OR 2.0, 95% CI 1.5-2.7 [black] and OR 2.2, 95% CI 1.6-2.9 [Hispanic/Latino and Asian], P<.001 for each comparison). Healthier patients, women, older patients, and those who read more notes were more likely to find notes extremely important to engage in care. Conclusions: Less educated and nonwhite patients using the portal each assigned higher importance to reading notes for several health behaviors than highly educated and white patients, and may find transparent notes especially valuable for understanding their health and engaging in their care. Facilitating access to notes may improve engagement in health care for some vulnerable populations who have historically been more challenging to reach. UR - http://www.jmir.org/2018/5/e191/ UR - http://dx.doi.org/10.2196/jmir.9196 UR - http://www.ncbi.nlm.nih.gov/pubmed/29793900 ID - info:doi/10.2196/jmir.9196 ER - TY - JOUR AU - Rapoport, J. Mark AU - Zucchero Sarracini, Carla AU - Kiss, Alex AU - Lee, Linda AU - Byszewski, Anna AU - Seitz, P. Dallas AU - Vrkljan, Brenda AU - Molnar, Frank AU - Herrmann, Nathan AU - Tang-Wai, F. David AU - Frank, Christopher AU - Henry, Blair AU - Pimlott, Nicholas AU - Masellis, Mario AU - Naglie, Gary PY - 2018/05/25 TI - Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e194 VL - 20 IS - 5 KW - dementia KW - mild cognitive impairment KW - automobile driving KW - decision support systems, clinical N2 - Background: Physicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports. Objective: The aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators. Methods: The study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm. Results: A total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ between the intervention and the control groups (50% vs 49%; Z=?0.19, P=.85). Two variables predicted algorithm-based reporting?caregiver concern (odds ratio [OR]=5.8, 95% CI 2.5-13.6, P<.001) and abnormal clock drawing (OR 6.1, 95% CI 3.1-11.8, P<.001). Conclusions: On the basis of this quantitative analysis, in-office abnormal clock drawing and expressions of concern about driving from caregivers substantially influenced physicians to report patients with mild dementia or mild cognitive impairment to transportation administrators, but the DD-DT tool itself did not increase such reports among these expert physicians. Trial Registration: ClinicalTrials.gov NCT02036099; https://clinicaltrials.gov/ct2/show/NCT02036099 (Archived by WebCite at http://www.webcitation.org/6zGMF1ky8) UR - http://www.jmir.org/2018/5/e194/ UR - http://dx.doi.org/10.2196/jmir.9126 UR - http://www.ncbi.nlm.nih.gov/pubmed/29802093 ID - info:doi/10.2196/jmir.9126 ER - TY - JOUR AU - Feenstra, EM Heleen AU - Vermeulen, E. Ivar AU - Murre, MJ Jaap AU - Schagen, B. Sanne PY - 2018/05/30 TI - Online Self-Administered Cognitive Testing Using the Amsterdam Cognition Scan: Establishing Psychometric Properties and Normative Data JO - J Med Internet Res SP - e192 VL - 20 IS - 5 KW - cognition KW - neuropsychological tests KW - self-assessment KW - internet KW - reproducibility of results KW - reference standards N2 - Background: Online tests enable efficient self-administered assessments and consequently facilitate large-scale data collection for many fields of research. The Amsterdam Cognition Scan is a new online neuropsychological test battery that measures a broad variety of cognitive functions. Objective: The aims of this study were to evaluate the psychometric properties of the Amsterdam Cognition Scan and to establish regression-based normative data. Methods: The Amsterdam Cognition Scan was self-administrated twice from home?with an interval of 6 weeks?by 248 healthy Dutch-speaking adults aged 18 to 81 years. Results: Test-retest reliability was moderate to high and comparable with that of equivalent traditional tests (intraclass correlation coefficients: .45 to .80; .83 for the Amsterdam Cognition Scan total score). Multiple regression analyses indicated that (1) participants? age negatively influenced all (12) cognitive measures, (2) gender was associated with performance on six measures, and (3) education level was positively associated with performance on four measures. In addition, we observed influences of tested computer skills and of self-reported amount of computer use on cognitive performance. Demographic characteristics that proved to influence Amsterdam Cognition Scan test performance were included in regression-based predictive formulas to establish demographically adjusted normative data. Conclusions: Initial results from a healthy adult sample indicate that the Amsterdam Cognition Scan has high usability and can give reliable measures of various generic cognitive ability areas. For future use, the influence of computer skills and experience should be further studied, and for repeated measurements, computer configuration should be consistent. The reported normative data allow for initial interpretation of Amsterdam Cognition Scan performances. UR - http://www.jmir.org/2018/5/e192/ UR - http://dx.doi.org/10.2196/jmir.9298 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jmir.9298 ER - TY - JOUR AU - Brunner, Melissa AU - McGregor, Deborah AU - Keep, Melanie AU - Janssen, Anna AU - Spallek, Heiko AU - Quinn, Deleana AU - Jones, Aaron AU - Tseris, Emma AU - Yeung, Wilson AU - Togher, Leanne AU - Solman, Annette AU - Shaw, Tim PY - 2018/05/15 TI - An eHealth Capabilities Framework for Graduates and Health Professionals: Mixed-Methods Study JO - J Med Internet Res SP - e10229 VL - 20 IS - 5 KW - telemedicine KW - mobile health KW - clinical competence KW - education, professional KW - education, graduate N2 - Background: The demand for an eHealth-ready and adaptable workforce is placing increasing pressure on universities to deliver eHealth education. At present, eHealth education is largely focused on components of eHealth rather than considering a curriculum-wide approach. Objective: This study aimed to develop a framework that could be used to guide health curriculum design based on current evidence, and stakeholder perceptions of eHealth capabilities expected of tertiary health graduates. Methods: A 3-phase, mixed-methods approach incorporated the results of a literature review, focus groups, and a Delphi process to develop a framework of eHealth capability statements. Results: Participants (N=39) with expertise or experience in eHealth education, practice, or policy provided feedback on the proposed framework, and following the fourth iteration of this process, consensus was achieved. The final framework consisted of 4 higher-level capability statements that describe the learning outcomes expected of university graduates across the domains of (1) digital health technologies, systems, and policies; (2) clinical practice; (3) data analysis and knowledge creation; and (4) technology implementation and codesign. Across the capability statements are 40 performance cues that provide examples of how these capabilities might be demonstrated. Conclusions: The results of this study inform a cross-faculty eHealth curriculum that aligns with workforce expectations. There is a need for educational curriculum to reinforce existing eHealth capabilities, adapt existing capabilities to make them transferable to novel eHealth contexts, and introduce new learning opportunities for interactions with technologies within education and practice encounters. As such, the capability framework developed may assist in the application of eHealth by emerging and existing health care professionals. Future research needs to explore the potential for integration of findings into workforce development programs. UR - http://www.jmir.org/2018/5/e10229/ UR - http://dx.doi.org/10.2196/10229 UR - http://www.ncbi.nlm.nih.gov/pubmed/29764794 ID - info:doi/10.2196/10229 ER - TY - JOUR AU - de Ruijter, Dennis AU - Candel, Math AU - Smit, Suzanne Eline AU - de Vries, Hein AU - Hoving, Ciska PY - 2018/05/22 TI - The Effectiveness of a Computer-Tailored E-Learning Program for Practice Nurses to Improve Their Adherence to Smoking Cessation Counseling Guidelines: Randomized Controlled Trial JO - J Med Internet Res SP - e193 VL - 20 IS - 5 KW - online learning KW - guideline adherence KW - advanced practice nursing KW - randomized controlled trial KW - smoking cessation N2 - Background: Improving practice nurses? (PN) adherence to smoking cessation counseling guidelines will benefit the quality of smoking cessation care and will potentially lead to higher smoking abstinence rates. However, support programs to aid PNs in improving their guideline uptake and adherence do not exist yet. Objective: The aim of this study was to assess the effects of a novel computer-tailored electronic learning (e-learning) program on PNs? smoking cessation guideline adherence. Methods: A Web-based randomized controlled trial (RCT) was conducted in which an intervention group (N=147) with full access to the