TY - JOUR AU - Woldaregay, Zebene Ashenafi AU - Årsand, Eirik AU - Botsis, Taxiarchis AU - Albers, David AU - Mamykina, Lena AU - Hartvigsen, Gunnar PY - 2019/05/01 TI - Data-Driven Blood Glucose Pattern Classification and Anomalies Detection: Machine-Learning Applications in Type 1 Diabetes JO - J Med Internet Res SP - e11030 VL - 21 IS - 5 KW - type 1 diabetes KW - blood glucose dynamics KW - anomalies detection KW - machine learning N2 - Background: Diabetes mellitus is a chronic metabolic disorder that results in abnormal blood glucose (BG) regulations. The BG level is preferably maintained close to normality through self-management practices, which involves actively tracking BG levels and taking proper actions including adjusting diet and insulin medications. BG anomalies could be defined as any undesirable reading because of either a precisely known reason (normal cause variation) or an unknown reason (special cause variation) to the patient. Recently, machine-learning applications have been widely introduced within diabetes research in general and BG anomaly detection in particular. However, irrespective of their expanding and increasing popularity, there is a lack of up-to-date reviews that materialize the current trends in modeling options and strategies for BG anomaly classification and detection in people with diabetes. Objective: This review aimed to identify, assess, and analyze the state-of-the-art machine-learning strategies and their hybrid systems focusing on BG anomaly classification and detection including glycemic variability (GV), hyperglycemia, and hypoglycemia in type 1 diabetes within the context of personalized decision support systems and BG alarm events applications, which are important constituents for optimal diabetes self-management. Methods: A rigorous literature search was conducted between September 1 and October 1, 2017, and October 15 and November 5, 2018, through various Web-based databases. Peer-reviewed journals and articles were considered. Information from the selected literature was extracted based on predefined categories, which were based on previous research and further elaborated through brainstorming. Results: The initial results were vetted using the title, abstract, and keywords and retrieved 496 papers. After a thorough assessment and screening, 47 articles remained, which were critically analyzed. The interrater agreement was measured using a Cohen kappa test, and disagreements were resolved through discussion. The state-of-the-art classes of machine learning have been developed and tested up to the task and achieved promising performance including artificial neural network, support vector machine, decision tree, genetic algorithm, Gaussian process regression, Bayesian neural network, deep belief network, and others. Conclusions: Despite the complexity of BG dynamics, there are many attempts to capture hypoglycemia and hyperglycemia incidences and the extent of an individual?s GV using different approaches. Recently, the advancement of diabetes technologies and continuous accumulation of self-collected health data have paved the way for popularity of machine learning in these tasks. According to the review, most of the identified studies used a theoretical threshold, which suffers from inter- and intrapatient variation. Therefore, future studies should consider the difference among patients and also track its temporal change over time. Moreover, studies should also give more emphasis on the types of inputs used and their associated time lag. Generally, we foresee that these developments might encourage researchers to further develop and test these systems on a large-scale basis. UR - https://www.jmir.org/2019/5/e11030/ UR - http://dx.doi.org/10.2196/11030 UR - http://www.ncbi.nlm.nih.gov/pubmed/31042157 ID - info:doi/10.2196/11030 ER - TY - JOUR AU - Wykes, Til AU - Schueller, Stephen PY - 2019/05/02 TI - Why Reviewing Apps Is Not Enough: Transparency for Trust (T4T) Principles of Responsible Health App Marketplaces JO - J Med Internet Res SP - e12390 VL - 21 IS - 5 KW - mobile health KW - digital health applications KW - consumer protection KW - ehealth KW - advertising standards KW - digital mental health interventions KW - digital health UR - https://www.jmir.org/2019/5/e12390/ UR - http://dx.doi.org/10.2196/12390 UR - http://www.ncbi.nlm.nih.gov/pubmed/31045497 ID - info:doi/10.2196/12390 ER - TY - JOUR AU - Bhattacharyya, Onil AU - Mossman, Kathryn AU - Gustafsson, Lovisa AU - Schneider, C. Eric PY - 2019/05/09 TI - Using Human-Centered Design to Build a Digital Health Advisor for Patients With Complex Needs: Persona and Prototype Development JO - J Med Internet Res SP - e10318 VL - 21 IS - 5 KW - chronic disease KW - user-centered design KW - medical applications N2 - Background: Twenty years ago, a ?Guardian Angel? or comprehensive digital health advisor was proposed to empower patients to better manage their own health. This is now technically feasible, but most digital applications have narrow functions and target the relatively healthy, with few designed for those with the greatest needs. Objective: The goal of the research was to identify unmet needs and key features of a general digital health advisor for frail elderly and people with multiple chronic conditions and their caregivers. Methods: In-depth interviews were used to develop personas and use cases, and iterative feedback from participants informed the creation of a low-fidelity prototype of a digital health advisor. Results were shared with developers, investors, regulators, and health system leaders for suggestions on how this could be developed and disseminated. Results: Patients highlighted the following goals: ?live my life,? ?love my life,? ?manage my health,? and ?feel understood.? Patients and caregivers reported interest in four functions to address these goals: tracking and insights, advice and information, providing a holistic picture of the patient, and coordination and communication. Experts and system stakeholders felt the prototype was technically feasible, and that while health care delivery organizations could help disseminate such a tool, it should be done in partnership with consumer-focused organizations. Conclusions: This study describes the key features of a comprehensive digital health advisor, but to spur its development, we need to clarify the business case and address the policy, organizational, and cultural barriers to creating tools that put patients and their goals at the center of the health system. UR - https://www.jmir.org/2019/5/e10318/ UR - http://dx.doi.org/10.2196/10318 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094334 ID - info:doi/10.2196/10318 ER - TY - JOUR AU - Hjollund, Ingvar Niels Henrik AU - Valderas, Maria José AU - Kyte, Derek AU - Calvert, Jane Melanie PY - 2019/05/21 TI - Health Data Processes: A Framework for Analyzing and Discussing Efficient Use and Reuse of Health Data With a Focus on Patient-Reported Outcome Measures JO - J Med Internet Res SP - e12412 VL - 21 IS - 5 KW - medical informatics KW - patient-reported outcome KW - patient-physician relationship KW - data collection UR - https://www.jmir.org/2019/5/e12412/ UR - http://dx.doi.org/10.2196/12412 UR - http://www.ncbi.nlm.nih.gov/pubmed/31115347 ID - info:doi/10.2196/12412 ER - TY - JOUR AU - Kirkendall, Steven Eric AU - Ni, Yizhao AU - Lingren, Todd AU - Leonard, Matthew AU - Hall, S. Eric AU - Melton, Kristin PY - 2019/05/22 TI - Data Challenges With Real-Time Safety Event Detection And Clinical Decision Support JO - J Med Internet Res SP - e13047 VL - 21 IS - 5 KW - decision support systems, clinical KW - clinical decision support KW - real-time systems KW - electronic medical records KW - electronic health records KW - medical records systems, computerized KW - informatics KW - data science KW - information science KW - patient safety N2 - Background: The continued digitization and maturation of health care information technology has made access to real-time data easier and feasible for more health care organizations. With this increased availability, the promise of using data to algorithmically detect health care?related events in real-time has become more of a reality. However, as more researchers and clinicians utilize real-time data delivery capabilities, it has become apparent that simply gaining access to the data is not a panacea, and some unique data challenges have emerged to the forefront in the process. Objective: The aim of this viewpoint was to highlight some of the challenges that are germane to real-time processing of health care system?generated data and the accurate interpretation of the results. Methods: Distinct challenges related to the use and processing of real-time data for safety event detection were compiled and reported by several informatics and clinical experts at a quaternary pediatric academic institution. The challenges were collated from the experiences of the researchers implementing real-time event detection on more than half a dozen distinct projects. The challenges have been presented in a challenge category-specific challenge-example format. Results: In total, 8 major types of challenge categories were reported, with 13 specific challenges and 9 specific examples detailed to provide a context for the challenges. The examples reported are anchored to a specific project using medication order, medication administration record, and smart infusion pump data to detect discrepancies and errors between the 3 datasets. Conclusions: The use of real-time data to drive safety event detection and clinical decision support is extremely powerful, but it presents its own set of challenges that include data quality and technical complexity. These challenges must be recognized and accommodated for if the full promise of accurate, real-time safety event clinical decision support is to be realized. UR - http://www.jmir.org/2019/5/e13047/ UR - http://dx.doi.org/10.2196/13047 UR - http://www.ncbi.nlm.nih.gov/pubmed/31120022 ID - info:doi/10.2196/13047 ER - TY - JOUR AU - Geneviève, Darryl Lester AU - Martani, Andrea AU - Wangmo, Tenzin AU - Paolotti, Daniela AU - Koppeschaar, Carl AU - Kjelsø, Charlotte AU - Guerrisi, Caroline AU - Hirsch, Marco AU - Woolley-Meza, Olivia AU - Lukowicz, Paul AU - Flahault, Antoine AU - Elger, Simone Bernice PY - 2019/05/23 TI - Participatory Disease Surveillance Systems: Ethical Framework JO - J Med Internet Res SP - e12273 VL - 21 IS - 5 KW - ethics KW - research KW - influenza, human KW - smartphone KW - public health surveillance UR - https://www.jmir.org/2019/5/e12273/ UR - http://dx.doi.org/10.2196/12273 UR - http://www.ncbi.nlm.nih.gov/pubmed/31124466 ID - info:doi/10.2196/12273 ER - TY - JOUR AU - Whiteside, Ursula AU - Richards, Julie AU - Huh, David AU - Hidalgo, Rianna AU - Nordhauser, Rebecca AU - Wong, J. Albert AU - Zhang, Xiaoshan AU - Luxton, D. David AU - Ellsworth, Michael AU - Lezine, DeQuincy PY - 2019/05/02 TI - Development and Evaluation of a Web-Based Resource for Suicidal Thoughts: NowMattersNow.org JO - J Med Internet Res SP - e13183 VL - 21 IS - 5 KW - dialectical behavior therapy KW - suicide KW - internet KW - help-seeking behavior KW - behavior therapy KW - crisis intervention KW - primary care KW - integrated health care systems N2 - Background: Nearly half of people who die by suicide see a health care provider in the month before their death. With the release of new care guidelines, detection of suicidal patients will likely increase. Providers need access to suicide-specific resources that can be used as part of immediate, brief interventions with a suicidal patient. Web-based suicide prevention resources have the potential to address this need. Objective: This study aimed to describe the development of the NowMattersNow.org website as a resource for individuals with suicidal thoughts and to evaluate the utility of the site via user experience surveys. Methods: NowMattersNow.org is an online video-based free public resource that provides evidence-based teachings, examples, and resources for managing suicidal thoughts and intense emotions focused largely around skills from dialectical behavior therapy. Developed with assistance from mental health consumers, it is intended to address gaps in access to services for suicidal patients in health care systems. Visitors stay an average of a minute and a half on the website. From March 2015 to December 2017, a user experience survey measured self-reported changes on a 1 (not at all) to 5 (completely overwhelming) scale regarding intensity of suicidal thoughts and negative emotions while on the website. Longitudinal regression analyses using generalized estimating equations evaluated the magnitude and statistical significance of user-reported changes in suicidal ideation and negative emotion. In secondary analyses, user-reported changes specific to subgroups, including men aged 36 to 64 years, mental health care providers, and other health care providers were evaluated. Results: During the period of analysis, there were 138,386 unique website visitors. We analyzed surveys (N=3670) collected during that time. Subsamples included men aged 36 to 64 years (n=512), mental health providers (n=460), and other health care providers (n=308). A total of 28% (1028/3670) of survey completers rated their suicidal thoughts as a 5 or ?completely overwhelming? when they entered the website. We observed significant reductions in self-reported intensity of suicidal thoughts (?0.21, P<.001) and negative emotions (?0.32, P<.001), including decreases for users with the most severe suicidal thoughts (?6.4%, P<.001), most severe negative emotions (?10.9%, P<.001), and for middle-aged men (?0.13, P<001). Results remained significant after controlling for length of visit to website (before the survey) and technology type (mobile, desktop, and tablet). Conclusions: Survey respondents reported measurable reductions in intensity of suicidal thoughts and emotions, including those rating their suicidal thoughts as completely or almost completely overwhelming and among middle-aged men. Although results from this user-experience survey administered at one point in time to a convenience sample of users must be interpreted with caution, results provide preliminary support for the potential effectiveness of the NowMattersNow.org website as a tool for short-term management of suicidal thoughts and negative emotions. UR - http://www.jmir.org/2019/5/e13183/ UR - http://dx.doi.org/10.2196/13183 UR - http://www.ncbi.nlm.nih.gov/pubmed/31045498 ID - info:doi/10.2196/13183 ER - TY - JOUR AU - Schuster, Raphael AU - Kalthoff, Inanna AU - Walther, Alexandra AU - Köhldorfer, Lena AU - Partinger, Edith AU - Berger, Thomas AU - Laireiter, Anton-Rupert PY - 2019/05/06 TI - Effects, Adherence, and Therapists? Perceptions of Web- and Mobile-Supported Group Therapy for Depression: Mixed-Methods Study JO - J Med Internet Res SP - e11860 VL - 21 IS - 5 KW - eHealth KW - mobile phone KW - computer-assisted therapy KW - monitoring KW - group therapy KW - depression KW - professional-patient relations N2 - Background: Blended group therapy (bGT) has been investigated a several times for anxiety and depression, but information on patients? adherence to and therapists? perception of the novel format is nonexistent. Furthermore, many studies investigated mainly female and highly educated populations, limiting the validity of previous findings. Objective: This study aimed to reduce the gaps and limitations of the previous findings by evaluating an integrated internet- and mobile-supported bGT format. Methods: A total of 27 patients diagnosed with major depression (14/27, 52% female and 7/27, 25.9% compulsory education) participated in a 7-week treatment at a university outpatient clinic. Furthermore, 8 novice therapists participated in semistructured interviews and a subsequent cross-validation survey. Results: Primary symptom reduction was high (d=1.31 to 1.51) and remained stable for the follow-up period. Therapists identified advantages (eg, patient engagement, treatment intensification, and improved therapeutic relation) and disadvantages (eg, increased workload, data issues, and undesired effects) of bGT. The required online guidance time was 10.3 min per patient and week, including guidance on exercises (67% or 6.9 min) and intimate communication (33% or 3.4 min). Concerning patients? adherence to bGT, tracked completion of all Web-based and mobile tasks was high and comparable with group attendance. Conclusions: Results suggest high feasibility of bGT in a gender-balanced, moderately educated sample. bGT provides group therapists with tools for individual care, resulting in an optimization of the therapy process, and high completion rates of the implemented bGT elements. The limited work experience of the involved therapists restricts the study findings, and potential drawbacks need to be regarded in the development of future bGT interventions. UR - https://www.jmir.org/2019/5/e11860/ UR - http://dx.doi.org/10.2196/11860 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066700 ID - info:doi/10.2196/11860 ER - TY - JOUR AU - Zhao, Yinan AU - Feng, Hui AU - Hu, Mingyue AU - Hu, Hengyu AU - Li, Hui AU - Ning, Hongting AU - Chen, Huijing AU - Liao, Lulu AU - Peng, Linlin PY - 2019/5/6 TI - Web-Based Interventions to Improve Mental Health in Home Caregivers of People With Dementia: Meta-Analysis JO - J Med Internet Res SP - e13415 VL - 21 IS - 5 KW - internet KW - education KW - mental health KW - caregivers KW - dementia N2 - Background: Dementia is a major cause of disability and dependency in older adults worldwide. It is often accompanied by general psychological distress, such as depression and anxiety symptoms, among caregivers of people with dementia (PwD). The physical and mental health of the caregiver is a prerequisite and a promise to help PwD continue to live as long and as well as possible. Web-based interventions can provide convenient and efficient support and an education tool to potentially reduce the negative outcomes associated with providing care. Objective: The aim of this study was to examine the effect of internet-based interventions on the mental health outcomes of family caregivers of PwD and to explore which components of the Web-based interventions play an important role. Methods: A comprehensive literature search was conducted in PubMed, Excerpta Medica dataBASE, PsycINFO, Cochrane Database, and the Cumulative Index to Nursing and Allied Health Literature using relevant terms such as Web-based and caregiver as keywords, covering all studies published before June 2018. A total of 2 reviewers independently reviewed all published abstracts, according to established inclusion and exclusion criteria. We extracted information about the participants, interventions, and results and reviewed article quality in terms of the randomized trial methods, using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Results: A total of 815 caregivers participated in 6 studies, with 4 of the studies using depression as an outcome. The analysis found that depression scores dropped an average of 0.23 (95% CI ?0.38 to ?0.07; P<.01) after Web-based interventions. In 2 studies of caregivers who were experiencing anxiety symptoms, the average score for anxiety dropped by 0.32 points (95% CI ?0.50 to ?0.14; P<.01). However, in terms of coping, pain, and stress, the Web-based interventions showed a poor effect. On the whole, the addition of professional psychological support on the basis of education can improve caregivers? mental health. Conclusions: Internet-based interventions were generally effective at reducing anxiety and depression in dementia caregivers, although negative results were found in some studies. As for burden and stress, further research is required. UR - http://www.jmir.org/2019/5/e13415/ UR - http://dx.doi.org/10.2196/13415 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066680 ID - info:doi/10.2196/13415 