e-learning program for 6 months was compared with a control group (N=122) without access. Data collection was fully automated at baseline and 6-month follow-up via online questionnaires, assessing PNs? demographics, work-related factors, potential behavioral predictors based on the I-Change model, and guideline adherence. PNs also completed counseling checklists to retrieve self-reported counseling activities for each consultation with a smoker (N=1175). To assess the program?s effectiveness in improving PNs? guideline adherence (ie, overall adherence and adherence to individual counseling guideline steps), mixed linear and logistic regression analyses were conducted, thus accommodating for the smokers being nested within PNs. Potential effect moderation by work-related factors and behavioral predictors was also examined. Results: After 6 months, 121 PNs in the intervention group (82.3%, 121/147) and 103 in the control group (84.4%, 103/122) completed the follow-up questionnaire. Mixed linear regression analysis revealed that counseling experience moderated the program?s effect on PNs? overall guideline adherence (beta=.589; 95% CI 0.111-1.068; PHolm-Bonferroni =.048), indicating a positive program effect on adherence for PNs with a more than average level of counseling experience. Mixed logistic regression analyses regarding adherence to individual guideline steps revealed a trend toward moderating effects of baseline levels of behavioral predictors and counseling experience. More specifically, for PNs with less favorable scores on behavioral predictors (eg, low baseline self-efficacy) and high levels of counseling experience, the program significantly increased adherence. Conclusions: Results from our RCT showed that among PNs with more than average counseling experience, the e-learning program resulted in significantly better smoking cessation guideline adherence. Experienced PNs might have been better able to translate the content of our e-learning program into practically applicable counseling strategies compared with less experienced colleagues. Less favorable baseline levels of behavioral predictors among PNs possibly contributed to this effect, as there was more room for improvement by consulting the tailored content of the e-learning program. To further substantiate the effectiveness of e-learning programs on guideline adherence by health care professionals (HCPs), it is important to assess how to support a wider range of HCPs. Trial Registration: Netherlands Trial Register NTR4436; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4436 (Archived by WebCite at http://www.webcitation.org/6zJQuSRq0) UR - http://www.jmir.org/2018/5/e193/ UR - http://dx.doi.org/10.2196/jmir.9276 UR - http://www.ncbi.nlm.nih.gov/pubmed/29789278 ID - info:doi/10.2196/jmir.9276 ER - TY - JOUR AU - Haubruck, Patrick AU - Nickel, Felix AU - Ober, Julian AU - Walker, Tilman AU - Bergdolt, Christian AU - Friedrich, Mirco AU - Müller-Stich, Peter Beat AU - Forchheim, Franziska AU - Fischer, Christian AU - Schmidmaier, Gerhard AU - Tanner, C. Michael PY - 2018/05/21 TI - Evaluation of App-Based Serious Gaming as a Training Method in Teaching Chest Tube Insertion to Medical Students: Randomized Controlled Trial JO - J Med Internet Res SP - e195 VL - 20 IS - 5 KW - games, experimental KW - education, professional KW - general surgery KW - emergency medicine KW - problem-based learning KW - chest tubes KW - simulation training KW - clinical competence N2 - Background: The insertion of a chest tube should be as quick and accurate as possible to maximize the benefit and minimize possible complications for the patient. Therefore, comprehensive training and assessment before an emergency situation are essential for proficiency in chest tube insertion. Serious games have become more prevalent in surgical training because they enable students to study and train a procedure independently, and errors made have no effect on patients. However, up-to-date evidence regarding the effect of serious games on performance in procedures in emergency medicine remains scarce. Objective: The aim of this study was to investigate the serious gaming approach in teaching medical students an emergency procedure (chest tube insertion) using the app Touch Surgery and a modified objective structural assessment of technical skills (OSATS). Methods: In a prospective, rater-blinded, randomized controlled trial, medical students were randomized into two groups: intervention group or control group. Touch Surgery has been established as an innovative and cost-free app for mobile devices. The fully automatic software enables users to train medical procedures and afterwards self-assess their training effort. The module chest tube insertion teaches each key step in the insertion of a chest tube and enables users the meticulous application of a chest tube. In contrast, the module ?Thoracocentesis? discusses a basic thoracocentesis. All students attended a lecture regarding chest tube insertion (regular curriculum) and afterwards received a Touch Surgery training lesson: intervention group used the module chest tube insertion and the control group used Thoracocentesis as control training. Participants? performance in chest tube insertion on a porcine model was rated on-site via blinded face-to-face rating and via video recordings using a modified OSATS tool. Afterwards, every participant received an individual questionnaire for self-evaluation. Here, trainees gave information about their individual training level, as well as previous experiences, gender, and hobbies. Primary end point was operative performance during chest tube insertion by direct observance. Results: A total of 183 students enrolled, 116 students participated (63.4%), and 21 were excluded because of previous experiences in chest tube insertion. Students were randomized to the intervention group (49/95, 52%) and control group (46/95, 48%). The intervention group performed significantly better than the control group (Intervention group: 38.0 [I50=7.0] points; control group: 30.5 [I50=8.0] points; P<.001). The intervention group showed significantly improved economy of time and motion (P=.004), needed significantly less help (P<.001), and was more confident in handling of instruments (P<.001) than the control group. Conclusions: The results from this study show that serious games are a valid and effective tool in education of operative performance in chest tube insertion. We believe that serious games should be implemented in the surgical curriculum, as well as residency programs, in addition to traditional learning methods. Trial Registration: German Clinical Trials Register (DRKS) DRKS00009994; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00009994 (Archived by Webcite at http://www.webcitation.org/6ytWF1CWg) UR - http://www.jmir.org/2018/5/e195/ UR - http://dx.doi.org/10.2196/jmir.9956 UR - http://www.ncbi.nlm.nih.gov/pubmed/29784634 ID - info:doi/10.2196/jmir.9956 ER - TY - JOUR AU - Wray, Jo AU - Brown, Katherine AU - Tregay, Jenifer AU - Crowe, Sonya AU - Knowles, Rachel AU - Bull, Kate AU - Gibson, Faith PY - 2018/05/09 TI - Parents? Experiences of Caring for Their Child at the Time of Discharge After Cardiac Surgery and During the Postdischarge Period: Qualitative Study Using an Online Forum JO - J Med Internet Res SP - e155 VL - 20 IS - 5 KW - congenital heart disease KW - parents KW - online forum KW - isolation N2 - Background: Congenital heart disease (CHD) is the most common class of birth defects, which encompasses a broad spectrum of severity ranging from relatively minor to extremely complex. Improvements in surgery and intensive care have resulted in an increasing number of infants with the most complex lesions surviving after surgery until the time of discharge from the hospital, but there remain concerns about out-of-hospital mortality, variability in how services are provided at the time of discharge and beyond, and difficulties experienced by some families in accessing care. Objective: As part of a mixed-methods program of research, this study aimed to elicit parental experiences of caring for a child with CHD after hospital discharge following a cardiac surgery and collect information to inform interviews for a subsequent stage of the project. Methods: A closed online discussion group was set up via the main Facebook page of the Children?s Heart Federation (CHF), a national charity offering support to children with heart disease and their families. The discussion group was advertised through the charity?s webpage, and interested participants were directed to the charity?s Facebook page from where they could access the closed Facebook group and respond to questions posted. The CHF moderated the forum, and the research team provided questions to be posted on the forum. Responses were collated into a single transcript and subjected to thematic analysis. Results: The forum was