ER - TY - JOUR AU - Cook, Lorna AU - Mostazir, Mohammod AU - Watkins, Edward PY - 2019/05/13 TI - Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating University Students JO - J Med Internet Res SP - e11349 VL - 21 IS - 5 KW - cognitive behavioral therapy KW - depression KW - prevention KW - rumination, cognitive KW - stress, psychological KW - student health services N2 - Background: Prevention of depression is a priority to reduce its global disease burden. Targeting specific risk factors, such as rumination, may improve prevention. Rumination-focused Cognitive Behavioral Therapy (RFCBT) was developed to specifically target depressive rumination. Objective: The primary objective of this study was to test whether guided Web-based RFCBT (i-RFCBT) would prevent the incidence of major depression relative to usual care in UK university students. The secondary objective was to test the feasibility and estimated effect sizes of unguided i-RFCBT. Methods: To address the primary objective, a phase III randomized controlled trial was designed and powered to compare high risk university students (N=235), selected with elevated worry/rumination, recruited via an open access website in response to circulars within universities and internet advertisements, randomized to receive either guided i-RFCBT (interactive Web-based RFCBT, supported by asynchronous written Web-based support from qualified therapists) or usual care control. To address the secondary objective, participants were also randomized to an adjunct arm of unguided (self-administered) i-RFCBT. The primary outcome was the onset of a major depressive episode over 15 months, assessed with structured diagnostic interviews at 3 (postintervention), 6, and 15 months post randomization, conducted by telephone, blind to the condition. Secondary outcomes of symptoms of depression and anxiety and levels of worry and rumination were self-assessed through questionnaires at baseline and the same follow-up intervals. Results: Participants were randomized to guided i-RFCBT (n=82), unguided i-RFCBT (n=76), or usual care (n=77). Guided i-RFCBT reduced the risk of depression by 34% relative to usual care (hazard ratio [HR] 0.66, 95% CI 0.35 to 1.25; P=.20). Participants with higher levels of baseline stress benefited most from the intervention (HR 0.43, 95% CI 0.21 to 0.87; P=.02). Significant improvements in rumination, worry, and depressive symptoms were found in the short-to-medium term. Of the 6 modules, guided participants completed a mean of 3.46 modules (SD 2.25), with 46% (38/82) being compliant (completing ?4 modules). Similar effect sizes and compliance rates were found for unguided i-RFCBT. Conclusions: Guided i-RFCBT can reduce the onset of depression in high-risk young people reporting high levels of worry/rumination and stress. The feasibility study argues for formally testing unguided i-RFCBT for prevention: if the observed effect sizes are robustly replicated in a phase III trial, it has potential as a scalable prevention intervention. Trial Registration: ISRCTN Registry ISRCTN12683436; https://www.isrctn.com/ISRCTN12683436 (Archived by WebCite at http://www.webcitation.org/77fqycyBX) International Registered Report Identifier (IRRID): RR2-10.1186/s13063-015-1128-9 UR - https://www.jmir.org/2019/5/e11349/ UR - http://dx.doi.org/10.2196/11349 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094331 ID - info:doi/10.2196/11349 ER - TY - JOUR AU - Martens, Kris AU - Takano, Keisuke AU - Barry, J. Tom AU - Goedleven, Jolien AU - Van den Meutter, Louise AU - Raes, Filip PY - 2019/05/14 TI - Remediating Reduced Autobiographical Memory in Healthy Older Adults With Computerized Memory Specificity Training (c-MeST): An Observational Before-After Study JO - J Med Internet Res SP - e13333 VL - 21 IS - 5 KW - memory specificity training KW - autobiographical memory KW - cognitive aging KW - online KW - depression KW - memory KW - telemedicine KW - rumination, cognitive N2 - Background: The ability to retrieve specific autobiographical memories decreases with cognitive aging. This decline is clinically relevant due to its association with impairments in problem solving, daily functioning, and depression. A therapist-delivered group training protocol, Memory Specificity Training (MeST), has been shown to enhance the retrieval of specific memories while ameliorating the impairments and negative outcomes associated with reduced specificity. The therapist-delivered nature of this intervention means it is relatively expensive to deliver and difficult for people with mobility impairments, such as older people, to receive. Objective: The objective of this study was to test if a novel, Web-based computerized version of a group training protocol called Memory Specificity Training, has the potential to increase autobiographical memory specificity and impact associated secondary psychological processes. Methods: A total of 21 participants (13 female; mean age 67.05, SD 6.55) who experienced a deficit in retrieving specific autobiographical memory were trained with c-MeST. We assessed memory specificity at preintervention and postintervention, as well as secondary processes such as depressive symptoms, rumination, and problem-solving skills. Results: Memory specificity increased significantly after participants completed c-MeST (r=.57). Session-to-session scores indicated that autobiographical memory specificity improved most from the online baseline assessment to the first Web-based session. Symptoms or secondary processes such as problem-solving skills did not change significantly. Conclusions: A Web-based automated individual version of MeST is a feasible, low-cost intervention for reduced memory specificity in healthy older adults. Future studies should clarify the preventive impact of c-MeST in other at-risk sample populations with longer follow-up times. UR - https://www.jmir.org/2019/5/e13333/ UR - http://dx.doi.org/10.2196/13333 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094362 ID - info:doi/10.2196/13333 ER - TY - JOUR AU - Jin, Xia AU - Xu, Junjie AU - Smith, Kumi M. AU - Xiao, Dong AU - Rapheal, R. Erica AU - Xiu, Xiangfei AU - Ding, Zhengwei AU - Zhang, Yang AU - Jie, Yang AU - Liao, Ying AU - Cao, Ningxiao AU - Wu, Hao AU - Bao, Yugang PY - 2019/05/15 TI - An Internet-Based Self-Testing Model (Easy Test): Cross-Sectional Survey Targeting Men Who Have Sex With Men Who Never Tested for HIV in 14 Provinces of China JO - J Med Internet Res SP - e11854 VL - 21 IS - 5 KW - internet KW - men who have sex with men (MSM) KW - HIV KW - China N2 - Background: With China?s explosive internet growth, activities such as socializing and partner seeking among men who have sex with men (MSM) has also become Web based through popular services such as Blued. This creates a new mode of health promotion with the potential to instantly reach large numbers of MSM, including those who rarely access traditional offline testing facilities. Objective: This study aimed to assess the feasibility of the Easy Test in increasing access and uptake of HIV testing and treatment services among MSM and to identify demographic and behavioral predictors of program uptake to inform future implementation. Methods: A feasibility study of the Easy Test model was conducted from October 2017 to December 2017 in 14 Chinese provinces. Applicants who provided informed consent completed a self-administered questionnaire and submitted a US $5 deposit to have the free test kit delivered to their homes. Orders were then received, processed, and posted by volunteers from local community-based organizations. Once applicants submitted images of their test results, the deposit was refunded to the applicant. Those whose test results were deemed to be HIV-positive were then connected to a peer navigator to accompany the individual to follow-up medical services. A chi-squared trend test was used to assess the relationship between lifetime HIV testing volume and HIV prevalence. Logistic regression models were used to identify independent risk factors associated with two outcomes: (1) never having tested for HIV and (2) receiving an HIV-positive result. Results: A total of 879 individuals submitted Web-based requests for test kits. Their median age was 28 (interquartile range 24-34 years); 69.3% (609/879) had at least a college education, and 51.5% (453/879) had a monthly income between US $450 to $750; 77.7% (683/879) of the applicants submitted images of their test results, among whom 14.3% (98/683) had an HIV-positive result. Among the 42.9% (293/683) who were first-time testers, the HIV prevalence was 18.8% (55/293). Nearly three-quarters (71/98, 72.4%) of those with a positive test result were connected with a peer navigator and enrolled in treatment. Among the first-time testers, having multiple sexual partners (2-3 sexual partners: adjusted odds ratio [aOR] 2.44, 95% CI 1.08-5.50; 4 or above sexual partners: aOR 3.55, 95% CI 1.18-10.68) and reporting inconsistent condom use in the previous 3 months (aOR 7.95, 95% CI 3.66-17.26) were both associated with an HIV-positive result. An inverse dose response relationship between lifetime HIV testing volume and HIV prevalence was also observed in this study (?23=55.0; P<.001). Conclusions: The Easy Test model reached a larger portion of first-time testers, many who reported higher risk sexual behaviors. This highlights the potential for an internet-based self-test model to increase access to HIV treatment services for HIV-positive MSM in China. UR - https://www.jmir.org/2019/5/e11854/ UR - http://dx.doi.org/10.2196/11854 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094339 ID - info:doi/10.2196/11854 ER - TY - JOUR AU - Clarke, Janine AU - Sanatkar, Samineh AU - Baldwin, Andrew Peter AU - Fletcher, Susan AU - Gunn, Jane AU - Wilhelm, Kay AU - Campbell, Lesley AU - Zwar, Nicholas AU - Harris, Mark AU - Lapsley, Helen AU - Hadzi-Pavlovic, Dusan AU - Christensen, Helen AU - Proudfoot, Judy PY - 2019/05/21 TI - A Web-Based Cognitive Behavior Therapy Intervention to Improve Social and Occupational Functioning in Adults With Type 2 Diabetes (The SpringboarD Trial): Randomized Controlled Trial JO - J Med Internet Res SP - e12246 VL - 21 IS - 5 KW - type 2 diabetes KW - depression KW - internet N2 - Background: Depressive symptoms are common in people with type 2 diabetes mellitus (T2DM). Effective depression treatments exist; however, access to psychological support is characteristically low. Web-based cognitive behavioral therapy (CBT) is accessible, nonstigmatizing, and may help address substantial personal and public health impact of comorbid T2DM and depression. Objective: The aim of this study was to evaluate the Web-based CBT program, myCompass, for improving social and occupational functioning in adults with T2DM and mild-to-moderate depressive symptoms. myCompass is a fully automated, self-guided public health treatment program for common mental health problems. The impact of treatment on depressive symptoms, diabetes-related distress, anxiety symptoms, and self-care behavior was also examined. Methods: Participants with T2DM and mild-to-moderate depressive symptoms (N=780) were recruited online via Google and Facebook advertisements targeting adults with T2DM and via community and general practice settings. Screening, consent, and self-report scales were all self-administered online. Participants were randomized using double-blind computerized block randomization to either myCompass (n=391) for 8 weeks plus a 4-week tailing-off period or an active placebo intervention (n=379). At baseline and postintervention (3 months), participants completed the Work and Social Adjustment Scale, the primary outcome measure. Secondary outcome measures included the Patient Health Questionnaire-9 item, Diabetes Distress Scale, Generalized Anxiety Disorder Questionnaire-7 item, and items from the Self-Management Profile for Type 2 Diabetes. Results: myCompass users logged in an average of 6 times and completed an average of .29 modules. Healthy Lifestyles users logged in an average of 4 times and completed an average of 1.37 modules. At baseline, mean scores on several outcome measures, including the primary outcome of work and social functioning, were near to the normal range, despite an extensive recruitment process. Approximately 61.6% (473/780) of participants completed the postintervention assessment. Intention-to-treat analyses revealed improvement in functioning, depression, anxiety, diabetes distress, and healthy eating over time in both groups. Except for blood glucose monitoring and medication adherence, there were no specific between-group effects. Follow-up analyses suggested the outcomes did not depend on age, morbidity, or treatment engagement. Conclusions: Improvement in social and occupational functioning and the secondary outcomes was generally no greater for myCompass users than for users of the control program at 3 months postintervention. These findings should be interpreted in light of near-normal mean baseline scores on several variables, the self-selected study sample, and sample attrition. Further attention to factors influencing uptake and engagement with mental health treatments by people with T2DM, and the impact of illness comorbidity on patient conceptualization and experience of mental health symptoms, is essential to reduce the burden of T2DM. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12615000931572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109&isReview=true (Archived by WebCite at http://www.webcitation.org/7850eg8pi) UR - http://www.jmir.org/2019/5/e12246/ UR - http://dx.doi.org/10.2196/12246 UR - http://www.ncbi.nlm.nih.gov/pubmed/31115345 ID - info:doi/10.2196/12246 ER - TY - JOUR AU - Romanzini, Possamai Catiana Leila AU - Romanzini, Marcelo AU - Batista, Biagi Mariana AU - Barbosa, Lopes Cynthia Correa AU - Shigaki, Blasquez Gabriela AU - Dunton, Genevieve AU - Mason, Tyler AU - Ronque, Vaz Enio Ricardo PY - 2019/05/15 TI - Methodology Used in Ecological Momentary Assessment Studies About Sedentary Behavior in Children, Adolescents, and Adults: Systematic Review Using the Checklist for Reporting Ecological Momentary Assessment Studies JO - J Med Internet Res SP - e11967 VL - 21 IS - 5 KW - physical activity KW - accelerometry KW - health behavior N2 - Background: The use of ecological momentary assessment (EMA) to measure sedentary behavior (SB) in children, adolescents, and adults can increase the understanding of the role of the context of SB in health outcomes. Objective: The aim of this study was to systematically review literature to describe EMA methodology used in studies on SB in youth and adults, verify how many studies adhere to the Methods aspect of the Checklist for Reporting EMA Studies (CREMAS), and detail measures used to assess SB and this associated context. Methods: A systematic literature review was conducted in the PubMed, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and SPORTDiscus databases, covering the entire period of existence of the databases until January 2018. Results: This review presented information about the characteristics and methodology used in 21 articles that utilized EMA to measure SB in youth and adults. There were more studies conducted among youth compared with adults, and studies of youth included more waves and more participants (n=696) than studies with adults (n=97). Most studies (85.7%) adhered to the Methods aspect of the CREMAS. The main criteria used to measure SB in EMA were self-report (81%) with only 19% measuring SB using objective methods (eg, accelerometer). The main equipment to collect objective SB was the ActiGraph, and the cutoff point to define SB was <100 counts/min. Studies most commonly used a 15-min window to compare EMA and accelerometer data. Conclusions: The majority of studies in this review met minimum CREMAS criteria for studies conducted with EMA. Most studies measured SB with EMA self-report (n=17; 81.0%), and a few studies also used objective methods (n=4; 19%). The standardization of the 15-min window criteria to compare EMA and accelerometer data would lead to a comparison between these and new studies. New studies using EMA with mobile phones should be conducted as they can be considered an attractive method for capturing information about the specific context of SB activities of young people and adults in real time or very close to it. UR - https://www.jmir.org/2019/5/e11967/ UR - http://dx.doi.org/10.2196/11967 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094349 ID - info:doi/10.2196/11967 ER - TY - JOUR AU - Gill, Roopan AU - Ogilvie, Gina AU - Norman, V. Wendy AU - Fitzsimmons, Brian AU - Maher, Ciana AU - Renner, Regina PY - 2019/05/29 TI - Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care in British Columbia: Phase I JO - J Med Internet Res SP - e13387 VL - 21 IS - 5 KW - mHealth KW - family planning KW - abortion, induced KW - sexual health KW - digital health KW - user-centered design N2 - Background: Over 30% of women in Canada undergo an abortion. Despite the prevalence of the procedure, stigma surrounding abortion in Canada leads to barriers for women to access this service. The vast majority of care is concentrated in urban settings. There is evidence to support utilization of innovative mobile and other technology solutions to empower women to safely and effectively self-manage aspects of the abortion process. This study is part 1 of a 3-phase study that utilizes user-centered design methodology to develop a digital health solution to specifically support follow-up after an induced surgical abortion. Objective: This study aimed to (1) understand how women at 3 surgical abortion clinics in an urban center of British Columbia utilize their mobile phones to access health care information and (2) understand women?s preferences of content and design of an intervention that will support follow-up care after an induced abortion, including contraceptive use. Methods: The study design was based on development-evaluation-implementation process from Medical Research Council Framework for Complex Medical Interventions. This was a mixed-methods formative study. Women (aged 14-45 years) were recruited from 3 urban abortion facilities in British Columbia who underwent an induced abortion. Adaptation of validated surveys and using the technology acceptance model and theory of reasoned action, a cross-sectional survey was designed. Interview topics included demographic information; type of wireless device used; cell phone usage; acceptable information to include in a mobile intervention to support women?s abortion care; willingness to use a mobile phone to obtain reproductive health information; optimal strategies to use a mobile intervention to support women; understand preferences for health information resources; and design qualities in a mobile intervention important for ease of use, privacy, and security. Responses to questions in the survey were summarized using descriptive statistics. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the local ethics board. Results: A waiting-room survey was completed by 50 participants, and semistructured interviews were completed with 8 participants. The average age of participants was 26 years. Furthermore, 94% (47/50) owned a smartphone, 85% (41/48) used their personal phones to go online, and 85% would use their cell phone to assist in clinical care. Qualitative analysis demonstrated that women prefer a comprehensive website that included secure email or text notifications to provide tools and resources for emotional well-being, contraceptive decision making, general sexual health, and postprocedure care. Conclusions: A community-based mixed-methods approach allowed us to understand how women use their cell phones and what women desire in a mobile intervention to support their postabortion care. The findings from this formative phase will assist in the development and testing of a mobile intervention to support follow-up care after an induced surgical abortion. UR - http://www.jmir.org/2019/5/e13387/ UR - http://dx.doi.org/10.2196/13387 UR - http://www.ncbi.nlm.nih.gov/pubmed/31144668 ID - info:doi/10.2196/13387 ER - TY - JOUR AU - Langford, Aisha AU - Loeb, Stacy PY - 2019/05/17 TI - Perceived Patient-Provider Communication Quality and Sociodemographic Factors Associated With Watching Health-Related Videos on YouTube: A Cross-Sectional Analysis JO - J Med Internet Res SP - e13512 VL - 21 IS - 5 KW - social media KW - communication KW - health communication KW - ethnic groups KW - physician-patient relations KW - emotions KW - attention KW - cross-sectional studies KW - logistic models KW - HINTS N2 - Background: Approximately 73% of US adults use YouTube, making it the most popular social media platform. Misinformation on social media is a growing concern; recent studies show a high proportion of misinformative health-related videos. Several studies on patient-provider communication and general health information seeking have been conducted. However, few studies to date have examined the potential association between patient-provider communication and health information seeking on specific social media platforms such as YouTube. A better understanding of this relationship may inform future health communication interventions. Objective: The aim was to use nationally representative cross-sectional data to describe the association between perceived patient-provider communication quality and sociodemographic factors on watching YouTube health-related videos. Methods: Data from the 2018 Health Information National Trends Survey were analyzed (N=3504). The primary outcome was whether participants watched a health-related video on YouTube over the past 12 months. A patient-provider communication composite score was created by summing responses about how often providers did the following: (1) gave you the chance to ask all the health-related questions you had, (2) gave attention to your feelings, (3) involved you in health care decisions as much as you wanted, (4) made sure that you understood the things you needed to do to take care of your health, (5) explained things in a way that you could understand, (6) spent enough time with you, and (7) helped you deal with feelings of uncertainty. Sociodemographic factors included age, gender, race/ethnicity, and education. Descriptive statistics and multivariable logistic regression were conducted. Results: Approximately 1067 (35% weighted prevalence) participants reported watching a health-related video on YouTube. Higher perceived quality of patient-provider communication on the composite score was significantly associated with lower odds of watching health-related videos on YouTube. Regarding sociodemographic factors, increasing age and being a high school graduate (compared with college graduate) were associated with lower odds of watching health-related videos on YouTube; whereas, Hispanic and non-Hispanic Asians were more likely to have watched a health-related video on YouTube. For individual aspects of patient-physician communication, two of seven patient-provider communication variables were significant. Those who reported that providers ?sometimes? spent enough time with them had higher odds of watching a health-related video on YouTube, compared with those who said providers ?always? spent enough time with them. Participants reporting that they ?never? have a chance to ask all their health-related questions also had higher odds of watching health-related videos on YouTube compared with those who reported ?always.? Conclusions: Higher perceived quality of patient-provider communication is associated with lower odds of watching health-related videos on YouTube. When providers do not spend enough time or give an opportunity to ask questions, patients are more likely to pursue health information on social media. UR - http://www.jmir.org/2019/5/e13512/ UR - http://dx.doi.org/10.2196/13512 UR - http://www.ncbi.nlm.nih.gov/pubmed/31102372 ID - info:doi/10.2196/13512 ER - TY - JOUR AU - Nitzburg, George AU - Weber, Ingmar AU - Yom-Tov, Elad PY - 2019/05/03 TI - Internet Searches for Medical Symptoms Before Seeking Information on 12-Step Addiction Treatment Programs: A Web-Search Log Analysis JO - J Med Internet Res SP - e10946 VL - 21 IS - 5 KW - alcohol use disorder KW - substance use disorder KW - 12-step programs KW - brief intervention KW - brief physician advice KW - anonymized internet search log data N2 - Background: Brief intervention is a critical method for identifying patients with problematic substance use in primary care settings and for motivating them to consider treatment options. However, despite considerable evidence of delay discounting in patients with substance use disorders, most brief advice by physicians focuses on the long-term negative medical consequences, which may not be the best way to motivate patients to seek treatment information. Objective: Identification of the specific symptoms that most motivate individuals to seek treatment information may offer insights for further improving brief interventions. To this end, we used anonymized internet search engine data to investigate which medical conditions and symptoms preceded searches for 12-step meeting locators and general 12-step information. Methods: We extracted all queries made by people in the United States on the Bing search engine from November 2016 to July 2017. These queries were filtered for those who mentioned seeking Alcoholics Anonymous (AA) or Narcotics Anonymous (NA); in addition, queries that contained a medical symptom or condition or a synonym thereof were analyzed. We identified medical symptoms and conditions that predicted searches for seeking treatment at different time lags. Specifically, symptom queries were first determined to be significantly predictive of subsequent 12-step queries if the probability of querying a medical symptom by those who later sought information about the 12-step program exceeded the probability of that same query being made by a comparison group of all other Bing users in the United States. Second, we examined symptom queries preceding queries on the 12-step program at time lags of 0-7 days, 7-14 days, and 14-30 days, where the probability of asking about a medical symptom was greater in the 30-day time window preceding 12-step program information-seeking as compared to all previous times that the symptom was queried. Results: In our sample of 11,784 persons, we found 10 medical symptoms that predicted AA information seeking and 9 symptoms that predicted NA information seeking. Of these symptoms, a substantial number could be categorized as nonsevere in nature. Moreover, when medical symptom persistence was examined across a 1-month time period, a substantial number of nonsevere, yet persistent, symptoms were identified. Conclusions: Our results suggest that many common or nonsevere medical symptoms and conditions motivate subsequent interest in AA and NA programs. In addition to highlighting severe long-term consequences, brief interventions could be restructured to highlight how increasing substance misuse can worsen discomfort from common medical symptoms in the short term, as well as how these worsening symptoms could exacerbate social embarrassment or decrease physical attractiveness. UR - https://www.jmir.org/2019/5/e10946/ UR - http://dx.doi.org/10.2196/10946 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066685 ID - info:doi/10.2196/10946 ER - TY - JOUR AU - Shah, Zubair AU - Martin, Paige AU - Coiera, Enrico AU - Mandl, D. Kenneth AU - Dunn, G. Adam PY - 2019/05/08 TI - Modeling Spatiotemporal Factors Associated With Sentiment on Twitter: Synthesis and Suggestions for Improving the Identification of Localized Deviations JO - J Med Internet Res SP - e12881 VL - 21 IS - 5 KW - text mining KW - social media KW - public health N2 - Background: Studies examining how sentiment on social media varies depending on timing and location appear to produce inconsistent results, making it hard to design systems that use sentiment to detect localized events for public health applications. Objective: The aim of this study was to measure how common timing and location confounders explain variation in sentiment on Twitter. Methods: Using a dataset of 16.54 million English-language tweets from 100 cities posted between July 13 and November 30, 2017, we estimated the positive and negative sentiment for each of the cities using a dictionary-based sentiment analysis and constructed models to explain the differences in sentiment using time of day, day of week, weather, city, and interaction type (conversations or broadcasting) as factors and found that all factors were independently associated with sentiment. Results: In the full multivariable model of positive (Pearson r in test data 0.236; 95% CI 0.231-0.241) and negative (Pearson r in test data 0.306; 95% CI 0.301-0.310) sentiment, the city and time of day explained more of the variance than weather and day of week. Models that account for these confounders produce a different distribution and ranking of important events compared with models that do not account for these confounders. Conclusions: In public health applications that aim to detect localized events by aggregating sentiment across populations of Twitter users, it is worthwhile accounting for baseline differences before looking for unexpected changes. UR - https://www.jmir.org/2019/5/e12881/ UR - http://dx.doi.org/10.2196/12881 UR - http://www.ncbi.nlm.nih.gov/pubmed/31344669 ID - info:doi/10.2196/12881 ER - TY - JOUR AU - Daughton, R. Ashlynn AU - Paul, J. Michael PY - 2019/05/13 TI - Identifying Protective Health Behaviors on Twitter: Observational Study of Travel Advisories and Zika Virus JO - J Med Internet Res SP - e13090 VL - 21 IS - 5 KW - social media KW - travel KW - behavior KW - communicable diseases KW - zika virus KW - public health KW - epidemiology KW - information science KW - travel-related illness N2 - Background: An estimated 3.9 billion individuals live in a location endemic for common mosquito-borne diseases. The emergence of Zika virus in South America in 2015 marked the largest known Zika outbreak and caused hundreds of thousands of infections. Internet data have shown promise in identifying human behaviors relevant for tracking and understanding other diseases. Objective: Using Twitter posts regarding the 2015-16 Zika virus outbreak, we sought to identify and describe considerations and self-disclosures of a specific behavior change relevant to the spread of disease?travel cancellation. If this type of behavior is identifiable in Twitter, this approach may provide an additional source of data for disease modeling. Methods: We combined keyword filtering and machine learning classification to identify first-person reactions to Zika in 29,386 English-language tweets in the context of travel, including considerations and reports of travel cancellation. We further explored demographic, network, and linguistic characteristics of users who change their behavior compared with control groups. Results: We found differences in the demographics, social networks, and linguistic patterns of 1567 individuals identified as changing or considering changing travel behavior in response to Zika as compared with a control sample of Twitter users. We found significant differences between geographic areas in the United States, significantly more discussion by women than men, and some evidence of differences in levels of exposure to Zika-related information. Conclusions: Our findings have implications for informing the ways in which public health organizations communicate with the public on social media, and the findings contribute to our understanding of the ways in which the public perceives and acts on risks of emerging infectious diseases. UR - https://www.jmir.org/2019/5/e13090/ UR - http://dx.doi.org/10.2196/13090 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094347 ID - info:doi/10.2196/13090 ER - TY - JOUR AU - Alvarez-Mon, Angel Miguel AU - Llavero-Valero, María AU - Sánchez-Bayona, Rodrigo AU - Pereira-Sanchez, Victor AU - Vallejo-Valdivielso, Maria AU - Monserrat, Jorge AU - Lahera, Guillermo AU - Asunsolo del Barco, Angel AU - Alvarez-Mon, Melchor PY - 2019/05/28 TI - Areas of Interest and Stigmatic Attitudes of the General Public in Five Relevant Medical Conditions: Thematic and Quantitative Analysis Using Twitter JO - J Med Internet Res SP - e14110 VL - 21 IS - 5 KW - social stigma KW - social media KW - psychosis KW - breast cancer KW - HIV KW - dementia KW - public opinion KW - diabetes N2 - Background: Twitter is an indicator of real-world performance, thus, is an appropriate arena to assess the social consideration and attitudes toward psychosis. Objective: The aim of this study was to perform a mixed-methods study of the content and key metrics of tweets referring to psychosis in comparison with tweets referring to control diseases (breast cancer, diabetes, Alzheimer, and human immunodeficiency virus). Methods: Each tweet?s content was rated as nonmedical (NM: testimonies, health care products, solidarity or awareness and misuse) or medical (M: included a reference to the illness?s diagnosis, treatment, prognosis, or prevention). NM tweets were classified as positive or pejorative. We assessed the appropriateness of the medical content. The number of retweets generated and the potential reach and impact of the hashtags analyzed was also investigated. Results: We analyzed a total of 15,443 tweets: 8055 classified as NM and 7287 as M. Psychosis-related tweets (PRT) had a significantly higher frequency of misuse 33.3% (212/636) vs 1.15% (853/7419; P<.001) and pejorative content 36.2% (231/636) vs 11.33% (840/7419; P<.001). The medical content of the PRT showed the highest scientific appropriateness 100% (391/391) vs 93.66% (6030/6439; P<.001) and had a higher frequency of content about disease prevention. The potential reach and impact of the tweets related to psychosis were low, but they had a high retweet-to-tweet ratio. Conclusions: We show a reduced number and a different pattern of contents in tweets about psychosis compared with control diseases. PRT showed a predominance of nonmedical content with increased frequencies of misuse and pejorative tone. However, the medical content of PRT showed high scientific appropriateness aimed toward prevention. UR - http://www.jmir.org/2019/5/e14110/ UR - http://dx.doi.org/10.2196/14110 UR - http://www.ncbi.nlm.nih.gov/pubmed/31140438 ID - info:doi/10.2196/14110 ER - TY - JOUR AU - Pereira-Sanchez, Victor AU - Alvarez-Mon, Angel Miguel AU - Asunsolo del Barco, Angel AU - Alvarez-Mon, Melchor AU - Teo, Alan PY - 2019/05/29 TI - Exploring the Extent of the Hikikomori Phenomenon on Twitter: Mixed Methods Study of Western Language Tweets JO - J Med Internet Res SP - e14167 VL - 21 IS - 5 KW - social isolation KW - loneliness KW - hikikomori KW - hidden youth KW - social media KW - Twitter KW - social withdrawal N2 - Background: Hikikomori is a severe form of social withdrawal, originally described in Japan but recently reported in other countries. Debate exists as to what extent hikikomori is viewed as a problem outside of the Japanese context. Objective: We aimed to explore perceptions about hikikomori outside Japan by analyzing Western language content from the popular social media platform, Twitter. Methods: We conducted a mixed methods analysis of all publicly available tweets using the hashtag #hikikomori between February 1 and August 16, 2018, in 5 Western languages (Catalan, English, French, Italian, and Spanish). Tweets were first classified as to whether they described hikikomori as a problem or a nonproblematic phenomenon. Tweets regarding hikikomori as a problem were then subclassified in terms of the type of problem (medical, social, or anecdotal) they referred to, and we marked if they referenced scientific publications or the presence of hikikomori in countries other than Japan. We also examined measures of interest in content related to hikikomori, including retweets, likes, and associated hashtags. Results: A total of 1042 tweets used #hikikomori, and 656 (62.3%) were included in the content analysis. Most of the included tweets were written in English (44.20%) and Italian (34.16%), and a majority (56.70%) discussed hikikomori as a problem. Tweets referencing scientific publications (3.96%) and hikikomori as present in countries other than Japan (13.57%) were less common. Tweets mentioning hikikomori outside Japan were statistically more likely to be retweeted (P=.01) and liked (P=.01) than those not mentioning it, whereas tweets with explicit scientific references were statistically more retweeted (P=.01) but not liked (P=.10) than those without that reference. Retweet and like figures were not statistically significantly different among other categories and subcategories. The most associated hashtags included references to Japan, mental health, and the youth. Conclusions: Hikikomori is a repeated word in non-Japanese Western languages on Twitter, suggesting the presence of hikikomori in countries outside Japan. Most tweets treat hikikomori as a problem, but the ways they post about it are highly heterogeneous. UR - http://www.jmir.org/2019/5/e14167/ UR - http://dx.doi.org/10.2196/14167 UR - http://www.ncbi.nlm.nih.gov/pubmed/31144665 ID - info:doi/10.2196/14167 ER - TY - JOUR AU - Ni, Zhaohui AU - Jin, Haijiao AU - Jiang, Gengru AU - Wang, Niansong AU - Peng, Ai AU - Guo, Zhiyong AU - Bai, Shoujun AU - Zhou, Rong AU - Lu, Jianrao AU - Wang, Yi AU - Li, Ying AU - Zhuang, Shougang AU - Yu, Chen AU - Deng, Yueyi AU - Jin, Huimin AU - Xu, Xudong AU - Zhang, Junli AU - Zhao, Junli AU - Yu, Xiuzhi AU - Wang, Xiaoxia AU - Zhang, Liming AU - Niu, Jianying AU - Liu, Kun AU - Bao, Xiaorong AU - Wang, Qin AU - Ma, Jun AU - Hu, Chun AU - Zang, Xiujuan AU - Yu, Qing PY - 2019/05/08 TI - A Telemedicine-Based Registration System for the Management of Renal Anemia in Patients on Maintenance Hemodialysis: Multicenter Study JO - J Med Internet Res SP - e13168 VL - 21 IS - 5 KW - telemedicine KW - dialysis registration system KW - hemodialysis KW - renal anemia KW - end-stage renal disease N2 - Background: Renal anemia is one of the most important complications in patients on maintenance hemodialysis (MHD). Telehealth-based dialysis registration systems have the advantage of real-time monitoring and have gradually been applied to the management of chronic diseases. Objective: The objective of our study was to evaluate the impact of a telehealth-based dialysis registration system on patients on MHD in terms of renal anemia control. Methods: The Red China project aimed to develop a dialysis registration system based on the WeChat mobile platform. Demographic and baseline laboratory parameters such as age, gender, primary disease, dialysis age, and baseline creatinine levels were recorded using this system. In addition, the hemoglobin and hematocrit levels were recorded monthly. The platform then generated a hemoglobin and hematocrit statistics report for each hemodialysis center monthly, including the detection rate, target rate, and distribution of hemoglobin and released it to physicians via the WeChat mobile phone app. The physicians were then able to treat the individual?s anemia appropriately by changing the doses of erythropoiesis-stimulating agents or iron use on the basis of this report. We analyzed the demographic and baseline laboratory parameters, detection rate, target rate, and average level and distribution of hemoglobin 28 months after the launch of the project. Results: A total of 8392 patients on MHD from 28 hemodialysis centers in Shanghai were enrolled from June 2015 to October 2017. The detection rate of hemoglobin increased from 54.18% to 73.61% (P<.001), the target rate of hemoglobin increased from 47.55% to 56.07% (P<.001), and the mean level of hemoglobin increased from 10.83 (SD 1. 60) g/dL to 11.07 (SD 1.60) g/dL (P<.001). In addition, the proportion of patients with hemoglobin levels ?11 g/dL but <13 g/dL increased from 40.40% to 47.48%. Conclusions: This telehealth-based dialysis registration system can provide timely reporting of the anemia status in patients on MHD, which may improve the awareness of anemia and the attention to and compliance with anemia monitoring. UR - https://www.jmir.org/2019/5/e13168/ UR - http://dx.doi.org/10.2196/13168 UR - http://www.ncbi.nlm.nih.gov/pubmed/31344676 ID - info:doi/10.2196/13168 ER - TY - JOUR AU - Lindauer, Allison AU - McKenzie, Glenise AU - LaFazia, David AU - McNeill, Loriann AU - Mincks, Kate AU - Spoden, Natasha AU - Myers, Marcella AU - Mattek, Nora AU - Teri, L. Linda PY - 2019/05/24 TI - Using Technology to Facilitate Fidelity Assessments: The Tele-STAR Caregiver Intervention JO - J Med Internet Res SP - e13599 VL - 21 IS - 5 KW - dementia KW - caregiving KW - fidelity N2 - Background: Families living with Alzheimer disease and related dementias have more access to support thanks to the development of effective telehealth-based programs. However, as technological science grows, so does the risk that these technology-based interventions will diverge from foundational protocols, diluting their efficacy. Strategies that ensure programs are delivered as intended, with fidelity to guiding protocols, are needed across the intervention spectrum?from development to wide-scale implementation. Few papers address fidelity in their technology-based work. Here, we present our translated telehealth intervention, Tele-STAR, with our fidelity findings. Objective: This study aimed to assess the preliminary efficacy of Tele-STAR on reducing family caregiver burden and depression. Across the implementation phases, we assessed the fidelity of a caregiver education intervention, STAR-C, as it was translated into a telehealth option (Tele-STAR). Methods: A total of 13 family caregivers consented to participate in an 8-week, videoconference-based intervention (Tele-STAR). Tele-STAR efficacy in reducing the affective burden of caregiving was assessed using pre- and postintervention paired t tests. Content experts assessed program fidelity by reviewing and rating Tele-STAR materials for adherence to the original STAR-C protocol. These experts assessed treatment fidelity by viewing videos of the intervention and rating adherence on a checklist. Results: Tele-STAR reduced caregiver burden and retained good program and treatment fidelity to STAR-C. Conclusions: We found Tele-STAR reduced caregiver burden and had good fidelity to the original protocol. Assessing fidelity is a complex process that requires incorporation of these procedures early in the research process. The technology used in this study facilitated the accrual of informative data about the fidelity of our translated intervention, Tele-STAR. UR - http://www.jmir.org/2019/5/e13599/ UR - http://dx.doi.org/10.2196/13599 UR - http://www.ncbi.nlm.nih.gov/pubmed/31127721 ID - info:doi/10.2196/13599 ER - TY - JOUR AU - Pham, My Tra AU - Abel, A. Gary AU - Gomez-Cano, Mayam AU - Lyratzopoulos, Georgios PY - 2019/05/02 TI - Predictors of Postal or Online Response Mode and Associations With Patient Experience and Satisfaction in the English Cancer Patient Experience Survey JO - J Med Internet Res SP - e11855 VL - 21 IS - 5 KW - cancer KW - patient survey KW - satisfaction KW - experience KW - online response KW - Web KW - internet N2 - Background: Patient experience surveys are important tools for improving the quality of cancer services, but the representativeness of responders is a concern. Increasingly, patient surveys that traditionally used postal questionnaires are incorporating an online response option. However, the characteristics and experience ratings of online responders are poorly understood. Objective: We sought to examine predictors of postal or online response mode, and associations with patient experience in the (English) Cancer Patient Experience Survey. Methods: We analyzed data from 71,186 patients with cancer recently treated in National Health Service hospitals who responded to the Cancer Patient Experience Survey 2015. Using logistic regression, we explored patient characteristics associated with greater probability of online response and whether, after adjustment for patient characteristics, the online response was associated with a more or less critical evaluation of cancer care compared to the postal response. Results: Of the 63,134 patients included in the analysis, 4635 (7.34%) responded online. In an adjusted analysis, male (women vs men: odds ratio [OR] 0.50, 95% confidence interval [CI] 0.46-0.54), younger (<55 vs 65-74 years: OR 3.49, 95% CI 3.21-3.80), least deprived (most vs least deprived quintile: OR 0.57, 95% CI 0.51-0.64), and nonwhite (nonwhite vs white ethnic group: OR 1.37, 95% CI 1.24-1.51) patients were more likely to respond online. Compared to postal responders, after adjustment for patient characteristics, online responders had a higher likelihood of reporting an overall satisfied experience of care (OR 1.24, 95% CI 1.16-1.32). For 34 of 49 other items, online responders more frequently reported a less than positive experience of care (8 reached statistical significance), and the associations were positive for the remaining 15 of 49 items (2 reached statistical significance). Conclusions: In the context of a national survey of patients with cancer, online and postal responders tend to differ in their characteristics and rating of satisfaction. Associations between online response and reported experience were generally small and mostly nonsignificant, but with a tendency toward less than positive ratings, although not consistently. Whether the observed associations between response mode and reported experience were causal needs to be examined using experimental survey designs. UR - https://www.jmir.org/2019/5/e11855/ UR - http://dx.doi.org/10.2196/11855 UR - http://www.ncbi.nlm.nih.gov/pubmed/31045503 ID - info:doi/10.2196/11855 ER - TY - JOUR AU - Mehmood, Amber AU - Taber, Niloufer AU - Bachani, M. Abdulgafoor AU - Gupta, Shivam AU - Paichadze, Nino AU - Hyder, A. Adnan PY - 2019/05/28 TI - Paper Versus Digital Data Collection for Road Safety Risk Factors: Reliability Comparative Analysis From Three Cities in Low- and Middle-Income Countries JO - J Med Internet Res SP - e13222 VL - 21 IS - 5 KW - information technology KW - public health informatics KW - mHealth KW - risk factors KW - population surveillance N2 - Background: Rapid advances in mobile technologies and applications and the continued growth in digital network coverage have the potential to transform data collection in low- and middle-income countries. A common perception is that digital data collection (DDC) is faster and quickly adaptable. Objective: The objective of this study was to test whether DDC is faster and more adaptable in a roadside environment. We conducted a reliability study comparing digital versus paper data collection in 3 cities in Ghana, Vietnam, and Indonesia observing road safety risk factors in real time. Methods: Roadside observation of helmet use among motorcycle passengers, seat belt use among 4-wheeler passengers, and speeding was conducted in Accra, Ghana; Ho Chi Minh City (HCMC), Vietnam; and Bandung, Indonesia. Two independent data collection teams were deployed to the same sites on the same dates and times, one using a paper-based data collection tool and the other using a digital tool. All research assistants were trained on paper-based data collection and DDC. A head-to-head analysis was conducted to compare the volume of observations, as well as the prevalence of each risk factor. Correlations (r) for continuous variables and kappa for categorical variables are reported with their level of statistical significance. Results: In Accra, there were 119 observation periods (90-min each) identical by date, time, and location during the helmet and seat belt use risk factor data collection and 118 identical periods observing speeding prevalence. In Bandung, there were 150 observation periods common to digital and paper data collection methods, whereas in HCMC, there were 77 matching observation periods for helmet use, 82 for seat belt use, and 84 for speeding. Data collectors using paper tools were more productive than their DDC counterparts during the study. The highest mean volume per session was recorded for speeding, with Bandung recording over 1000 vehicles on paper (paper: mean 1092 [SD 435]; digital: mean 807 [SD 261]); whereas the lowest volume per session was from HCMC for seat belts (paper: mean 52 [SD 28]; digital: mean 62 [SD 30]). Accra and Bandung showed good-to-high correlation for all 3 risk factors (r=0.52 to 0.96), with higher reliability in speeding and helmet use over seat belt use; HCMC showed high reliability for speeding (r=0.99) but lower reliability for helmet and seat belt use (r=0.08 to 0.32). The reported prevalence of risk factors was comparable in all cities regardless of the data collection method. Conclusions: DDC was convenient and reliable during roadside observational data collection. There was some site-related variability in implementing DDC methods, and generally the productivity was higher using the more familiar paper-based method. Even with low correlations between digital and paper data collection methods, the overall reported population prevalence was similar for all risk factors. UR - http://www.jmir.org/2019/5/e13222/ UR - http://dx.doi.org/10.2196/13222 UR - http://www.ncbi.nlm.nih.gov/pubmed/31140431 ID - info:doi/10.2196/13222 ER - TY - JOUR AU - Din, Naz Hena AU - McDaniels-Davidson, Corinne AU - Nodora, Jesse AU - Madanat, Hala PY - 2019/05/14 TI - Profiles of a Health Information?Seeking Population and the Current Digital Divide: Cross-Sectional Analysis of the 2015-2016 California Health Interview Survey JO - J Med Internet Res SP - e11931 VL - 21 IS - 5 KW - internet KW - digital divide KW - health information KW - patient portals KW - online health information seeking KW - eHealth N2 - Background: Internet use for health information is important, given the rise of electronic health (eHealth) that integrates technology into health care. Despite the perceived widespread use of the internet, a persistent ?digital divide? exists in which many individuals have ready access to the internet and others do not. To date, most published reports have compared characteristics of internet users seeking health information vs nonusers. However, there is little understanding of the differences between internet users seeking health information online and users who do not seek such information online. Understanding these differences could enable targeted outreach for health interventions and promotion of eHealth technologies. Objective: This study aims to assess population-level characteristics associated with different types of internet use, particularly for seeking online health information. Methods: The 2015-2016 California Health Interview Survey datasets were used for this study. Internet use was classified as never used the internet (Never use), ever used the internet but not to search for health information in the last 12 months (Use not for health), and ever used the internet and have used it to search for health information in the last 12 months (Use for health). Weighted multinomial logistic regression was used to assess sociodemographic and health characteristics associated with types of internet use. Findings are reported as odds ratios (ORs) with 95% CIs. Results: Among 42,087 participants (weighted sample of 29,236,426), 19% reported Never Use of the internet, 27.9% reported Use not for health, and 53.1% reported Use for health. Compared to Never Use individuals, Use for health individuals were more likely to be younger (OR: 0.1, 95% CI 0.1-0.2 for ?60 years vs <60 years), female (OR: 1.6, 95% CI 1.3-1.9 compared to males), and non-Hispanic white (OR: 0.54, 95% CI 0.4-0.7 for Latinos and OR: 0.2, 95% CI 0.2-0.4 for African Americans) and have a higher socioeconomic status (>400% of Federal Poverty Guidelines; OR: 1.3, 95% CI 1.4-2.4). Overall, characteristics for the Use not for health and Use for health groups were similar, except for those with lower levels of education and respondents not having visited a physician in the last year. For these two characteristics, the Use not for health group was more similar to the Never Use group. Conclusions: Our findings indicate that a digital divide characterized by sociodemographic and health information exists across three types of users. Our results are in line with those of previous studies on the divide, specifically with regard to disparities in use and access related to age, race/ethnicity, and socioeconomic status. Disparities in online health-seeking behavior may reflect existing disparities in health care access extending into a new era of health technology. These findings support the need for interventions to target internet access and health literacy among Never Use and Use not for health groups. UR - https://www.jmir.org/2019/5/e11931/ UR - http://dx.doi.org/10.2196/11931 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094350 ID - info:doi/10.2196/11931 ER - TY - JOUR AU - Paslakis, Georgios AU - Fischer-Jacobs, Josefine AU - Pape, Lars AU - Schiffer, Mario AU - Gertges, Raoul AU - Tegtbur, Uwe AU - Zimmermann, Tanja AU - Nöhre, Mariel AU - de Zwaan, Martina PY - 2019/05/16 TI - Assessment of Use and Preferences Regarding Internet-Based Health Care Delivery: Cross-Sectional Questionnaire Study JO - J Med Internet Res SP - e12416 VL - 21 IS - 5 KW - telemedicine KW - health care delivery KW - internet KW - eHealth KW - teleconference KW - electronic medical records KW - online psychotherapy N2 - Background: There has been an incremental increase in the use of technology in health care delivery. Feasibility, acceptability, and efficacy of interventions based on internet technologies are supported by a growing body of evidence. Objective: The aim of this study was to investigate use and preferences in the general adult population in Germany for remote, internet-based interaction (eg, email, videoconferencing, electronic medical records, apps). Methods: A nationwide cross-sectional questionnaire survey in adults that was representative in terms of age, sex and educational level was carried out. Results: A total of 22.16% (538/2428) of survey participants reported not using the internet for work or private use. The nonuser phenotype can be described as being older, having lower educational and income status, and living in less populated areas. The majority of participants within the cohort of internet users reported that they would not consider using electronic medical records (973/1849, 52.62%), apps (988/1854, 53.29%), or emails to report symptoms (1040/1838, 56.58%); teleconference with one (1185/1852, 63.98%) or more experts (1239/1853, 66.86%); or participate in video psychotherapy (1476/1853, 79.65%) for the purpose of medical consultation or treatment. Older age and lower educational level were the most robust predictors of assumed future denial of use. Conclusions: Our results point toward low use and preference rates among the general population for the use of telemedicine. It also seems that those who might benefit from telemedical interventions the most, are, in fact, those who are most hesitating. These low use and preference rates of eHealth should be considered prior to designing and providing future telemedical care, supporting the need for easy-to-use, data secure solutions. UR - http://www.jmir.org/2019/5/e12416/ UR - http://dx.doi.org/10.2196/12416 UR - http://www.ncbi.nlm.nih.gov/pubmed/31099338 ID - info:doi/10.2196/12416 ER - TY - JOUR AU - Hansen, Helen Anne AU - Bradway, Meghan AU - Broz, Jan AU - Claudi, Tor AU - Henriksen, Øystein AU - Wangberg, C. Silje AU - Årsand, Eirik PY - 2019/05/29 TI - Inequalities in the Use of eHealth Between Socioeconomic Groups Among Patients With Type 1 and Type 2 Diabetes: Cross-Sectional Study JO - J Med Internet Res SP - e13615 VL - 21 IS - 5 KW - inequalities KW - eHealth KW - internet KW - health care utilization KW - cross-sectional study KW - diabetes mellitus, type 1 KW - diabetes mellitus, type 2 KW - education KW - income KW - Norway N2 - Background: The prevalence of diabetes and the use of electronic health (eHealth) are increasing. People with diabetes need frequent monitoring and follow-up of health parameters, and eHealth services can be highly valuable. However, little is known about the use of eHealth in different socioeconomic groups among people with diabetes. Objective: The aim of this study was to investigate the use of 4 different eHealth platforms (apps, search engines, video services, and social media sites) and the association with socioeconomic status (SES) among people diagnosed with type 1 and type 2 diabetes mellitus (T1D and T2D, respectively). Methods: We used email survey data from 1250 members of the Norwegian Diabetes Association (aged 18-89 years), collected in 2018. Eligible for analyses were the 1063 respondents having T1D (n=523) and T2D (n=545). 