open for 4 months, and 91 participants (mean age 35 years, range 23-58 years, 89 females, 89 parents, and 2 grandparents) submitted demographic information and were given access to the closed forum group. A common experience of isolation emerged from the data, with descriptions of how that isolation was experienced (physical, social, knowledge) and its psychological impact, together with the factors that made it worse or better. Woven through this theme was the notion that parents developed expertise over time. Conclusions: The use of an online forum provided a means for eliciting data from a large number of parents regarding their experiences of caring for their child after hospital discharge following cardiac surgery. Parents engaged with the forum and were able to articulate what went well and what went less well, together with sharing their stories and supporting each other through doing so. Some parents clearly found participating in the forum a positive experience in itself, demonstrating the potential of social media as a mechanism for providing support and reducing isolation. Information gained from the forum was used to shape questions for interviews with parents in a subsequent phase of the study. Furthermore, the themes identified in the online forum have contributed to identifying ways of improving the provision of care and support for parents of high-risk babies following discharge after cardiac surgery. UR - http://www.jmir.org/2018/5/e155/ UR - http://dx.doi.org/10.2196/jmir.9104 UR - http://www.ncbi.nlm.nih.gov/pubmed/29743157 ID - info:doi/10.2196/jmir.9104 ER - TY - JOUR AU - Kirkman, Louise Jessica Jane AU - Leo, Briony AU - Moore, Christopher Jamie PY - 2018/5/17 TI - Alcohol Consumption Reduction Among a Web-Based Supportive Community Using the Hello Sunday Morning Blog Platform: Observational Study JO - J Med Internet Res SP - e196 VL - 20 IS - 5 KW - alcohol drinking KW - internet KW - Web-based brief alcohol intervention KW - moderate drinking KW - alcohol use KW - alcohol abuse KW - binge drinking KW - internet intervention KW - relapse prevention KW - drinking behavior KW - alcoholic intoxication KW - social network KW - blogging KW - blog search KW - internet media KW - platforms KW - community KW - engagement N2 - Background: Alcohol misuse is a major social and public health issue in Australia, with an estimated cost to the community of Aus $30 billion per annum. Until recently, a major barrier in addressing this significant public health issue is the fact that the majority of individuals with alcohol use disorders and alcohol misuse are not receiving treatment. Objective: This study aimed to assess whether alcohol consumption changes are associated with participation in Hello Sunday Morning?s blog platform, an online forum discussing experiences in abstaining from alcohol. Methods: The study reports on Hello Sunday Morning participants who signed up for a 3-month period of abstinence from November 2009 to November 2016. The sample comprised 1917 participants (female: 1227/1917, 64.01%; male: 690/1917, 35.99%). Main outcome measures were Alcohol Use Disorders Identification Test (AUDIT) scores, mood, program engagement metrics, and slip-ups. Results: Individuals who reported hazardous (preprogram AUDIT mean 11.92, SD 2.25) and harmful consumption levels (preprogram AUDIT mean 17.52, SD 1.08) and who engaged in the Hello Sunday Morning program reported a significant decrease in alcohol consumption, moving to lower risk consumption levels (hazardous, mean 7.59, SD 5.70 and harmful, mean 10.38, SD 7.43), 4 months following program commencement (P<.001). Those who reported high-risk or dependent consumption levels experienced the biggest reduction (preprogram mean 25.38, SD 4.20), moving to risky consumption (mean 15.83, SD 11.11), 4 months following program commencement (P<.001). These reductions in risk were maintained by participants in each group, 7 months following program commencement. Furthermore, those who engaged in the program more (as defined by more sign-ins, blogs posted, check-ins completed, and engagement with the community through likes and following) had lower alcohol consumption. Finally, those who experienced more slip-ups had lower alcohol consumption. Conclusions: Participation in an online forum can support long-term behavior change in individuals wishing to change their drinking behavior. Importantly, reductions in AUDIT scores appeared larger for those drinking at high-risk and hazardous levels before program commencement. This has promising implications for future models of alcohol reduction treatment, as online forums are an anonymous, accessible, and cost-effective alternative or adjunct to treatment-as-usual. Further research is needed into the specific mechanisms of change within a Web-based supportive community, as well as the role of specific mood states in predicting risky drinking behavior. UR - http://www.jmir.org/2018/5/e196/ UR - http://dx.doi.org/10.2196/jmir.9605 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jmir.9605 ER - TY - JOUR AU - Henderson, Jette AU - Ke, Junyuan AU - Ho, C. Joyce AU - Ghosh, Joydeep AU - Wallace, C. Byron PY - 2018/05/04 TI - Phenotype Instance Verification and Evaluation Tool (PIVET): A Scaled Phenotype Evidence Generation Framework Using Web-Based Medical Literature JO - J Med Internet Res SP - e164 VL - 20 IS - 5 KW - medical informatics KW - medical subject headings KW - algorithms KW - clustering analysis KW - classification KW - databases as topic KW - information storage and retrieval KW - MEDLINE N2 - Background: Researchers are developing methods to automatically extract clinically relevant and useful patient characteristics from raw healthcare datasets. These characteristics, often capturing essential properties of patients with common medical conditions, are called computational phenotypes. Being generated by automated or semiautomated, data-driven methods, such potential phenotypes need to be validated as clinically meaningful (or not) before they are acceptable for use in decision making. Objective: The objective of this study was to present Phenotype Instance Verification and Evaluation Tool (PIVET), a framework that uses co-occurrence analysis on an online corpus of publically available medical journal articles to build clinical relevance evidence sets for user-supplied phenotypes. PIVET adopts a conceptual framework similar to the pioneering prototype tool PheKnow-Cloud that was developed for the phenotype validation task. PIVET completely refactors each part of the PheKnow-Cloud pipeline to deliver vast improvements in speed without sacrificing the quality of the insights PheKnow-Cloud achieved. Methods: PIVET leverages indexing in NoSQL databases to efficiently generate evidence sets. Specifically, PIVET uses a succinct representation of the phenotypes that corresponds to the index on the corpus database and an optimized co-occurrence algorithm inspired by the Aho-Corasick algorithm. We compare PIVET?s phenotype representation with PheKnow-Cloud?s by using PheKnow-Cloud?s experimental setup. In PIVET?s framework, we also introduce a statistical model trained on domain expert?verified phenotypes to automatically classify phenotypes as clinically relevant or not. Additionally, we show how the classification model can be used to examine user-supplied phenotypes in an online, rather than batch, manner. Results: PIVET maintains the discriminative power of PheKnow-Cloud in terms of identifying clinically relevant phenotypes for the same corpus with which PheKnow-Cloud was originally developed, but PIVET?s analysis is an order of magnitude faster than that of PheKnow-Cloud. Not only is PIVET much faster, it can be scaled to a larger corpus and still retain speed. We evaluated multiple classification models on top of the PIVET framework and found ridge regression to perform best, realizing an average F1 score of 0.91 when predicting clinically relevant phenotypes. Conclusions: Our study shows that PIVET improves on the most notable existing computational tool for phenotype validation in terms of speed and automation and is comparable in terms of accuracy. UR - http://www.jmir.org/2018/5/e164/ UR - http://dx.doi.org/10.2196/jmir.9610 UR - http://www.ncbi.nlm.nih.gov/pubmed/29728351 ID - info:doi/10.2196/jmir.9610 ER - TY - JOUR AU - Contreras, Ivan AU - Vehi, Josep PY - 2018/05/30 TI - Artificial Intelligence for Diabetes Management and Decision Support: Literature Review JO - J Med Internet Res SP - e10775 VL - 20 IS - 5 KW - diabetes management KW - artificial intelligence KW - machine learning KW - mobile computing KW - blood glucose N2 - Background: Artificial intelligence methods in combination with the latest technologies, including medical devices, mobile computing, and sensor technologies, have the potential to enable the creation and delivery of better management services to deal with chronic diseases. One of the most lethal and prevalent chronic diseases is diabetes mellitus, which is characterized by dysfunction of glucose homeostasis. Objective: The objective of this paper is to review recent efforts to use artificial intelligence techniques to assist in the management of diabetes, along with the associated challenges. Methods: A review of the literature was conducted using PubMed and related bibliographic resources. Analyses of the literature from 2010 to 2018 yielded 1849 pertinent articles, of which we selected 141 for detailed review. Results: We propose a functional taxonomy for diabetes management and artificial intelligence. Additionally, a detailed analysis of each subject category was performed using related key outcomes. This approach revealed that the experiments and studies reviewed yielded encouraging results. Conclusions: We obtained evidence of an acceleration of research activity aimed at developing artificial intelligence-powered tools for prediction and prevention of complications associated with diabetes. Our results indicate that artificial intelligence methods are being progressively established as suitable for use in clinical daily practice, as well as for the self-management of diabetes. Consequently, these methods provide powerful tools for improving patients? quality of life. UR - http://www.jmir.org/2018/5/e10775/ UR - http://dx.doi.org/10.2196/10775 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/10775 ER - TY - JOUR AU - Kelly-Hedrick, Margot AU - Grunberg, H. Paul AU - Brochu, Felicia AU - Zelkowitz, Phyllis PY - 2018/05/23 TI - ?It?s Totally Okay to Be Sad, but Never Lose Hope?: Content Analysis of Infertility-Related Videos on YouTube in Relation to Viewer Preferences JO - J Med Internet Res SP - e10199 VL - 20 IS - 5 KW - infertility KW - internet KW - YouTube KW - social media KW - online health information N2 - Background: Infertility patients frequently use the internet to find fertility-related information and support from people in similar circumstances. YouTube is increasingly used as a source of health-related information and may influence health decision making. There have been no studies examining the content of infertility-related videos on YouTube. Objective: The purpose of this study was to (1) describe the content of highly viewed videos on YouTube related to infertility and (2) identify video characteristics that relate to viewer preference. Methods: Using the search term ?infertility,? the 80 top-viewed YouTube videos and their viewing statistics (eg, views, likes, and comments) were collected. Videos that were non-English, unrelated to infertility, or had age restrictions were excluded. Content analysis was used to examine videos, employing a coding rubric that measured the presence or absence of video codes related to purpose, tone, and demographic and fertility characteristics (eg, sex, parity, stage of fertility treatment). Results: A total of 59 videos, with a median of 156,103 views, met the inclusion criteria and were categorized into 35 personal videos (35/59, 59%) and 24 informational-educational videos (24/59, 41%). Personal videos did not differ significantly from informational-educational videos on number of views, dislikes, subscriptions driven, or shares. However, personal videos had significantly more likes (P<.001) and comments (P<.001) than informational-educational videos. The purposes of the videos were treatment outcomes (33/59, 56%), sharing information (30/59, 51%), emotional aspects of infertility (20/59, 34%), and advice to others (6/59, 10%). The tones of the videos were positive (26/59, 44%), neutral (25/59, 42%), and mixed (8/59, 14%); there were no videos with negative tone. No videos contained only male posters. Videos with a positive tone did not differ from neutral videos in number of views, dislikes, subscriptions driven, or shares; however, positive videos had significantly more likes (P<.001) and comments (P<.001) than neutral videos. A majority (21/35, 60%) of posters of personal videos shared a pregnancy announcement. Conclusions: YouTube is a source of both technical and personal experience-based information about infertility. However, videos that include personal experiences may elicit greater viewer engagement. Positive videos and stories of treatment success may provide hope to viewers but could also create and perpetuate unrealistic expectations about the success rates of fertility treatment. UR - http://www.jmir.org/2018/5/e10199/ UR - http://dx.doi.org/10.2196/10199 UR - http://www.ncbi.nlm.nih.gov/pubmed/29792296 ID - info:doi/10.2196/10199 ER - TY - JOUR AU - Algarin, B. Angel AU - Ward, J. Patrick AU - Christian, Jay W. AU - Rudolph, E. Abby AU - Holloway, W. Ian AU - Young, M. April PY - 2018/05/31 TI - Spatial Distribution of Partner-Seeking Men Who Have Sex With Men Using Geosocial Networking Apps: Epidemiologic Study JO - J Med Internet Res SP - e173 VL - 20 IS - 5 KW - men who have sex with men KW - public health KW - mobile phone KW - social environment KW - HIV KW - sexually transmitted diseases N2 - Background: Geosocial networking apps have made sexual partner-seeking easier for men who have sex with men, raising both challenges and opportunities for human immunodeficiency virus and sexually transmitted infection prevention and research. Most studies on men who have sex with men geosocial networking app use have been conducted in large urban areas, despite research indicating similar patterns of online- and app-based sex-seeking among men who have sex with men in rural and midsize cities. Objective: The goal of our research was to examine the spatial distribution of geosocial networking app usage and characterize areas with increasing numbers of partner-seeking men who have sex with men in a midsize city in the South. Methods: Data collection points (n=62) were spaced in 2-mile increments along 9 routes (112 miles) covering the county encompassing the city. At each point, staff logged into 3 different geosocial networking apps to record the number of geosocial networking app users within a 1-mile radius. Data were collected separately during weekday daytime (9:00 AM to 4:00 PM) and weekend nighttime (8:00 PM to 12:00 AM) hours. Empirical Bayesian kriging was used to create a raster estimating the number of app users throughout the county. Raster values were summarized for each of the county's 208 Census block groups and used as the outcome measure (ie, geosocial networking app usage). Negative binomial regression and Wilcoxon signed rank sum tests were used to examine Census block group variables (eg, median income, median age) associated with geosocial networking app usage and temporal differences in app usage, respectively. Results: The number of geosocial networking app users within a 1-mile radius of the data collection points ranged from 0 to 36 during weekday daytime hours and 0 to 39 during weekend nighttime hours. In adjusted analyses, Census block group median income and percent Hispanic ethnicity were negatively associated with geosocial networking app usage for all 3 geosocial networking apps during weekday daytime and weekend nighttime hours. Population density and the presence of businesses were positively associated with geosocial networking app usage for all 3 geosocial networking apps during both times. Conclusions: In this midsize city, geosocial networking app usage was highest in areas that were more population-dense, were lower income, and had more businesses. This research is an example of how geosocial networking apps? geospatial capabilities can be used to better understand patterns of virtual partner-seeking among men who have sex with men. UR - http://www.jmir.org/2018/5/e173/ UR - http://dx.doi.org/10.2196/jmir.9919 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jmir.9919 ER - TY - JOUR AU - Cartwright, F. Alice AU - Karunaratne, Mihiri AU - Barr-Walker, Jill AU - Johns, E. Nicole AU - Upadhyay, D. Ushma PY - 2018/05/14 TI - Identifying National Availability of Abortion Care and Distance From Major US Cities: Systematic Online Search JO - J Med Internet Res SP - e186 VL - 20 IS - 5 KW - abortion seekers KW - reproductive health KW - internet KW - access to information KW - information seeking KW - abortion patients KW - reproductive health services KW - information seeking behavior N2 - Background: Abortion is a common medical procedure, yet its availability has become more limited across the United States over the past decade. Women who do not know where to go for abortion care may use the internet to find abortion facility information, and there appears to be more online searches for abortion in states with more restrictive abortion laws. While previous studies have examined the distances women must travel to reach an abortion provider, to our knowledge no studies have used a systematic online search to document the geographic locations and services