5 respondents reported having both diabetes types and thus entered into both groups. Using descriptive statistics, we estimated the use of the different types of eHealth. By logistic regressions, we studied the associations between the use of these types of eHealth and SES (education and household income), adjusted for gender, age, and self-rated health. Results: We found that 87.0% (447/514) of people with T1D and 77.7% (421/542) of people with T2D had used 1 or more forms of eHealth sometimes or often during the previous year. The proportion of people using search engines was the largest in both diagnostic groups, followed by apps, social media, and video services. We found a strong association between a high level of education and the use of search engines, whereas there were no educational differences for the use of apps, social media, or video services. In both diagnostic groups, high income was associated with the use of apps. In people with T1D, lower income was associated with the use of video services. Conclusions: This paper indicates a digital divide among people with diabetes in Norway, with consequences that may contribute to sustaining and shaping inequalities in health outcomes. The strong relationship between higher education and the use of search engines, along with the finding that the use of apps, social media, and video services was not associated with education, indicates that adequate communication strategies for audiences with varying education levels should be a focus in future efforts to reduce inequalities in health outcomes. UR - http://www.jmir.org/2019/5/e13615/ UR - http://dx.doi.org/10.2196/13615 UR - http://www.ncbi.nlm.nih.gov/pubmed/31144669 ID - info:doi/10.2196/13615 ER - TY - JOUR AU - Li, HongMin AU - Xu, Jin AU - Li, Lingui AU - Meng, Qingyue PY - 2019/05/31 TI - Health-Related Internet Use in Hard-to-Reach Populations: Empirical Findings From a Survey in a Remote and Mountainous Province in China JO - J Med Internet Res SP - e12693 VL - 21 IS - 5 KW - eHealth KW - rural population KW - cross-sectional survey KW - China N2 - Background: The expanding use of the internet contributes to more effective searches for health-related information and opens up opportunities for direct Web-based communication with health care professionals. However, little is known about how users? characteristics on the demand side influence health-related internet use, especially in remote and rural areas within developing countries. The absence of accurate estimates of users? characteristics and their impact on adaptations of health care services in developing countries constrains focused policy-centered discussions and the design of appropriate policies. Objective: The aim of this study was to assess the prevalence of health-related internet use and to identify its determinants in a remote province in China. Methods: We conducted a cross-sectional survey in June and July of 2018 in Ningxia, located in northwestern China. Rural households were selected by multistage random sampling, and households? key members were interviewed face-to-face at the respondents? home. Dependent variables were whether the households use Web health services or not. Independent variables were chosen based on the Andersen behavioral model. Sociodemographic characteristics were compared between households that used health-related Web services with nonusers. We applied logistic regression models to evaluate multivariate associations between respondents? characteristics and their usage of Web-based health services and obtained odds ratios with 95% CI. Results: A total of 1354 respondents from rural households were interviewed, of whom 707 (52.22%) were men. The mean age of the respondents was 44.54 years (SD 10.22). Almost half of the surveyed households (640/1354, 47.27%) reported using 1 or more Web-based health care services, whereas 37.8% (502/1354) reported using the internet to obtain health-related information, 15.51% (210/1354) used the internet to communicate with professionals about health issues, and 7.24% (98/1354) had engaged in Web-based consultations in the last year. After controlling for potential confounders, households engaged in health-related internet use were found to be wealthier, have higher health demands, and have less geographic access to high-quality health care compared with other households. Conclusions: The internet has become a major health information resource in rural Ningxia. Social structures, family enabling factors, health needs, and characteristics relating to health care access were significant predictors of households? health-related internet use in rural and remote areas in China. Those who belong to older age groups, have low income, and whose education levels do not extend beyond primary school education are significantly less likely to use Web-based health care services and to benefit from Web-based health care programs. A need for continued collaborative efforts involving multiple stakeholders, including communities, Web-based and other health care providers, family members, and the government is needed. UR - http://www.jmir.org/2019/5/e12693/ UR - http://dx.doi.org/10.2196/12693 UR - http://www.ncbi.nlm.nih.gov/pubmed/31152526 ID - info:doi/10.2196/12693 ER - TY - JOUR AU - McKay, Rana AU - Mills, Hannah AU - Werner, Lillian AU - Choudhury, Atish AU - Choueiri, Toni AU - Jacobus, Susanna AU - Pace, Amanda AU - Polacek, Laura AU - Pomerantz, Mark AU - Prisby, Judith AU - Sweeney, Christopher AU - Walsh, Meghara AU - Taplin, Mary-Ellen PY - 2019/05/02 TI - Evaluating a Video-Based, Personalized Webpage in Genitourinary Oncology Clinical Trials: A Phase 2 Randomized Trial JO - J Med Internet Res SP - e12044 VL - 21 IS - 5 KW - cancer KW - prostatic neoplasms KW - kidney neoplasms KW - clinical trial KW - instructional films and videos KW - education N2 - Background: The pace of drug discovery and approvals has led to expanding treatments for cancer patients. Although extensive research exists regarding barriers to enrollment in oncology clinical trials, there are limited studies evaluating processes to optimize patient education, oral anticancer therapy administration, and adherence for patients enrolled in clinical trials. In this study, we assess the feasibility of a video-based, personalized webpage for patients enrolled in genitourinary oncology clinical trials involving 1 or more oral anticancer therapy. Objective: The primary objective of this trial was to assess the differences in the number of patient-initiated violations in the intervention arm compared with a control arm over 4 treatment cycles. Secondary objectives included patient satisfaction, frequently asked questions by patients on the intervention arm, patient-initiated calls to study team members, and patient-reported stress levels. Methods: Eligible patients enrolling on a therapeutic clinical trial for a genitourinary malignancy were randomized 2:1 to the intervention arm or control arm. Patients randomized to the intervention arm received access to a video-based, personalized webpage, which included videos of patients? own clinic encounters with their providers, instructional videos on medication administration and side effects, and electronic versions of educational documents. Results: A total of 99 patients were enrolled (89 were evaluable; 66 completed 4 cycles). In total, 71% (40/56) of patients in the intervention arm had 1 or more patient-initiated violation compared with 70% (23/33) in the control arm. There was no difference in the total number of violations across 4 cycles between the 2 arms (estimate=?0.0939, 95% CI?0.6295 to 0.4418, P value=.73). Median baseline satisfaction scores for the intervention and control arms were 72 and 73, respectively, indicating high levels of patient satisfaction in both arms. Median baseline patient-reported stress levels were 10 and 13 for the intervention and control arms, respectively, indicating low stress levels in both arms at baseline. Conclusions: This study is among the first to evaluate a video-based, personalized webpage that provides patients with educational videos and video recordings of clinical trial appointments. Despite not meeting the primary endpoint of reduced patient-initiated violations, this study demonstrates the feasibility of a video-based, personalized webpage in clinical trials. Future research assessing this tool might be better suited for realms outside of clinical trials and might consider the use of an endpoint that assesses patient-reported outcomes directly. A major limitation of this study was the lack of prior data for estimating the null hypothesis in this population. UR - https://www.jmir.org/2019/5/e12044/ UR - http://dx.doi.org/10.2196/12044 UR - http://www.ncbi.nlm.nih.gov/pubmed/31045501 ID - info:doi/10.2196/12044 ER - TY - JOUR AU - Alvarez-Lopez, Fernando AU - Maina, Fabián Marcelo AU - Saigí-Rubió, Francesc PY - 2019/05/03 TI - Use of Commercial Off-The-Shelf Devices for the Detection of Manual Gestures in Surgery: Systematic Literature Review JO - J Med Internet Res SP - e11925 VL - 21 IS - 5 KW - minimally invasive surgery KW - user-computer interface KW - operating room KW - education, medical KW - computer-assisted surgery N2 - Background: The increasingly pervasive presence of technology in the operating room raises the need to study the interaction between the surgeon and computer system. A new generation of tools known as commercial off-the-shelf (COTS) devices enabling touchless gesture?based human-computer interaction is currently being explored as a solution in surgical environments. Objective: The aim of this systematic literature review was to provide an account of the state of the art of COTS devices in the detection of manual gestures in surgery and to identify their use as a simulation tool for motor skills teaching in minimally invasive surgery (MIS). Methods: For this systematic literature review, a search was conducted in PubMed, Excerpta Medica dataBASE, ScienceDirect, Espacenet, OpenGrey, and the Institute of Electrical and Electronics Engineers databases. Articles published between January 2000 and December 2017 on the use of COTS devices for gesture detection in surgical environments and in simulation for surgical skills learning in MIS were evaluated and selected. Results: A total of 3180 studies were identified, 86 of which met the search selection criteria. Microsoft Kinect (Microsoft Corp) and the Leap Motion Controller (Leap Motion Inc) were the most widely used COTS devices. The most common intervention was image manipulation in surgical and interventional radiology environments, followed by interaction with virtual reality environments for educational or interventional purposes. The possibility of using this technology to develop portable low-cost simulators for skills learning in MIS was also examined. As most of the articles identified in this systematic review were proof-of-concept or prototype user testing and feasibility testing studies, we concluded that the field was still in the exploratory phase in areas requiring touchless manipulation within environments and settings that must adhere to asepsis and antisepsis protocols, such as angiography suites and operating rooms. Conclusions: COTS devices applied to hand and instrument gesture?based interfaces in the field of simulation for skills learning and training in MIS could open up a promising field to achieve ubiquitous training and presurgical warm up. UR - https://www.jmir.org/2019/5/e11925/ UR - http://dx.doi.org/10.2196/11925 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066679 ID - info:doi/10.2196/11925 ER - TY - JOUR AU - Holter, TS Marianne AU - Johansen, B. Ayna AU - Ness, Ottar AU - Brinkmann, Svend AU - Høybye, T. Mette AU - Brendryen, Håvar PY - 2019/05/06 TI - Qualitative Interview Studies of Working Mechanisms in Electronic Health: Tools to Enhance Study Quality JO - J Med Internet Res SP - e10354 VL - 21 IS - 5 KW - telemedicine KW - eHealth KW - mobile health KW - telehealth KW - mHealth KW - interviews as topic KW - health care evaluation mechanisms KW - data collection UR - https://www.jmir.org/2019/5/e10354/ UR - http://dx.doi.org/10.2196/10354 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066683 ID - info:doi/10.2196/10354 ER - TY - JOUR AU - Liu, Xingyun AU - Liu, Xiaoqian AU - Sun, Jiumo AU - Yu, Xiaonan Nancy AU - Sun, Bingli AU - Li, Qing AU - Zhu, Tingshao PY - 2019/05/08 TI - Proactive Suicide Prevention Online (PSPO): Machine Identification and Crisis Management for Chinese Social Media Users With Suicidal Thoughts and Behaviors JO - J Med Internet Res SP - e11705 VL - 21 IS - 5 KW - suicide identification KW - crisis management KW - machine learning KW - microblog direct message KW - social network KW - Chinese young people N2 - Background: Suicide is a great public health challenge. Two hundred million people attempt suicide in China annually. Existing suicide prevention programs require the help-seeking initiative of suicidal individuals, but many of them have a low motivation to seek the required help. We propose that a proactive and targeted suicide prevention strategy can prompt more people with suicidal thoughts and behaviors to seek help. Objective: The goal of the research was to test the feasibility and acceptability of Proactive Suicide Prevention Online (PSPO), a new approach based on social media that combines proactive identification of suicide-prone individuals with specialized crisis management. Methods: We first located a microblog group online. Their comments on a suicide note were analyzed by experts to provide a training set for the machine learning models for suicide identification. The best-performing model was used to automatically identify posts that suggested suicidal thoughts and behaviors. Next, a microblog direct message containing crisis management information, including measures that covered suicide-related issues, depression, help-seeking behavior and an acceptability test, was sent to users who had been identified by the model to be at risk of suicide. For those who replied to the message, trained counselors provided tailored crisis management. The Simplified Chinese Linguistic Inquiry and Word Count was also used to analyze the users? psycholinguistic texts in 1-month time slots prior to and postconsultation. Results: A total of 27,007 comments made in April 2017 were analyzed. Among these, 2786 (10.32%) were classified as indicative of suicidal thoughts and behaviors. The performance of the detection model was good, with high precision (.86), recall (.78), F-measure (.86), and accuracy (.88). Between July 3, 2017, and July 3, 2018, we sent out a total of 24,727 direct messages to 12,486 social media users, and 5542 (44.39%) responded. Over one-third of the users who were contacted completed the questionnaires included in the direct message. Of the valid responses, 89.73% (1259/1403) reported suicidal ideation, but more than half (725/1403, 51.67%) reported that they had not sought help. The 9-Item Patient Health Questionnaire (PHQ-9) mean score was 17.40 (SD 5.98). More than two-thirds of the participants (968/1403, 69.00%) thought the PSPO approach was acceptable. Moreover, 2321 users replied to the direct message. In a comparison of the frequency of word usage in their microblog posts 1-month before and after the consultation, we found that the frequency of death-oriented words significantly declined while the frequency of future-oriented words significantly increased. Conclusions: The PSPO model is suitable for identifying populations that are at risk of suicide. When followed up with proactive crisis management, it may be a useful supplement to existing prevention programs because it has the potential to increase the accessibility of antisuicide information to people with suicidal thoughts and behaviors but a low motivation to seek help. UR - https://www.jmir.org/2019/5/e11705/ UR - http://dx.doi.org/10.2196/11705 UR - http://www.ncbi.nlm.nih.gov/pubmed/31344675 ID - info:doi/10.2196/11705 ER - TY - JOUR AU - Kuipers, Esther AU - Poot, C. Charlotte AU - Wensing, Michel AU - Chavannes, H. Niels AU - de Smet, AGM Peter AU - Teichert, Martina PY - 2019/05/30 TI - Self-Management Maintenance Inhalation Therapy With eHealth (SELFIE): Observational Study on the Use of an Electronic Monitoring Device in Respiratory Patient Care and Research JO - J Med Internet Res SP - e13551 VL - 21 IS - 5 KW - eHealth KW - pharmacy KW - inhalation therapy KW - asthma KW - COPD KW - pharmacy practice research N2 - Background: Electronic inhalation monitoring devices (EIMDs) are available to remind patients with respiratory diseases to take their medication and register inhalations for feedback to patients and health care providers as well as for data collection in research settings. Objective: This study aimed to assess the validity as well as the patient-reported usability and acceptability of an EIMD. Methods: This observational study planned to include 21 community pharmacies in the Netherlands. Patient-reported inhalations were collected and compared to EIMD registrations to evaluate the positive predictive value of these registrations as actual patient inhalations. Patients received questionnaires on their experiences and acceptance. Results: A convenience sample of 32 patients was included from across 18 pharmacies, and 932 medication doses were validated. Of these, 796 registrations matched with patient-reported use (true-positive, 85.4%), and 33 inhalation registrations did not match with patient-reported use (false-positive, 3.5%). The positive predictive value was 96.0%, and 103 patient-reported inhalations were not recorded in the database (false-negative, 11.1%). Overall, patients considered the EIMD to be acceptable and easy to use, but many hesitated to continue its use. Reminders and motivational messages were not appreciated by all users, and more user-tailored features in the app were desired. Conclusions: Patients? interaction with the device in real-world settings is critical for objective measurement of medication adherence. The positive predictive value of this EIMD was found to be acceptable. However, patients reported false-negative registrations and a desire to include more user-tailored features to increase the usability and acceptability of the EIMD. UR - http://www.jmir.org/2019/5/e13551/ UR - http://dx.doi.org/10.2196/13551 UR - http://www.ncbi.nlm.nih.gov/pubmed/31148542 ID - info:doi/10.2196/13551 ER - TY - JOUR AU - Walker, Jan AU - Leveille, Suzanne AU - Bell, Sigall AU - Chimowitz, Hannah AU - Dong, Zhiyong AU - Elmore, G. Joann AU - Fernandez, Leonor AU - Fossa, Alan AU - Gerard, Macda AU - Fitzgerald, Patricia AU - Harcourt, Kendall AU - Jackson, Sara AU - Payne, H. Thomas AU - Perez, Jocelyn AU - Shucard, Hannah AU - Stametz, Rebecca AU - DesRoches, Catherine AU - Delbanco, Tom PY - 2019/05/06 TI - OpenNotes After 7 Years: Patient Experiences With Ongoing Access to Their Clinicians? Outpatient Visit Notes JO - J Med Internet Res SP - e13876 VL - 21 IS - 5 KW - patient portal KW - physician-patient relations KW - electronic health record KW - health care survey KW - patient participation N2 - Background: Following a 2010-2011 pilot intervention in which a limited sample of primary care doctors offered their patients secure Web-based portal access to their office visit notes, the participating sites expanded OpenNotes to nearly all clinicians in primary care, medical, and surgical specialty practices. Objective: The aim of this study was to examine the ongoing experiences and perceptions of patients who read ambulatory visit notes written by a broad range of doctors, nurses, and other clinicians. Methods: A total of 3 large US health systems in Boston, Seattle, and rural Pennsylvania conducted a Web-based survey of adult patients who used portal accounts and had at least 1 visit note available in a recent 12-month period. The main outcome measures included patient-reported behaviors and their perceptions concerning benefits versus risks. Results: Among 136,815 patients who received invitations, 21.68% (29,656/136,815) responded. Of the 28,782 patient respondents, 62.82% (18,081/28,782) were female, 72.90% (20,982/28,782) were aged 45 years or older, 76.94% (22,146/28,782) were white, and 14.30% (4115/28,782) reported fair or poor health. Among the 22,947 who reported reading 1 or more notes, 3 out of 4 reported reading them for 1 year or longer, half reported reading at least 4 notes, and 37.74% (8588/22,753) shared a note with someone else. Patients rated note reading as very important for helping take care of their health (16,354/22,520, 72.62%), feeling in control of their care (15,726/22,515, 69.85%), and remembering the plan of care (14,821/22,516, 65.82%). Few were very confused (737/22,304, 3.3%) or more worried (1078/22,303, 4.83%) after reading notes. About a third reported being encouraged by their clinicians to read notes and a third told their clinicians they had read them. Less educated, nonwhite, older, and Hispanic patients, and individuals who usually did not speak English at home, were those most likely to report major benefits from note reading. Nearly all respondents (22,593/22,947, 98.46%) thought Web-based access to visit notes a good idea, and 62.38% (13,427/21,525) rated this practice as very important for choosing a future provider. Conclusions: In this first large-scale survey of patient experiences with a broad range of clinicians working in practices in which shared notes are well established, patients find note reading very important for their health management and share their notes frequently with others. Patients are rarely troubled by what they read, and those traditionally underserved in the United States report particular benefit. However, fewer than half of clinicians and patients actively address their shared notes during visits. As the practice continues to spread rapidly in the United States and internationally, our findings indicate that OpenNotes brings benefits to patients that largely outweigh the risks. UR - https://www.jmir.org/2019/5/e13876/ UR - http://dx.doi.org/10.2196/13876 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066717 ID - info:doi/10.2196/13876 ER - TY - JOUR AU - Anderberg, Peter AU - Eivazzadeh, Shahryar AU - Berglund, Sanmartin Johan PY - 2019/05/23 TI - A Novel Instrument for Measuring Older People?s Attitudes Toward Technology (TechPH): Development and Validation JO - J Med Internet Res SP - e13951 VL - 21 IS - 5 KW - technophilia KW - aging KW - internet KW - health technology KW - eHealth N2 - Background: The use of health technology by older people is coming increasingly in focus with the demographic changes. Health information