of abortion facilities. Objective: The objective of our study was to describe abortion facilities and services available in the United States from the perspective of a potential patient searching online and to identify US cities where people must travel the farthest to obtain abortion care. Methods: In early 2017, we conducted a systematic online search for abortion facilities in every state and the largest cities in each state. We recorded facility locations, types of abortion services available, and facility gestational limits. We then summarized the frequencies by region and state. If the online information was incomplete or unclear, we called the facility using a mystery shopper method, which simulates the perspective of patients calling for services. We also calculated distance to the closest abortion facility from all US cities with populations of 50,000 or more. Results: We identified 780 facilities through our online search, with the fewest in the Midwest and South. Over 30% (236/780, 30.3%) of all facilities advertised the provision of medication abortion services only; this proportion was close to 40% in the Northeast (89/233, 38.2%) and West (104/262, 39.7%). The lowest gestational limit at which services were provided was 12 weeks in Wyoming; the highest was 28 weeks in New Mexico. People in 27 US cities must travel over 100 miles (160 km) to reach an abortion facility; the state with the largest number of such cities is Texas (n=10). Conclusions: Online searches can provide detailed information about the location of abortion facilities and the types of services they provide. However, these facilities are not evenly distributed geographically, and many large US cities do not have an abortion facility. Long distances can push women to seek abortion in later gestations when care is even more limited. UR - http://www.jmir.org/2018/5/e186/ UR - http://dx.doi.org/10.2196/jmir.9717 UR - http://www.ncbi.nlm.nih.gov/pubmed/29759954 ID - info:doi/10.2196/jmir.9717 ER - TY - JOUR AU - Karnoe, Astrid AU - Furstrand, Dorthe AU - Christensen, Bang Karl AU - Norgaard, Ole AU - Kayser, Lars PY - 2018/05/10 TI - Assessing Competencies Needed to Engage With Digital Health Services: Development of the eHealth Literacy Assessment Toolkit JO - J Med Internet Res SP - e178 VL - 20 IS - 5 KW - health literacy KW - computer literacy KW - questionnaires KW - telemedicine KW - consumer health informatics N2 - Background: To achieve full potential in user-oriented eHealth projects, we need to ensure a match between the eHealth technology and the user?s eHealth literacy, described as knowledge and skills. However, there is a lack of multifaceted eHealth literacy assessment tools suitable for screening purposes. Objective: The objective of our study was to develop and validate an eHealth literacy assessment toolkit (eHLA) that assesses individuals? health literacy and digital literacy using a mix of existing and newly developed scales. Methods: From 2011 to 2015, scales were continuously tested and developed in an iterative process, which led to 7 tools being included in the validation study. The eHLA validation version consisted of 4 health-related tools (tool 1: ?functional health literacy,? tool 2: ?health literacy self-assessment,? tool 3: ?familiarity with health and health care,? and tool 4: ?knowledge of health and disease?) and 3 digitally-related tools (tool 5: ?technology familiarity,? tool 6: ?technology confidence,? and tool 7: ?incentives for engaging with technology?) that were tested in 475 respondents from a general population sample and an outpatient clinic. Statistical analyses examined floor and ceiling effects, interitem correlations, item-total correlations, and Cronbach coefficient alpha (CCA). Rasch models (RM) examined the fit of data. Tools were reduced in items to secure robust tools fit for screening purposes. Reductions were made based on psychometrics, face validity, and content validity. Results: Tool 1 was not reduced in items; it consequently consists of 10 items. The overall fit to the RM was acceptable (Anderson conditional likelihood ratio, CLR=10.8; df=9; P=.29), and CCA was .67. Tool 2 was reduced from 20 to 9 items. The overall fit to a log-linear RM was acceptable (Anderson CLR=78.4, df=45, P=.002), and CCA was .85. Tool 3 was reduced from 23 to 5 items. The final version showed excellent fit to a log-linear RM (Anderson CLR=47.7, df=40, P=.19), and CCA was .90. Tool 4 was reduced from 12 to 6 items. The fit to a log-linear RM was acceptable (Anderson CLR=42.1, df=18, P=.001), and CCA was .59. Tool 5 was reduced from 20 to 6 items. The fit to the RM was acceptable (Anderson CLR=30.3, df=17, P=.02), and CCA was .94. Tool 6 was reduced from 5 to 4 items. The fit to a log-linear RM taking local dependency (LD) into account was acceptable (Anderson CLR=26.1, df=21, P=.20), and CCA was .91. Tool 7 was reduced from 6 to 4 items. The fit to a log-linear RM taking LD and differential item functioning into account was acceptable (Anderson CLR=23.0, df=29, P=.78), and CCA was .90. Conclusions: The eHLA consists of 7 short, robust scales that assess individual?s knowledge and skills related to digital literacy and health literacy. UR - http://www.jmir.org/2018/5/e178/ UR - http://dx.doi.org/10.2196/jmir.8347 UR - http://www.ncbi.nlm.nih.gov/pubmed/29748163 ID - info:doi/10.2196/jmir.8347 ER - TY - JOUR AU - Verheij, A. Robert AU - Curcin, Vasa AU - Delaney, C. Brendan AU - McGilchrist, M. Mark PY - 2018/05/29 TI - Possible Sources of Bias in Primary Care Electronic Health Record Data Use and Reuse JO - J Med Internet Res SP - e185 VL - 20 IS - 5 KW - electronic health record KW - data accuracy KW - data sharing KW - health information interoperability KW - health care systems KW - health information systems KW - medical informatics N2 - Background: Enormous amounts of data are recorded routinely in health care as part of the care process, primarily for managing individual patient care. There are significant opportunities to use these data for other purposes, many of which would contribute to establishing a learning health system. This is particularly true for data recorded in primary care settings, as in many countries, these are the first place patients turn to for most health problems. Objective: In this paper, we discuss whether data that are recorded routinely as part of the health care process in primary care are actually fit to use for other purposes such as research and quality of health care indicators, how the original purpose may affect the extent to which the data are fit for another purpose, and the mechanisms behind these effects. In doing so, we want to identify possible sources of bias that are relevant for the use and reuse of these type of data. Methods: This paper is based on the authors? experience as users of electronic health records data, as general practitioners, health informatics experts, and health services researchers. It is a product of the discussions they had during the Translational Research and Patient Safety in Europe (TRANSFoRm) project, which was funded by the European Commission and sought to develop, pilot, and evaluate a core information architecture for the learning health system in Europe, based on primary care electronic health records. Results: We first describe the different stages in the processing of electronic health record data, as well as the different purposes for which these data are used. Given the different data processing steps and purposes, we then discuss the possible mechanisms for each individual data processing step that can generate biased outcomes. We identified 13 possible sources of bias. Four of them are related to the organization of a health care system, whereas some are of a more technical nature. Conclusions: There are a substantial number of possible sources of bias; very little is known about the size and direction of their impact. However, anyone that uses or reuses data that were recorded as part of the health care process (such as researchers and clinicians) should be aware of the associated data collection process and environmental influences that can affect the quality of the data. Our stepwise, actor- and purpose-oriented approach may help to identify these possible sources of bias. Unless data quality issues are better understood and unless adequate controls are embedded throughout the data lifecycle, data-driven health care will not live up to its expectations. We need a data quality research agenda to devise the appropriate instruments needed to assess the magnitude of each of the possible sources of bias, and then start measuring their impact. The possible sources of bias described in this paper serve as a starting point for this research agenda. UR - http://www.jmir.org/2018/5/e185/ UR - http://dx.doi.org/10.2196/jmir.9134 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jmir.9134 ER - TY - JOUR AU - Daskivich, Timothy AU - Luu, Michael AU - Noah, Benjamin AU - Fuller, Garth AU - Anger, Jennifer AU - Spiegel, Brennan PY - 2018/05/09 TI - Differences in Online Consumer Ratings of Health Care Providers Across Medical, Surgical, and Allied Health Specialties: Observational Study of 212,933 Providers JO - J Med Internet Res SP - e176 VL - 20 IS - 5 KW - online ratings KW - consumer ratings KW - patient satisfaction KW - digital health KW - telemedicine N2 - Background: Health care consumers are increasingly using online ratings to select providers, but differences in the distribution of scores across specialties and skew of the data have the potential to mislead consumers about the interpretation of ratings. Objective: The objective of our study was to determine whether distributions of consumer ratings differ across specialties and to provide specialty-specific data to assist consumers and clinicians in interpreting ratings. Methods: We sampled 212,933 health care providers rated on the Healthgrades consumer ratings website, representing 29 medical specialties (n=128,678), 15 surgical specialties (n=72,531), and 6 allied health (nonmedical, nonnursing) professions (n=11,724) in the United States. We created boxplots depicting distributions and tested the normality of overall patient satisfaction scores. We then determined the specialty-specific percentile rank for scores across groupings of specialties and individual specialties. Results: Allied health providers had higher median overall satisfaction scores (4.5, interquartile range [IQR] 4.0-5.0) than physicians in medical specialties (4.0, IQR 3.3-4.5) and surgical specialties (4.2, IQR 3.6-4.6, P<.001). Overall satisfaction scores were highly left skewed (normal between ?0.5 and 0.5) for all specialties, but skewness was greatest among allied health providers (?1.23, 95% CI ?1.280 to ?1.181), followed by surgical (?0.77, 95% CI ?0.787 to ?0.755) and medical specialties (?0.64, 95% CI ?0.648 to ?0.628). As a result of the skewness, the percentages of overall satisfaction scores less than 4 were only 23% for allied health, 37% for surgical specialties, and 50% for medical specialties. Percentile ranks for overall satisfaction scores varied across specialties; percentile ranks for scores of 2 (0.7%, 2.9%, 0.8%), 3 (5.8%, 16.6%, 8.1%), 4 (23.0%, 50.3%, 37.3%), and 5 (63.9%, 89.5%, 86.8%) differed for allied health, medical specialties, and surgical specialties, respectively. Conclusions: Online consumer ratings of health care providers are highly left skewed, fall within narrow ranges, and differ by specialty, which precludes meaningful interpretation by health care consumers. Specialty-specific percentile ranks may help consumers to more meaningfully assess online physician ratings. UR - http://www.jmir.org/2018/5/e176/ UR - http://dx.doi.org/10.2196/jmir.9160 UR - http://www.ncbi.nlm.nih.gov/pubmed/29743150 ID - info:doi/10.2196/jmir.9160 ER - TY - JOUR AU - Créquit, Perrine AU - Mansouri, Ghizlène AU - Benchoufi, Mehdi AU - Vivot, Alexandre AU - Ravaud, Philippe PY - 2018/05/15 TI - Mapping of Crowdsourcing in Health: Systematic Review JO - J Med Internet Res SP - e187 VL - 20 IS - 5 KW - review [publication type] KW - crowdsourcing KW - health N2 - Background: Crowdsourcing involves obtaining ideas, needed services, or content by soliciting Web-based contributions from a crowd. The 4 types of crowdsourced tasks (problem solving, data processing, surveillance or monitoring, and surveying) can be applied in the 3 categories of health (promotion, research, and care). Objective: This study aimed to map the different applications of crowdsourcing in health to assess the fields of health that are using crowdsourcing and the crowdsourced tasks used. We also describe the logistics of crowdsourcing and the characteristics of crowd workers. Methods: MEDLINE, EMBASE, and ClinicalTrials.gov were searched for available reports from inception to March 30, 2016, with no restriction on language or publication status. Results: We identified 202 relevant studies that used crowdsourcing, including 9 randomized controlled trials, of which only one had posted results at ClinicalTrials.gov. Crowdsourcing was used in health promotion (91/202, 45.0%), research (73/202, 36.1%), and care (38/202, 18.8%). The 4 most frequent areas of application were public health (67/202, 33.2%), psychiatry (32/202, 15.8%), surgery (22/202, 10.9%), and oncology (14/202, 6.9%). Half of the reports (99/202, 49.0%) referred to data processing, 34.6% (70/202) referred to surveying, 10.4% (21/202) referred to surveillance or monitoring, and 5.9% (12/202) referred to problem-solving. Labor market platforms (eg, Amazon Mechanical Turk) were used in most studies (190/202, 94%). The crowd workers? characteristics were poorly reported, and crowdsourcing logistics were missing from two-thirds of the reports. When reported, the median size of the crowd was 424 (first and third quartiles: 167-802); crowd workers? median age was 34 years (32-36). Crowd workers were mainly recruited nationally, particularly in the United States. For many studies (58.9%, 119/202), previous experience in crowdsourcing was required, and passing a qualification test or training was seldom needed (11.9% of studies; 24/202). For half of the studies, monetary incentives were mentioned, with mainly less than US $1 to perform the task. The time needed to perform the task was mostly less than 10 min (58.9% of studies; 119/202). Data quality validation was used in 54/202 studies (26.7%), mainly by attention check questions or by replicating the task with several crowd workers. Conclusions: The use of crowdsourcing, which allows access to a large pool of participants as well as saving time in data collection, lowering costs, and speeding up innovations, is increasing in health promotion, research, and care. However, the description of crowdsourcing logistics and crowd workers? characteristics is frequently missing in study reports and needs to be precisely reported to better interpret the study findings and replicate them. UR - http://www.jmir.org/2018/5/e187/ UR - http://dx.doi.org/10.2196/jmir.9330 UR - http://www.ncbi.nlm.nih.gov/pubmed/29764795 ID - info:doi/10.2196/jmir.9330 ER - TY - JOUR AU - Paré, Guy AU - Leaver, Chad AU - Bourget, Claire PY - 2018/05/02 TI - Diffusion of the Digital Health Self-Tracking Movement in Canada: Results of a National Survey JO - J Med Internet Res SP - e177 VL - 20 IS - 5 KW - self-tracking KW - quantified-self KW - wearable devices KW - activity trackers KW - survey methodology N2 - Background: With the ever-increasing availability of mobile apps, consumer wearables, and smart medical devices, more and more individuals are self-tracking and managing their personal health data. Objective: The aim of this study was to investigate the diffusion of the digital self-tracking movement in Canada. It provides a comprehensive, yet detailed account of this phenomenon. It examines the profile of digital self-trackers, traditional self-trackers, and nontrackers, further investigating the primary motivations for self-tracking and reasons for nontracking; barriers to adoption of connected care technologies; users? appreciation of their self-tracking devices, including what they perceive to be the main benefits; factors that influence people?s intention to continue using connected care technologies in the future; and the reasons for usage discontinuance. Methods: We conducted an online survey with a sample of 4109 Canadian adults, one of the largest ever. To ensure a representative sample, quota method was used (gender, age), following stratification by region. The maximum margin of error is estimated at 1.6%, 19 times out of 20. Results: Our findings reveal that 66.20% (2720/4109) of our respondents regularly self-track one or more aspects of their health. About one in 4 respondents (1014/4109, 24.68%) currently owns a wearable or smart medical device, and 57.20% (580/1014) use their devices on a regular basis for self-tracking purposes. Digital self-trackers are typically young or mature adults, healthy, employed, university educated, with an annual family income of over $80,000 CAD. The most popular reported device is the fitness tracker or smartwatch that can capture a range of parameters. Currently, mobile apps and digital self-tracking devices are mainly used to monitor physical activity (856/1669, 51.13%), nutrition (545/1669, 32.65%), sleep patterns (482/1669, 28.88%) and, to a much lesser extent, cardiovascular and pulmonary biomarkers (215/1669, 12.88%), medication intake (126/1669, 7.55%), and glucose level (79/1669, 4.73%). Most users of connected care technologies (481/580, 83.0%) are highly satisfied and 88.2% (511/580) intend to continue using their apps and devices in the future. A majority said smart digital devices have allowed them to maintain or improve their health condition (398/580, 68.5%) and