technology is generally perceived as an important factor in enabling increased quality of life and reducing the cost of care for this group. Age-appropriate design and facilitation of technology adoption are important to ensure functionality and removal of various barriers to usage. Development of assessment tools and instruments for evaluating older persons? technology adoption and usage as well as measuring the effects of the interventions are of high priority. Both usability and acceptance of a specific technology or service are important factors in evaluating the impact of a health information technology intervention. Psychometric measures are seldom included in evaluations of health technology. However, basic attitudes and sentiments toward technology (eg, technophilia) could be argued to influence both the level of satisfaction with the technology itself as well as the perception of the health intervention outcome. Objective: The purpose of this study is to develop a reduced and refined instrument for measuring older people's attitudes and enthusiasm for technology based on relevant existing instruments for measuring technophilia. A requirement of the new instrument is that it should be short and simple to make it usable for evaluation of health technology for older people. Methods: Initial items for the TechPH questionnaire were drawn from a content analysis of relevant existing technophilia measure instruments. An exploratory factor analysis was conducted in a random selection of persons aged 65 years or older (N=374) on eight initial items. The scale was reduced to six items, and the internal consistency and reliability of the scale were examined. Further validation was made by a confirmatory factor analysis (CFA). Results: The exploratory factor analysis resulted in two factors. These factors were analyzed and labeled techEnthusiasm and techAnxiety. They demonstrated relatively good internal consistency (Cronbach alpha=.72 and .68, respectively). The factors were confirmed in the CFA and showed good model fit (?28=21.2, ?2/df=2.65, comparative fit index=0.97, adjusted goodness-of-fit index=0.95, root mean square error of approximation=0.067, standardized root mean square residual=0.036). Conclusions: The construed TechPH score showed expected relations to external real-world criteria, and the two factors showed interesting internal relations. Different technophilia personality traits distinguish clusters with different behaviors of adaptation as well as usage of new technology. Whether there is an independent association with the TechPH score against outcomes in health technology projects needs to be shown in further studies. The instrument must also be validated in different contexts, such as other countries. UR - http://www.jmir.org/2019/5/e13951/ UR - http://dx.doi.org/10.2196/13951 UR - http://www.ncbi.nlm.nih.gov/pubmed/31124467 ID - info:doi/10.2196/13951 ER - TY - JOUR AU - Liaw, Ying Sok AU - Tan, Kiat Khoon AU - Wu, Ting Ling AU - Tan, Chee Seng AU - Choo, Hyekyung AU - Yap, John AU - Lim, Mui Sok AU - Wong, Lilian AU - Ignacio, Jeanette PY - 2019/05/28 TI - Finding the Right Blend of Technologically Enhanced Learning Environments: Randomized Controlled Study of the Effect of Instructional Sequences on Interprofessional Learning JO - J Med Internet Res SP - e12537 VL - 21 IS - 5 KW - blended learning KW - constructivism KW - instructional sequence KW - interprofessional learning KW - simulation KW - technologically-enhanced learning KW - virtual reality KW - web-based instruction N2 - Background: With the availability and capabilities of varied technologically enhanced learning activities, the blended learning approach has become increasingly popular in interprofessional education. The combined use of different technologically enhanced learning activities has not been fully examined, particularly to determine the effects of instructional sequences for effective learning outcomes. Objective: The objective of this study was to investigate whether the instructional sequences of a blended learning approach can improve students? learning outcomes on interprofessional competencies. Methods: A randomized controlled study was conducted with 40 interprofessional health care teams. These teams undertook three technologically enhanced learning activities?Web-based instruction (WI), virtual reality (VR), and simulation exercise (SE)?after random assignment to three groups based on three different instructional sequences (WI-VR-SE, WI-SE-VR, and SE-WI-VR). Pretests and posttests were conducted to evaluate the students? learning outcomes on interprofessional competencies. Results: A total of 198 participants from the three groups completed the questionnaires. All three groups reported significant improvement in their levels of self-efficacy (P<.05) and attitudes (P<.001) toward interprofessional team care about 1 month after the interprofessional learning activity. Although no significant difference was found (P=.06) between the WI-VR-SE and WI-SE-VR groups in the self-efficacy posttests, participants in the SE-WI-VR group reported significantly lower (P<.05) posttest scores than those in the WI-SE-VR group. The majority of the participants (137/198, 69.1%) selected the instructional sequence ?WI-VR-SE? as their top preference. Conclusions: This study shows that the instructional sequence of a blended learning approach can have a significant impact on students? learning outcomes. The learning of concepts from WI followed by problem-solving activity in the SE was found to be a more effective learning sequence than the reverse sequence. We recommend that future studies focus on scaffolding students? learning when planning instructional sequences for technologically enhanced learning activities within blended learning environments. UR - http://www.jmir.org/2019/5/e12537/ UR - http://dx.doi.org/10.2196/12537 UR - http://www.ncbi.nlm.nih.gov/pubmed/31140432 ID - info:doi/10.2196/12537 ER - TY - JOUR AU - Dorst, Taylor Marian AU - Anders, H. Shilo AU - Chennupati, Sai AU - Chen, Qingxia AU - Purcell Jackson, Gretchen PY - 2019/05/09 TI - Health Information Technologies in the Support Systems of Pregnant Women and Their Caregivers: Mixed-Methods Study JO - J Med Internet Res SP - e10865 VL - 21 IS - 5 KW - pregnancy KW - social networks KW - social media KW - health information technology KW - caregivers KW - life stress N2 - Background: The quality and quantity of families? support systems during pregnancy can affect maternal and fetal outcomes. The support systems of expecting families can include many elements, such as family members, friends, and work or community groups. Emerging health information technologies (eg, social media, internet websites, and mobile apps) provide new resources for pregnant families to augment their support systems and to fill information gaps. Objective: This study sought to determine the number and nature of the components of the support systems of pregnant women and their caregivers (eg, family members) and the role of health information technologies in these support systems. We examined the differences between pregnant women?s support systems and those of their caregivers and the associations between support system composition and stress levels. Methods: We enrolled pregnant women and caregivers from advanced maternal-fetal and group prenatal care clinics. Participants completed surveys assessing sociodemographic characteristics, health literacy, numeracy, and stress levels and were asked to draw a picture of their support system. Support system elements were extracted from drawings, categorized by type (ie, individual persons, groups, technologies, and other) and summarized for pregnant women and caregivers. Participant characteristics and support system elements were compared using the Pearson chi-square test for categorical variables and Wilcoxon ranked sum test for continuous variables. Associations between support system characteristics and stress levels were measured with Spearman correlation coefficient. Results: The study enrolled 100 participants: 71 pregnant women and 29 caregivers. The support systems of pregnant women were significantly larger than those of caregivers?an average of 7.4 components for pregnant women and 5.4 components for caregivers (P=.003). For all participants, the most commonly reported support system elements were individual persons (408/680, 60.0%), followed by people groups (132/680, 19.4%), technologies (112/680, 16.5%), and other resources (28/680, 4.1%). Pregnant women?s and caregivers? technology preferences within their support systems differed?pregnant women more often identified informational websites, apps, and social media as parts of their support systems, whereas caregivers more frequently reported general internet search engines. The size and components of these support systems were not associated with levels of stress. Conclusions: This study is one of the first demonstrating that technologies comprise a substantial portion of the support systems of pregnant women and their caregivers. Pregnant women more frequently reported specific medical information websites as part of their support system, whereas caregivers more often reported general internet search engines. Although social support is important for maternal and fetal health outcomes, no associations among stress, support system size, and support system components were found in this study. As health information technologies continue to evolve and their adoption increases, their role in patient and caregiver support systems and their effects should be further explored. UR - https://www.jmir.org/2019/5/e10865/ UR - http://dx.doi.org/10.2196/10865 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094327 ID - info:doi/10.2196/10865 ER - TY - JOUR AU - Han, Peijin AU - Nicholson, Wanda AU - Norton, Anna AU - Graffeo, Karen AU - Singerman, Richard AU - King, Steven AU - Sundaresan, Aditi AU - Bennett, Wendy PY - 2019/05/10 TI - DiabetesSistersVoices: Virtual Patient Community to Identify Research Priorities for Women Living With Diabetes JO - J Med Internet Res SP - e13312 VL - 21 IS - 5 KW - social media KW - online social networking KW - women?s health KW - diabetes mellitus N2 - Background: Women with or at high risk of diabetes have unique health concerns across their life course. Effective methods are needed to engage women living with diabetes to develop and carry out a patient-centered research agenda. Objective: This study aimed to (1) describe the creation of DiabetesSistersVoices, a virtual patient community for women living with and at risk for diabetes and (2) assess the feasibility and acceptability of DiabetesSistersVoices for engaging women in talking about their experiences, health care, and research priorities. Methods: We partnered with a national advocacy organization to create DiabetesSistersVoices and to develop recruitment strategies, which included use of social media, Web-based newsletters, and weblinks through partnering organizations. Study inclusion criteria were as follows: Being a woman aged ?18 years, residing in the United States, and self-reporting a diagnosis of diabetes or risk of diabetes. Eligible participants were given access to DiabetesSistersVoices and completed online surveys at enrollment and 6 months. We assessed trends in participants? activities, including posting questions, sharing experiences about living with diabetes, and searching for posted resources. Results: We enrolled 332 women (white: 86.5%; type 1 diabetes: 76.2%; median age: 51 years [interquartile range: 31 to 59 years]) over 8 months. Most (41.6%, 138/332) were classified as being active users (ie, posting) of the virtual community, 36.1% (120/332) as observers (ie, logged in but no posts), and 22.3% (74/332) as never users (ie, completed baseline surveys but then never logged in). Online activities were constant during the study, although participants had the highest website usage during the first 10 weeks after their enrollment. Conclusions: We demonstrated the feasibility and acceptability of an online patient community for women living with diabetes by showing durability of recruitment and online usage over 6 months of testing. Next steps are to address barriers to joining a virtual patient community for women of color and women with type 2 diabetes to enhance inclusiveness and gain diverse perspectives to inform diabetes research. UR - https://www.jmir.org/2019/5/e13312/ UR - http://dx.doi.org/10.2196/13312 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094360 ID - info:doi/10.2196/13312 ER - TY - JOUR AU - Wang, Xiaofang AU - Zhang, Yan AU - Hao, Shiying AU - Zheng, Le AU - Liao, Jiayu AU - Ye, Chengyin AU - Xia, Minjie AU - Wang, Oliver AU - Liu, Modi AU - Weng, Ho Ching AU - Duong, Q. Son AU - Jin, Bo AU - Alfreds, T. Shaun AU - Stearns, Frank AU - Kanov, Laura AU - Sylvester, G. Karl AU - Widen, Eric AU - McElhinney, B. Doff AU - Ling, B. Xuefeng PY - 2019/05/16 TI - Prediction of the 1-Year Risk of Incident Lung Cancer: Prospective Study Using Electronic Health Records from the State of Maine JO - J Med Internet Res SP - e13260 VL - 21 IS - 5 KW - lung cancer KW - risk prediction model KW - electronic health records KW - prospective study N2 - Background: Lung cancer is the leading cause of cancer death worldwide. Early detection of individuals at risk of lung cancer is critical to reduce the mortality rate. Objective: The aim of this study was to develop and validate a prospective risk prediction model to identify patients at risk of new incident lung cancer within the next 1 year in the general population. Methods: Data from individual patient electronic health records (EHRs) were extracted from the Maine Health Information Exchange network. The study population consisted of patients with at least one EHR between April 1, 2016, and March 31, 2018, who had no history of lung cancer. A retrospective cohort (N=873,598) and a prospective cohort (N=836,659) were formed for model construction and validation. An Extreme Gradient Boosting (XGBoost) algorithm was adopted to build the model. It assigned a score to each individual to quantify the probability of a new incident lung cancer diagnosis from October 1, 2016, to September 31, 2017. The model was trained with the clinical profile in the retrospective cohort from the preceding 6 months and validated with the prospective cohort to predict the risk of incident lung cancer from April 1, 2017, to March 31, 2018. Results: The model had an area under the curve (AUC) of 0.881 (95% CI 0.873-0.889) in the prospective cohort. Two thresholds of 0.0045 and 0.01 were applied to the predictive scores to stratify the population into low-, medium-, and high-risk categories. The incidence of lung cancer in the high-risk category (579/53,922, 1.07%) was 7.7 times higher than that in the overall cohort (1167/836,659, 0.14%). Age, a history of pulmonary diseases and other chronic diseases, medications for mental disorders, and social disparities were found to be associated with new incident lung cancer. Conclusions: We retrospectively developed and prospectively validated an accurate risk prediction model of new incident lung cancer occurring in the next 1 year. Through statistical learning from the statewide EHR data in the preceding 6 months, our model was able to identify statewide high-risk patients, which will benefit the population health through establishment of preventive interventions or more intensive surveillance. UR - http://www.jmir.org/2019/5/e13260/ UR - http://dx.doi.org/10.2196/13260 UR - http://www.ncbi.nlm.nih.gov/pubmed/31099339 ID - info:doi/10.2196/13260 ER - TY - JOUR AU - Hyppönen, Hannele AU - Kaipio, Johanna AU - Heponiemi, Tarja AU - Lääveri, Tinja AU - Aalto, Anna-Mari AU - Vänskä, Jukka AU - Elovainio, Marko PY - 2019/05/16 TI - Developing the National Usability-Focused Health Information System Scale for Physicians: Validation Study JO - J Med Internet Res SP - e12875 VL - 21 IS - 5 KW - physicians KW - health information systems KW - questionnaire KW - validation studies N2 - Background: Problems in the usability of health information systems (HISs) are well acknowledged, but research still lacks a validated questionnaire for measuring and monitoring different dimensions of usability of HISs. Such questionnaires are needed not only for research but also for developing usability of HISs from the viewpoint of end-user experiences. Objective: This study aimed to develop and test the validity of the questionnaire measuring the National Usability-Focused HIS-Scale (NuHISS) among a nationally representative sample of Finnish physicians. Methods: We utilized 2 cross-sectional data collected from a random sample of Finnish physicians in 2014 (N=3781; of which 2340 [61.9%] were women) and 2017 (N=4018; of which 2604 [64.8%] were women). Exploratory and confirmatory factor analyses (structural equation modeling [SEM]) were applied to test the structural validity of the NuHISS. As the concurrent validity measure, we used the self-reported overall quality of the electronic health record system (school grade) provided by the participants using marginal structural models. Results: The exploratory factor analyses with Varimax rotation suggested that the 7-factor solution did offer a good fit to the data in both samples (C2=2136.14 in 2014 and C2=2109.83 in 2017, both P<.001). Moreover, structural equation modelling analyses, using comparative fit index (CFI), Tucker-Lewis Index (TLI), Normed Fit Index (NFI), root mean squared error of approximation (RMSEA), and Standardized Root Mean square Residual (SRMR), showed that the 7-factor solution provided an acceptable fit in both samples (CFI=0.92/0.91, TLI=0.92/0.91, NFI=0.92/0.91, RMSEA=0.048/0.049, and SRMR=0.040/0.039). In addition, concurrent validity of this solution was shown to be acceptable. Ease of use, but also all other dimensions, was especially associated with overall quality reports independent of measured confounders. The 7-factor solution included dimensions of technical quality, information quality, feedback, ease of use, benefits, internal collaboration, and cross-organizational collaboration. Conclusions: NuHISS provides a useful tool for measuring usability of HISs among physicians and offers a valid measure for monitoring the long-term development of HISs on a large scale. The relative importance of items needs to be assessed against national electronic health policy goals and complemented with items that have remained outside the NuHISS from the questionnaire when appropriate. UR - https://www.jmir.org/2019/5/e12875/ UR - http://dx.doi.org/10.2196/12875 UR - http://www.ncbi.nlm.nih.gov/pubmed/31099336 ID - info:doi/10.2196/12875 ER - TY - JOUR AU - Gaupp-Berghausen, Mailin AU - Raser, Elisabeth AU - Anaya-Boig, Esther AU - Avila-Palencia, Ione AU - de Nazelle, Audrey AU - Dons, Evi AU - Franzen, Helen AU - Gerike, Regine AU - Götschi, Thomas AU - Iacorossi, Francesco AU - Hössinger, Reinhard AU - Nieuwenhuijsen, Mark AU - Rojas-Rueda, David AU - Sanchez, Julian AU - Smeds, Emilia AU - Deforth, Manja AU - Standaert, Arnout AU - Stigell, Erik AU - Cole-Hunter, Tom AU - Int Panis, Luc PY - 2019/05/06 TI - Evaluation of Different Recruitment Methods: Longitudinal, Web-Based, Pan-European Physical Activity Through Sustainable Transport Approaches (PASTA) Project JO - J Med Internet Res SP - e11492 VL - 21 IS - 5 KW - longitudinal survey KW - multicentral KW - Web-based survey KW - opportunistic sampling KW - recruitment KW - Web-based questionnaire KW - mobile phone N2 - Background: Sufficient sample size and minimal sample bias are core requirements for empirical data analyses. Combining opportunistic recruitment with a Web-based survey and data-collection platform yields new benefits over traditional recruitment approaches. Objective: This paper aims to report the success of different recruitment methods and obtain data on participants? characteristics, participation