to be better informed about their health in general (387/580, 66.6%). About 33.80% of our sample (1389/4109) is composed of people who do not monitor their health or well-being on a regular basis. Conclusions: Our study shows an opportunity to advance the health of Canadians through connected care technologies. Our findings can be used to set baseline information for future research on the rise of digital health self-tracking and its impacts. Although the use of mobile apps, consumer wearables, and smart medical devices could potentially benefit the growing population of patients with chronic conditions, the question remains as to whether it will diffuse broadly beyond early adopters and across cost inequities. UR - http://www.jmir.org/2018/5/e177/ UR - http://dx.doi.org/10.2196/jmir.9388 UR - http://www.ncbi.nlm.nih.gov/pubmed/29720359 ID - info:doi/10.2196/jmir.9388 ER - TY - JOUR AU - Galvão Gomes da Silva, Joana AU - Kavanagh, J. David AU - Belpaeme, Tony AU - Taylor, Lloyd AU - Beeson, Konna AU - Andrade, Jackie PY - 2018/05/03 TI - Experiences of a Motivational Interview Delivered by a Robot: Qualitative Study JO - J Med Internet Res SP - e116 VL - 20 IS - 5 KW - robotics KW - counseling KW - motivational interviewing KW - motivation KW - exercise KW - qualitative research KW - computer-assisted therapy KW - person-centered therapy N2 - Background: Motivational interviewing is an effective intervention for supporting behavior change but traditionally depends on face-to-face dialogue with a human counselor. This study addressed a key challenge for the goal of developing social robotic motivational interviewers: creating an interview protocol, within the constraints of current artificial intelligence, which participants will find engaging and helpful. Objective: The aim of this study was to explore participants? qualitative experiences of a motivational interview delivered by a social robot, including their evaluation of usability of the robot during the interaction and its impact on their motivation. Methods: NAO robots are humanoid, child-sized social robots. We programmed a NAO robot with Choregraphe software to deliver a scripted motivational interview focused on increasing physical activity. The interview was designed to be comprehensible even without an empathetic response from the robot. Robot breathing and face-tracking functions were used to give an impression of attentiveness. A total of 20 participants took part in the robot-delivered motivational interview and evaluated it after 1 week by responding to a series of written open-ended questions. Each participant was left alone to speak aloud with the robot, advancing through a series of questions by tapping the robot?s head sensor. Evaluations were content-analyzed utilizing Boyatzis? steps: (1) sampling and design, (2) developing themes and codes, and (3) validating and applying the codes. Results: Themes focused on interaction with the robot, motivation, change in physical activity, and overall evaluation of the intervention. Participants found the instructions clear and the navigation easy to use. Most enjoyed the interaction but also found it was restricted by the lack of individualized response from the robot. Many positively appraised the nonjudgmental aspect of the interview and how it gave space to articulate their motivation for change. Some participants felt that the intervention increased their physical activity levels. Conclusions: Social robots can achieve a fundamental objective of motivational interviewing, encouraging participants to articulate their goals and dilemmas aloud. Because they are perceived as nonjudgmental, robots may have advantages over more humanoid avatars for delivering virtual support for behavioral change. UR - http://www.jmir.org/2018/5/e116/ UR - http://dx.doi.org/10.2196/jmir.7737 UR - http://www.ncbi.nlm.nih.gov/pubmed/29724701 ID - info:doi/10.2196/jmir.7737 ER - TY - JOUR AU - Granja, Conceição AU - Janssen, Wouter AU - Johansen, Alise Monika PY - 2018/05/01 TI - Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature JO - J Med Internet Res SP - e10235 VL - 20 IS - 5 KW - telemedicine KW - eHealth KW - medical informatics KW - systematic review KW - success KW - failure N2 - Background: eHealth has an enormous potential to improve healthcare cost, effectiveness, and quality of care. However, there seems to be a gap between the foreseen benefits of research and clinical reality. Objective: Our objective was to systematically review the factors influencing the outcome of eHealth interventions in terms of success and failure. Methods: We searched the PubMed database for original peer-reviewed studies on implemented eHealth tools that reported on the factors for the success or failure, or both, of the intervention. We conducted the systematic review by following the patient, intervention, comparison, and outcome framework, with 2 of the authors independently reviewing the abstract and full text of the articles. We collected data using standardized forms that reflected the categorization model used in the qualitative analysis of the outcomes reported in the included articles. Results: Among the 903 identified articles, a total of 221 studies complied with the inclusion criteria. The studies were heterogeneous by country, type of eHealth intervention, method of implementation, and reporting perspectives. The article frequency analysis did not show a significant discrepancy between the number of reports on failure (392/844, 46.5%) and on success (452/844, 53.6%). The qualitative analysis identified 27 categories that represented the factors for success or failure of eHealth interventions. A quantitative analysis of the results revealed the category quality of healthcare (n=55) as the most mentioned as contributing to the success of eHealth interventions, and the category costs (n=42) as the most mentioned as contributing to failure. For the category with the highest unique article frequency, workflow (n=51), we conducted a full-text review. The analysis of the 23 articles that met the inclusion criteria identified 6 barriers related to workflow: workload (n=12), role definition (n=7), undermining of face-to-face communication (n=6), workflow disruption (n=6), alignment with clinical processes (n=2), and staff turnover (n=1). Conclusions: The reviewed literature suggested that, to increase the likelihood of success of eHealth interventions, future research must ensure a positive impact in the quality of care, with particular attention given to improved diagnosis, clinical management, and patient-centered care. There is a critical need to perform in-depth studies of the workflow(s) that the intervention will support and to perceive the clinical processes involved. UR - http://www.jmir.org/2018/5/e10235/ UR - http://dx.doi.org/10.2196/10235 UR - http://www.ncbi.nlm.nih.gov/pubmed/29716883 ID - info:doi/10.2196/10235 ER - TY - JOUR AU - Holtz, Peter AU - Fetahu, Besnik AU - Kimmerle, Joachim PY - 2018/05/10 TI - Effects of Contributor Experience on the Quality of Health-Related Wikipedia Articles JO - J Med Internet Res SP - e171 VL - 20 IS - 5 KW - Wikipedia KW - health-information online KW - collaborative knowledge construction KW - contributor characteristics N2 - Background: Consulting the Internet for health-related information is a common and widespread phenomenon, and Wikipedia is arguably one of the most important resources for health-related information. Therefore, it is relevant to identify factors that have an impact on the quality of health-related Wikipedia articles. Objective: In our study we have hypothesized a positive effect of contributor experience on the quality of health-related Wikipedia articles. Methods: We mined the edit history of all (as of February 2017) 18,805 articles that were listed in the categories on the portal health & fitness in the English language version of Wikipedia. We identified tags within the articles? edit histories, which indicated potential issues with regard to the respective article?s quality or neutrality. Of all of the sampled articles, 99 (99/18,805, 0.53%) articles had at some point received at least one such tag. In our analysis we only considered those articles with a minimum of 10 edits (10,265 articles in total; 96 tagged articles, 0.94%). Additionally, to test our hypothesis, we constructed contributor profiles, where a profile consisted of all the articles edited by a contributor and the corresponding number of edits contributed. We did not differentiate between rollbacks and edits with novel content. Results: Nonparametric Mann-Whitney U-tests indicated a higher number of previously edited articles for editors of the nontagged articles (mean rank tagged 2348.23, mean rank nontagged 5159.29; U=9.25, P<.001). However, we did not find a significant difference for the contributors? total number of edits (mean rank tagged 4872.85, mean rank