behavior, recruitment rates, and representativeness of the sample. Methods: A longitudinal, Web-based survey was implemented as part of the European PASTA (Physical Activity through Sustainable Transport Approaches) project, between November 2014 and December 2016. During this period, participants were recruited from 7 European cities on a rolling basis. A standardized guide on recruitment strategy was developed for all cities, to reach a sufficient number of adult participants. To make use of the strengths and minimize weakness, a combination of different opportunistic recruitment methods was applied. In addition, the random sampling approach was applied in the city of Örebro. To reduce the attrition rate and improve real-time monitoring, the Web-based platform featured a participant?s and a researchers? user interface and dashboard. Results: Overall, 10,691 participants were recruited; most people found out about the survey through their workplace or employer (2300/10691, 21.51%), outreach promotion (2219/10691, 20.76%), and social media (1859/10691, 17.39%). The average number of questionnaires filled in per participant varied significantly between the cities (P<.001), with the highest number in Zurich (11.0, SE 0.33) and the lowest in Örebro (4.8, SE 0.17). Collaboration with local organizations, the use of Facebook and mailing lists, and direct street recruitment were the most effective approaches in reaching a high share of participants (P<.001). Considering the invested working hours, Facebook was one of the most time-efficient methods. Compared with the cities? census data, the composition of study participants was broadly representative in terms of gender distribution; however, the study included younger and better-educated participants. Conclusions: We observed that offering a mixed recruitment approach was highly effective in achieving a high participation rate. The highest attrition rate and the lowest average number of questionnaires filled in per participant were observed in Örebro, which also recruited participants through random sampling. These findings suggest that people who are more interested in the topic are more willing to participate and stay in a survey than those who are selected randomly and may not have a strong connection to the research topic. Although direct face-to-face contacts were very effective with respect to the number of recruited participants, recruiting people through social media was not only effective but also very time efficient. The collected data are based on one of the largest recruited longitudinal samples with a common recruitment strategy in different European cities. UR - https://www.jmir.org/2019/5/e11492/ UR - http://dx.doi.org/10.2196/11492 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066715 ID - info:doi/10.2196/11492 ER - TY - JOUR AU - Fletcher, Susan AU - Clarke, Janine AU - Sanatkar, Samineh AU - Baldwin, Peter AU - Gunn, Jane AU - Zwar, Nick AU - Campbell, Lesley AU - Wilhelm, Kay AU - Harris, Mark AU - Lapsley, Helen AU - Hadzi-Pavlovic, Dusan AU - Proudfoot, Judy PY - 2019/05/24 TI - Recruiting to a Randomized Controlled Trial of a Web-Based Program for People With Type 2 Diabetes and Depression: Lessons Learned at the Intersection of e-Mental Health and Primary Care JO - J Med Internet Res SP - e12793 VL - 21 IS - 5 KW - e-mental health KW - primary care KW - patient recruitment KW - depression KW - type 2 diabetes KW - learning N2 - Background: E-mental health (eMH) interventions are now widely available and they have the potential to revolutionize the way that health care is delivered. As most health care is currently delivered by primary care, there is enormous potential for eMH interventions to support, or in some cases substitute, services currently delivered face to face in the community setting. However, randomized trials of eMH interventions have tended to recruit participants using online recruitment methods. Consequently, it is difficult to know whether participants who are recruited online differ from those who attend primary care. Objective: This paper aimed to document the experience of recruiting to an eMH trial through primary care and compare the characteristics of participants recruited through this and other recruitment methods. Methods: Recruitment to the SpringboarD randomized controlled trial was initially focused on general practices in 2 states of Australia. Over 15 months, we employed a comprehensive approach to engaging practice staff and supporting them to recruit patients, including face-to-face site visits, regular contact via telephone and trial newsletters, and development of a Web-based patient registration portal. Nevertheless, it became apparent that these efforts would not yield the required sample size, and we therefore supplemented recruitment through national online advertising and promoted the study through existing networks. Baseline characteristics of participants recruited to the trial through general practice, online, or other sources were compared using the analysis of variance and chi square tests. Results: Between November 2015 and October 2017, 780 people enrolled in SpringboarD, of whom 740 provided information on the recruitment source. Of these, only 24 were recruited through general practice, whereas 520 were recruited online and 196 through existing networks. Key barriers to general practice recruitment included perceived mismatch between trial design and diabetes population, prioritization of acute health issues, and disruptions posed by events at the practice and community level. Participants recruited through the 3 different approaches differed in age, gender, employment status, depressive symptoms, and diabetes distress, with online participants being distinguished from those recruited through general practice or other sources. However, most differences reached only a small effect size and are unlikely to be of clinical importance. Conclusions: Time, labor, and cost-intensive efforts did not translate into successful recruitment through general practice in this instance, with barriers identified at several different levels. Online recruitment yielded more participants, who were broadly similar to those recruited via general practice. UR - https://www.jmir.org/2019/5/e12793/ UR - http://dx.doi.org/10.2196/12793 UR - http://www.ncbi.nlm.nih.gov/pubmed/31127718 ID - info:doi/10.2196/12793 ER - TY - JOUR AU - Sun, Yalin AU - Zhang, Yan AU - Gwizdka, Jacek AU - Trace, B. Ciaran PY - 2019/05/02 TI - Consumer Evaluation of the Quality of Online Health Information: Systematic Literature Review of Relevant Criteria and Indicators JO - J Med Internet Res SP - e12522 VL - 21 IS - 5 KW - health information quality KW - health information seeking KW - consumer health informatics KW - online health information N2 - Background: As the quality of online health information remains questionable, there is a pressing need to understand how consumers evaluate this information. Past reviews identified content-, source-, and individual-related factors that influence consumer judgment in this area. However, systematic knowledge concerning the evaluation process, that is, why and how these factors influence the evaluation behavior, is lacking. Objective: This review aims (1) to identify criteria (rules that reflect notions of value and worth) that consumers use to evaluate the quality of online health information and the indicators (properties of information objects to which criteria are applied to form judgments) they use to support the evaluation in order to achieve a better understanding of the process of information quality evaluation and (2) to explicate the relationship between indicators and criteria to provide clear guidelines for designers of consumer health information systems. Methods: A systematic literature search was performed in seven digital reference databases including Medicine, Psychology, Communication, and Library and Information Science to identify empirical studies that report how consumers directly and explicitly describe their evaluation of online health information quality. Thirty-seven articles met the inclusion criteria. A qualitative content analysis was performed to identify quality evaluation criteria, indicators, and their relationships. Results: We identified 25 criteria and 165 indicators. The most widely reported criteria used by consumers were trustworthiness, expertise, and objectivity. The indicators were related to source, content, and design. Among them, 114 were positive indicators (entailing positive quality judgments), 35 were negative indicators (entailing negative judgments), and 16 indicators had both positive and negative quality influence, depending on contextual factors (eg, source and individual differences) and criteria applied. The most widely reported indicators were site owners/sponsors; consensus among multiple sources; characteristics of writing and language; advertisements; content authorship; and interface design. Conclusions: Consumer evaluation of online health information is a complex cost-benefit analysis process that involves the use of a wide range of criteria and a much wider range of quality indicators. There are commonalities in the use of criteria across user groups and source types, but the differences are hard to ignore. Evidently, consumers? health information evaluation can be characterized as highly subjective and contextualized, and sometimes, misinformed. These findings invite more research into how different user groups evaluate different types of online sources and a personalized approach to educate users about evaluating online health information quality. UR - https://www.jmir.org/2019/5/e12522/ UR - http://dx.doi.org/10.2196/12522 UR - http://www.ncbi.nlm.nih.gov/pubmed/31045507 ID - info:doi/10.2196/12522 ER - TY - JOUR AU - Ferreira, Giovanni AU - Traeger, C. Adrian AU - Machado, Gustavo AU - O'Keeffe, Mary AU - Maher, G. Christopher PY - 2019/05/07 TI - Credibility, Accuracy, and Comprehensiveness of Internet-Based Information About Low Back Pain: A Systematic Review JO - J Med Internet Res SP - e13357 VL - 21 IS - 5 KW - medical informatics KW - low back pain KW - patient portals KW - systematic review KW - consumer health information N2 - Background: Low back pain (LBP) affects millions of people worldwide, and misconceptions about effective treatment options for this condition are very common. Websites sponsored by organizations recognized as trustworthy by the public, such as government agencies, hospitals, universities, professional associations, health care organizations and consumer organizations are an important source of health information for many people. However, the content of these websites regarding treatment recommendations for LBP has not been fully evaluated. Objective: This study aimed to determine the credibility, accuracy, and comprehensiveness of treatment recommendations for LBP in noncommercial, freely accessible websites. Methods: We conducted a systematic review of websites from government agencies, hospitals, universities, professional associations, health care organizations and consumer organizations. We conducted searches on Google. Treatment recommendations were coded based on the 2016 National Institute for Health and Care Excellence (NICE) guidelines and the 2017 American College of Physicians guideline on LBP. Primary outcomes were credibility of the website (4-item Journal of the American Medical Association benchmark), accuracy (proportion of website treatment recommendations that were appropriate), and comprehensiveness of website treatment recommendations (proportion of guideline treatment recommendations that were appropriately covered by a website). Results: We included 79 websites from 6 English-speaking countries. In terms of credibility, 31% (25/79) of the websites clearly disclosed that they had been updated after the publication of the NICE guidelines. Only 43.28% (487/1125) website treatment recommendations were judged as accurate. Comprehensiveness of treatment recommendations correctly covered by websites was very low across all types of LBP. For acute LBP, an average of 28% (4/14) guideline recommendations were correctly covered by websites. Websites for radicular LBP were the least comprehensive, correctly covering an average of 16% (2.3/14) recommendations. Conclusions: Noncommercial freely accessible websites demonstrated low credibility standards, provided mostly inaccurate information, and lacked comprehensiveness across all types of LBP. UR - https://www.jmir.org/2019/5/e13357/ UR - http://dx.doi.org/10.2196/13357 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066689 ID - info:doi/10.2196/13357 ER - TY - JOUR AU - Abed Elhadi Shahbari, Nour AU - Gesser-Edelsburg, Anat AU - Mesch, S. Gustavo PY - 2019/05/17 TI - Case of Paradoxical Cultural Sensitivity: Mixed Method Study of Web-Based Health Informational Materials About the Human Papillomavirus Vaccine in Israel JO - J Med Internet Res SP - e13373 VL - 21 IS - 5 KW - web-based health informational materials KW - HPV vaccine KW - Israel KW - cultural sensitivity KW - transparency KW - sexuality KW - quantitative analysis KW - qualitative content analysis KW - Hebrew and Arabic N2 - Background: Designing web-based informational materials regarding the human papillomavirus (HPV) vaccine has become a challenge for designers and decision makers in the health authorities because of the scientific and public controversy regarding the vaccine?s safety and effectiveness and the sexual and moral concerns related to its use. Objective: The study aimed to investigate how cultural sensitivity (CS) is articulated in the explanatory informational materials on the HPV vaccine that are posted on the websites of the Israeli health authorities. In addition, the study examined the effect of transparency on the expression of CS in the informational materials. Methods: The study employed a quantitative and qualitative content analysis of the texts of explanatory informational materials published on the Arabic and Hebrew websites of the Israel Ministry of Health and the Clalit health maintenance organization (HMO). Results: The findings revealed the differences in the dimensions of CS (based on the CS model by Resnicow) between the informational materials targeting the majority Jewish population and those targeting the minority Arab population. Indeed, the research findings point to a paradox. On the one hand, the materials appealing to the conservative Arab population exhibited CS, in that the sexual context of the vaccine was missing. On the other hand, analysis of Resnicow's deep dimensions showed that disregarding the sexual context does not allow the relevant target audience to reflect on the barriers and concerns. In addition, the way the information was provided exhibited a lack of transparency regarding the CS dimensions (surface and deep). Conclusions: The public health authorities have 2 main objectives in the context of vaccinations. One is to raise the vaccination rates and the other is to provide full and culturally sensitive information to give the public the tools to make intelligent decisions. The findings of this study indicated that despite the high uptake rate for HPV vaccination in the Arab population, the health authorities did not exercise full transparency and CS in transmitting the association between engaging in sexual relations and the necessity of the vaccination. Thus, the major challenge for the health authorities is to find ways to implement the objective of communicating information about the vaccination in a way that is transparent and culturally sensitive, even if this raises questions and fears among the public deriving from their culture. UR - http://www.jmir.org/2019/5/e13373/ UR - http://dx.doi.org/10.2196/13373 UR - http://www.ncbi.nlm.nih.gov/pubmed/31102371 ID - info:doi/10.2196/13373 ER - TY - JOUR AU - Chevrier, Raphaël AU - Foufi, Vasiliki AU - Gaudet-Blavignac, Christophe AU - Robert, Arnaud AU - Lovis, Christian PY - 2019/05/31 TI - Use and Understanding of Anonymization and De-Identification in the Biomedical Literature: Scoping Review JO - J Med Internet Res SP - e13484 VL - 21 IS - 5 KW - anonymization KW - anonymisation KW - de-identification KW - deidentification KW - pseudonymization KW - privacy KW - confidentiality KW - secondary use KW - data protection KW - scoping review N2 - Background: The secondary use of health data is central to biomedical research in the era of data science and precision medicine. National and international initiatives, such as the Global Open Findable, Accessible, Interoperable, and Reusable (GO FAIR) initiative, are supporting this approach in different ways (eg, making the sharing of research data mandatory or improving the legal and ethical frameworks). Preserving patients? privacy is crucial in this context. De-identification and anonymization are the two most common terms used to refer to the technical approaches that protect privacy and facilitate the secondary use of health data. However, it is difficult to find a consensus on the definitions of the concepts or on the reliability of the techniques used to apply them. A comprehensive review is needed to better understand the domain, its capabilities, its challenges, and the ratio of risk between the data subjects? privacy on one side, and the benefit of scientific advances on the other. Objective: This work aims at better understanding how the research community comprehends and defines the concepts of de-identification and anonymization. A rich overview should also provide insights into the use and reliability of the methods. Six aspects will be studied: (1) terminology and definitions, (2) backgrounds and places of work of the researchers, (3) reasons for anonymizing or de-identifying health data, (4) limitations of the techniques, (5) legal and ethical aspects, and (6) recommendations of the researchers. Methods: Based on a scoping review protocol designed a priori, MEDLINE was searched for publications discussing de-identification or anonymization and published between 2007 and 2017. The search was restricted to MEDLINE to focus on the life sciences community. The screening process was performed by two reviewers independently. Results: After searching 7972 records that matched at least one search term, 135 publications were screened and 60 full-text articles were included. (1) Terminology: Definitions of the terms de-identification and anonymization were provided in less than half of the articles (29/60, 48%). When both terms were used (41/60, 68%), their meanings divided the authors into two equal groups (19/60, 32%, each) with opposed views. The remaining articles (3/60, 5%) were equivocal. (2) Backgrounds and locations: Research groups were based predominantly in North America (31/60, 52%) and in the European Union (22/60, 37%). The authors came from 19 different domains; computer science (91/248, 36.7%), biomedical informatics (47/248, 19.0%), and medicine (38/248, 15.3%) were the most prevalent ones. (3) Purpose: The main reason declared for applying these techniques is to facilitate biomedical research. (4) Limitations: Progress is made on specific techniques but, overall, limitations remain numerous. (5) Legal and ethical aspects: Differences exist between nations in the definitions, approaches, and legal practices. (6) Recommendations: The combination of organizational, legal, ethical, and technical approaches is necessary to protect health data. Conclusions: Interest is growing for privacy-enhancing techniques in the life sciences community. This interest crosses scientific boundaries, involving primarily computer science, biomedical informatics, and medicine. The variability observed in the use of the terms de-identification and anonymization emphasizes the need for clearer definitions as well as for better education and dissemination of information on the subject. The same observation applies to the methods. Several