nontagged 5135.48; U=0.87, P=.39). Using logistic regression analysis with the respective article?s number of edits and number of editors as covariates, only the number of edited articles yielded a significant effect on the article?s status as tagged versus nontagged (dummy-coded; Nagelkerke R2 for the full model=.17; B [SE B]=-0.001 [0.00]; Wald c2 [1]=19.70; P<.001), whereas we again found no significant effect for the mere number of edits (Nagelkerke R2 for the full model=.15; B [SE B]=0.000 [0.01]; Wald c2 [1]=0.01; P=.94). Conclusions: Our findings indicate an effect of contributor experience on the quality of health-related Wikipedia articles. However, only the number of previously edited articles was a predictor of the articles? quality but not the mere volume of edits. More research is needed to disentangle the different aspects of contributor experience. We have discussed the implications of our findings with respect to ensuring the quality of health-related information in collaborative knowledge-building platforms. UR - http://www.jmir.org/2018/5/e171/ UR - http://dx.doi.org/10.2196/jmir.9683 UR - http://www.ncbi.nlm.nih.gov/pubmed/29748161 ID - info:doi/10.2196/jmir.9683 ER - TY - JOUR AU - Jalali, S. Mohammad AU - Kaiser, P. Jessica PY - 2018/05/28 TI - Cybersecurity in Hospitals: A Systematic, Organizational Perspective JO - J Med Internet Res SP - e10059 VL - 20 IS - 5 KW - cybersecurity KW - hospitals KW - organizational models KW - computer simulation N2 - Background: Cybersecurity incidents are a growing threat to the health care industry in general and hospitals in particular. The health care industry has lagged behind other industries in protecting its main stakeholder (ie, patients), and now hospitals must invest considerable capital and effort in protecting their systems. However, this is easier said than done because hospitals are extraordinarily technology-saturated, complex organizations with high end point complexity, internal politics, and regulatory pressures. Objective: The purpose of this study was to develop a systematic and organizational perspective for studying (1) the dynamics of cybersecurity capability development at hospitals and (2) how these internal organizational dynamics interact to form a system of hospital cybersecurity in the United States. Methods: We conducted interviews with hospital chief information officers, chief information security officers, and health care cybersecurity experts; analyzed the interview data; and developed a system dynamics model that unravels the mechanisms by which hospitals build cybersecurity capabilities. We then use simulation analysis to examine how changes to variables within the model affect the likelihood of cyberattacks across both individual hospitals and a system of hospitals. Results: We discuss several key mechanisms that hospitals use to reduce the likelihood of cybercriminal activity. The variable that most influences the risk of cyberattack in a hospital is end point complexity, followed by internal stakeholder alignment. Although resource availability is important in fueling efforts to close cybersecurity capability gaps, low levels of resources could be compensated for by setting a high target level of cybersecurity. Conclusions: To enhance cybersecurity capabilities at hospitals, the main focus of chief information officers and chief information security officers should be on reducing end point complexity and improving internal stakeholder alignment. These strategies can solve cybersecurity problems more effectively than blindly pursuing more resources. On a macro level, the cyber vulnerability of a country?s hospital infrastructure is affected by the vulnerabilities of all individual hospitals. In this large system, reducing variation in resource availability makes the whole system less vulnerable?a few hospitals with low resources for cybersecurity threaten the entire infrastructure of health care. In other words, hospitals need to move forward together to make the industry less attractive to cybercriminals. Moreover, although compliance is essential, it does not equal security. Hospitals should set their target level of cybersecurity beyond the requirements of current regulations and policies. As of today, policies mostly address data privacy, not data security. Thus, policy makers need to introduce policies that not only raise the target level of cybersecurity capabilities but also reduce the variability in resource availability across the entire health care system. UR - http://www.jmir.org/2018/5/e10059/ UR - http://dx.doi.org/10.2196/10059 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/10059 ER - TY - JOUR AU - Heilemann, V. MarySue AU - Martinez, Adrienne AU - Soderlund, D. Patricia PY - 2018/05/02 TI - A Mental Health Storytelling Intervention Using Transmedia to Engage Latinas: Grounded Theory Analysis of Participants? Perceptions of the Story?s Main Character JO - J Med Internet Res SP - e10028 VL - 20 IS - 5 KW - depression KW - anxiety KW - transmedia storytelling KW - Internet KW - cell phone KW - mental health KW - eHealth KW - mood disorders KW - smartphone N2 - Background: Transmedia storytelling was used to attract English-speaking Latina women with elevated symptoms of depression and anxiety to engage in an intervention that included videos and a webpage with links to symptom management resources. However, a main character for the storyline who was considered dynamic, compelling, and relatable by the target group was needed. Objective: We conducted interviews with 28 English-speaking Latinas (target group) with elevated symptoms of depression or anxiety who participated in an Internet-accessible transmedia storytelling intervention. The objective of this study was to examine participants? perceptions of the lead character of the story. Development of this character was informed by deidentified data from previous studies with members of the target group. Critique of the character from a panel of therapists informed editing, as did input from women of the target group. Methods: All interviews were conducted via telephone, audio-recorded, and transcribed. Data analysis was guided by grounded theory methodology. Results: Participants embraced the main character, Catalina, related to her as a person with an emotional life and a temporal reality, reported that they learned from her and wanted more episodes that featured her and her life. Grounded theory analysis led to the development of one category (She ?just felt so real?: relating to Catalina as a real person with a past, present, and future) with 4 properties. Properties included (1) relating emotionally to Catalina?s vulnerability, (2) recognizing shared experiences, (3) needing to support others while simultaneously lacking self-support, and (4) using Catalina as a springboard for imagining alternative futures. Participants found Catalina?s efforts to pursue mental health treatment to be meaningful and led them to compare themselves to her and consider how they might pursue treatment themselves. Conclusions: When creating a story-based mental health intervention to be delivered through an app, regardless of type, careful development of the main character is valuable. Theoretical guidance, previous deidentified data from the target group, critique from key stakeholders and members of the target group, and preliminary testing are likely to enhance the main character?s relatability and appropriateness, which can increase sustained engagement. UR - http://www.jmir.org/2018/5/e10028/ UR - http://dx.doi.org/10.2196/10028 UR - http://www.ncbi.nlm.nih.gov/pubmed/29720357 ID - info:doi/10.2196/10028 ER - TY - JOUR AU - Reynolds, Nathan Andrew PY - 2018/05/01 TI - Comment on ?An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations Versus a Plate Method Diet in Overweight Individuals With Type 2 Diabetes: A Randomized Controlled Trial? JO - J Med Internet Res SP - e180 VL - 20 IS - 5 KW - eHealth KW - diet KW - weight loss KW - type 2 diabetes mellitus KW - low-carbohydrate diets KW - type 2 diabetes UR - http://www.jmir.org/2018/5/e180/ UR - http://dx.doi.org/10.2196/jmir.7672 UR - http://www.ncbi.nlm.nih.gov/pubmed/29716884 ID - info:doi/10.2196/jmir.7672 ER - TY - JOUR AU - Saslow, Laura AU - Mason, E. Ashley AU - Kim, Sarah AU - Goldman, Veronica AU - Ploutz-Snyder, Robert AU - Bayandorian, Hovig AU - Daubenmier, Jennifer AU - Hecht, M. Frederick AU - Moskowitz, T. Judith PY - 2018/05/01 TI - Authors? Reply: Comment on ?An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations Versus a Plate Method Diet in Overweight Individuals With Type 2 Diabetes: A Randomized Controlled Trial? JO - J Med Internet Res SP - e181 VL - 20 IS - 5 KW - low-carbohydrate diets KW - type 2 diabetes UR - http://www.jmir.org/2018/5/e181/ UR - http://dx.doi.org/10.2196/jmir.8776 UR - http://www.ncbi.nlm.nih.gov/pubmed/29716886 ID - info:doi/10.2196/jmir.8776 ER -