legislations, such as the American Health Insurance Portability and Accountability Act (HIPAA) and the European General Data Protection Regulation (GDPR), regulate the domain. Using the definitions they provide could help address the variable use of these two concepts in the research community. UR - http://www.jmir.org/2019/5/e13484/ UR - http://dx.doi.org/10.2196/13484 UR - http://www.ncbi.nlm.nih.gov/pubmed/31152528 ID - info:doi/10.2196/13484 ER - TY - JOUR AU - Wang, Tao AU - Mentzakis, Emmanouil AU - Brede, Markus AU - Ianni, Antonella PY - 2019/05/03 TI - Estimating Determinants of Attrition in Eating Disorder Communities on Twitter: An Instrumental Variables Approach JO - J Med Internet Res SP - e10942 VL - 21 IS - 5 KW - medical informatics KW - eating disorders KW - social media KW - attrition KW - emotions KW - social network KW - causality KW - instrumental variables N2 - Background: The use of social media as a key health information source has increased steadily among people affected by eating disorders (EDs). Research has examined characteristics of individuals engaging in online communities, whereas little is known about discontinuation of engagement and the phenomenon of participants dropping out of these communities. Objective: This study aimed to investigate the characteristics of dropout behaviors among eating disordered individuals on Twitter and to estimate the causal effects of personal emotions and social networks on dropout behaviors. Methods: Using a snowball sampling method, we collected a set of individuals who self-identified with EDs in their Twitter profile descriptions, as well as their tweets and social networks, leading to 241,243,043 tweets from 208,063 users. Individuals? emotions are measured from their language use in tweets using an automatic sentiment analysis tool, and network centralities are measured from users? following networks. Dropout statuses of users are observed in a follow-up period 1.5 years later (from February 11, 2016 to August 17, 2017). Linear and survival regression instrumental variables models are used to estimate the effects of emotions and network centrality on dropout behaviors. The average levels of attributes among an individual?s followees (ie, people who are followed by the individual) are used as instruments for the individual?s attributes. Results: Eating disordered users have relatively short periods of activity on Twitter with one half of our sample dropping out at 6 months after account creation. Active users show more negative emotions and higher network centralities than dropped-out users. Active users tend to connect to other active users, whereas dropped-out users tend to cluster together. Estimation results suggest that users? emotions and network centralities have causal effects on their dropout behaviors on Twitter. More specifically, users with positive emotions are more likely to drop out and have shorter lasting periods of activity online than users with negative emotions, whereas central users in a social network have longer lasting participation than peripheral users. Findings on users? tweeting interests further show that users who attempt to recover from EDs are more likely to drop out than those who promote EDs as a lifestyle choice. Conclusions: Presence in online communities is strongly determined by the individual?s emotions and social networks, suggesting that studies analyzing and trying to draw condition and population characteristics through online health communities are likely to be biased. Future research needs to examine in more detail the links between individual characteristics and participation patterns if better understanding of the entire population is to be achieved. At the same time, such attrition dynamics need to be acknowledged and controlled when designing online interventions so as to accurately capture their intended populations. UR - https://www.jmir.org/2019/5/e10942/ UR - http://dx.doi.org/10.2196/10942 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066718 ID - info:doi/10.2196/10942 ER - TY - JOUR AU - Alhuwail, Dari AU - Abdulsalam, Yousef PY - 2019/05/24 TI - Assessing Electronic Health Literacy in the State of Kuwait: Survey of Internet Users From an Arab State JO - J Med Internet Res SP - e11174 VL - 21 IS - 5 KW - eHEALS KW - literacy KW - health information KW - information-seeking KW - informatics KW - Arab KW - Kuwait N2 - Background: The internet and social media have become an important source for health information. In 2017, the State of Kuwait ranked first in mobile subscription penetration in the Arab world; nearly 90% of its population uses the internet. Electronic health (eHealth) literacy is important in populations that have easy and affordable access to internet resources to more effectively manage health conditions as well as improve general population health. Objective: The aim of this study was to assess eHealth literacy levels across internet users in Kuwait and identify demographic characteristics that influence eHealth literacy. Furthermore, the study aimed to identify the reasons and type of information that people seek online. Finally, this study examined the utilization of various social media channels for accessing online health information. The social media platforms considered were as follows: WhatsApp, Twitter, Instagram, YouTube, Facebook, and Snapchat. Methods: A cross-sectional anonymous Web-based survey was used to collect data about eHealth literacy and related information. The eHealth literacy scale (eHEALS), originally developed by Norman and Skinner, is measured using 8 Likert-type scales. A linear regression model estimates the effect of demographic variables such as age, gender, and education on eHealth literacy while controlling for participants? perceived usefulness and importance of the internet. Participants were also surveyed about their frequency in using social media platforms for seeking health information. Results: Kuwait?s composite eHEALS, based on a sample of 386 participants, was 28.63, which is very similar to eHEALS observed among adult populations in other developed countries. Females in Kuwait demonstrated a higher average eHEALS compared with males. Among the social media platforms, the survey results indicated that YouTube is the most frequently used to seek health information, with Facebook being the least frequently used. Conclusions: Internet users in Kuwait appear confident in their ability to search for health-related information online compared with other populations, as indicated by aggregate eHEALS scores. Considering this finding, government and health care organizations should shift more efforts from traditional media toward online health information, focusing on the social media outlets that people in Kuwait find more useful for seeking health information. UR - http://www.jmir.org/2019/5/e11174/ UR - http://dx.doi.org/10.2196/11174 UR - http://www.ncbi.nlm.nih.gov/pubmed/31127723 ID - info:doi/10.2196/11174 ER - TY - JOUR AU - Yang, Lin AU - Huang, Xiaoshuo AU - Li, Jiao PY - 2019/05/28 TI - Discovering Clinical Information Models Online to Promote Interoperability of Electronic Health Records: A Feasibility Study of OpenEHR JO - J Med Internet Res SP - e13504 VL - 21 IS - 5 KW - openEHR KW - clinical information model KW - health information interoperability KW - information retrieval KW - probabilistic graphical model N2 - Background: Clinical information models (CIMs) enabling semantic interoperability are crucial for electronic health record (EHR) data use and reuse. Dual model methodology, which distinguishes the CIMs from the technical domain, could help enable the interoperability of EHRs at the knowledge level. How to help clinicians and domain experts discover CIMs from an open repository online to represent EHR data in a standard manner becomes important. Objective: This study aimed to develop a retrieval method to identify CIMs online to represent EHR data. Methods: We proposed a graphical retrieval method and validated its feasibility using an online CIM repository: openEHR Clinical Knowledge Manager (CKM). First, we represented CIMs (archetypes) using an extended Bayesian network. Then, an inference process was run in the network to discover relevant archetypes. In the evaluation, we defined three retrieval tasks (medication, laboratory test, and diagnosis) and compared our method with three typical retrieval methods (BM25F, simple Bayesian network, and CKM), using mean average precision (MAP), average precision (AP), and precision at 10 (P@10) as evaluation metrics. Results: We downloaded all available archetypes from the CKM. Then, the graphical model was applied to represent the archetypes as a four-level clinical resources network. The network consisted of 5513 nodes, including 3982 data element nodes, 504 concept nodes, 504 duplicated concept nodes, and 523 archetype nodes, as well as 9867 edges. The results showed that our method achieved the best MAP (MAP=0.32), and the AP was almost equal across different retrieval tasks (AP=0.35, 0.31, and 0.30, respectively). In the diagnosis retrieval task, our method could successfully identify the models covering ?diagnostic reports,? ?problem list,? ?patients background,? ?clinical decision,? etc, as well as models that other retrieval methods could not find, such as ?problems and diagnoses.? Conclusions: The graphical retrieval method we propose is an effective approach to meet the uncertainty of finding CIMs. Our method can help clinicians and domain experts identify CIMs to represent EHR data in a standard manner, enabling EHR data to be exchangeable and interoperable. UR - http://www.jmir.org/2019/5/e13504/ UR - http://dx.doi.org/10.2196/13504 UR - http://www.ncbi.nlm.nih.gov/pubmed/31140433 ID - info:doi/10.2196/13504 ER - TY - JOUR AU - Krishnan, Anirudh AU - Finkelstein, Andrew Eric AU - Levine, Erica AU - Foley, Perry AU - Askew, Sandy AU - Steinberg, Dori AU - Bennett, G. Gary PY - 2019/05/17 TI - A Digital Behavioral Weight Gain Prevention Intervention in Primary Care Practice: Cost and Cost-Effectiveness Analysis JO - J Med Internet Res SP - e12201 VL - 21 IS - 5 KW - cost-effectiveness KW - cost-benefit analysis KW - obesity KW - telemedicine KW - women?s health KW - minority health KW - weight gain prevention KW - weight gain N2 - Background: Obesity is one of the largest drivers of health care spending but nearly half of the population with obesity demonstrate suboptimal readiness for weight loss treatment. Black women are disproportionately likely to have both obesity and limited weight loss readiness. However, they have been shown to be receptive to strategies that prevent weight gain. Objective: The aim of this study was to evaluate the costs and cost-effectiveness of a digital weight gain prevention intervention (Shape) for black women. Shape consisted of adaptive telephone-based coaching by health system personnel, a tailored skills training curriculum, and patient self-monitoring delivered via a fully automated interactive voice response system. Methods: A cost and cost-effectiveness analysis based on a randomized clinical trial of the Shape intervention was conducted from the payer perspective. Costs included those of delivering the program to 91 intervention participants in the trial and were summarized by program elements: self-monitoring, skills training, coaching, and administration. Effectiveness was measured in quality-adjusted life years (QALYs). The primary outcome was the incremental cost per QALY of Shape relative to usual care. Results: Shape cost an average of US $758 per participant. The base-case model in which quality of life benefits decay linearly to zero 5 years post intervention cessation, generated an incremental cost-effectiveness ratio (ICER) of US $55,264 per QALY. Probabilistic sensitivity analyses suggest an ICER below US $50,000 per QALY and US $100,000 per QALY in 39% and 98% of simulations, respectively. Results are highly sensitive to durability of benefits, rising to US $165,730 if benefits end 6 months post intervention. Conclusions: Results suggest that the Shape intervention is cost-effective based on established benchmarks, indicating that it can be a part of a successful strategy to address the nation?s growing obesity epidemic in low-income at-risk communities. UR - http://www.jmir.org/2019/5/e12201/ UR - http://dx.doi.org/10.2196/12201 UR - http://www.ncbi.nlm.nih.gov/pubmed/31102373 ID - info:doi/10.2196/12201 ER - TY - JOUR AU - Harst, Lorenz AU - Lantzsch, Hendrikje AU - Scheibe, Madlen PY - 2019/05/21 TI - Theories Predicting End-User Acceptance of Telemedicine Use: Systematic Review JO - J Med Internet Res SP - e13117 VL - 21 IS - 5 KW - systematic review KW - telemedicine KW - technology KW - patient compliance N2 - Background: Only a few telemedicine applications have made their way into regular care. One reason is the lack of acceptance of telemedicine by potential end users. Objective: The aim of this systematic review was to identify theoretical predictors that influence the acceptance of telemedicine. Methods: An electronic search was conducted in PubMed and PsycINFO in June 2018 and supplemented by a hand search. Articles were identified using predefined inclusion and exclusion criteria. In total, two reviewers independently assessed the title, abstract, and full-text screening and then individually performed a quality assessment of all included studies. Results: Out of 5917 potentially relevant titles (duplicates excluded), 24 studies were included. The Axis Tool for quality assessment of cross-sectional studies revealed a high risk of bias for all studies except for one study. The most commonly used models were the Technology Acceptance Model (n=11) and the Unified Theory of Acceptance and Use of Technology (n=9). The main significant predictors of acceptance were perceived usefulness (n=11), social influences (n=6), and attitude (n=6). The results show a superiority of technology acceptance versus original behavioral models. Conclusions: The main finding of this review is the applicability of technology acceptance models and theories on telemedicine adoption. Characteristics of the technology, such as its usefulness, as well as attributes of the individual, such as his or her need for social support, inform end-user acceptance. Therefore, in the future, requirements of the target group and the group?s social environment should already be taken into account when planning telemedicine applications. The results support the importance of theory-guided user-centered design approaches to telemedicine development. UR - http://www.jmir.org/2019/5/e13117/ UR - http://dx.doi.org/10.2196/13117 UR - http://www.ncbi.nlm.nih.gov/pubmed/31115340 ID - info:doi/10.2196/13117 ER - TY - JOUR AU - Washington, Peter AU - Kalantarian, Haik AU - Tariq, Qandeel AU - Schwartz, Jessey AU - Dunlap, Kaitlyn AU - Chrisman, Brianna AU - Varma, Maya AU - Ning, Michael AU - Kline, Aaron AU - Stockham, Nathaniel AU - Paskov, Kelley AU - Voss, Catalin AU - Haber, Nick AU - Wall, Paul Dennis PY - 2019/05/23 TI - Validity of Online Screening for Autism: Crowdsourcing Study Comparing Paid and Unpaid Diagnostic Tasks JO - J Med Internet Res SP - e13668 VL - 21 IS - 5 KW - crowdsourcing KW - autism KW - mechanical turk KW - pediatrics KW - diagnostics KW - diagnosis KW - neuropsychiatric conditions KW - human-computer interaction KW - citizen healthcare KW - biomedical data science KW - mobile health KW - digital health N2 - Background: Obtaining a diagnosis of neuropsychiatric disorders such as autism requires long waiting times that can exceed a year and can be prohibitively expensive. Crowdsourcing approaches may provide a scalable alternative that can accelerate general access to care and permit underserved populations to obtain an accurate diagnosis. Objective: We aimed to perform a series of studies to explore whether paid crowd workers on Amazon Mechanical Turk (AMT) and citizen crowd workers on a public website shared on social media can provide accurate online detection of autism, conducted via crowdsourced ratings of short home video clips. Methods: Three online studies were performed: (1) a paid crowdsourcing task on AMT (N=54) where crowd workers were asked to classify 10 short video clips of children as ?Autism? or ?Not autism,? (2) a more complex paid crowdsourcing task (N=27) with only those raters who correctly rated ?8 of the 10 videos during the first study, and (3) a public unpaid study (N=115) identical to the first study. Results: For Study 1, the mean score of the participants who completed all questions was 7.50/10 (SD 1.46). When only analyzing the workers who scored ?8/10 (n=27/54), there was a weak negative correlation between the time spent rating the videos and the sensitivity (?=?0.44, P=.02). For Study 2, the mean score of the participants rating new videos was 6.76/10 (SD 0.59). The average deviation between the crowdsourced answers and gold standard ratings provided by two expert clinical research coordinators was 0.56, with an SD of 0.51 (maximum possible SD is 3). All paid crowd workers who scored 8/10 in Study 1 either expressed enjoyment in performing the task in Study 2 or provided no negative comments. For Study 3, the mean score of the participants who completed all questions was 6.67/10 (SD 1.61). There were weak correlations between age and score (r=0.22, P=.014), age and sensitivity (r=?0.19, P=.04), number of family members with autism and sensitivity (r=?0.195, P=.04), and number of family members with autism and precision (r=?0.203, P=.03). A two-tailed t test between the scores of the paid workers in Study 1 and the unpaid workers in Study 3 showed a significant difference (P<.001). Conclusions: Many paid crowd workers on AMT enjoyed answering screening questions from videos, suggesting higher intrinsic motivation to make quality assessments. Paid crowdsourcing provides promising screening assessments of pediatric autism with an average deviation <20% from professional gold standard raters, which is potentially a clinically informative estimate for parents. Parents of children with autism likely overfit their intuition to their own affected child. This work provides preliminary demographic data on raters who may have higher ability to recognize and measure features of autism across its wide range of phenotypic manifestations. UR - http://www.jmir.org/2019/5/e13668/ UR - http://dx.doi.org/10.2196/13668 UR - http://www.ncbi.nlm.nih.gov/pubmed/31124463 ID - info:doi/10.2196/13668 ER - TY - JOUR AU - Lu, Xinyi AU - Zhang, Runtong PY - 2019/05/13 TI - Impact of Physician-Patient Communication in Online Health Communities on Patient Compliance: Cross-Sectional Questionnaire Study JO - J Med Internet Res SP - e12891 VL - 21 IS - 5 KW - patient portals KW - communication KW - patient compliance KW - consumer health information KW - decision making KW - physician-patient relations KW - personal autonomy N2 - Background: In China, the utilization of medical resources is tense, and most hospitals are highly congested because of the large population and uneven distribution of medical resources. Online health communities (OHCs) play an important role in alleviating hospital congestions, thereby improving the utilization of medical resources and relieving medical resource shortages. OHCs have positive effects on physician-patient relationships and health outcomes. Moreover, as one of the main ways for patients to seek health-related information in OHCs, physician-patient communication may affect patient compliance in various ways. In consideration of the inevitable development of OHCs, although they have several shortcomings, identifying how physician-patient communication can impact patient compliance is important to improve patients? health outcomes through OHCs. Objective: This study aimed to investigate the impact of physician-patient communication on patient compliance in OHCs through the mediation of the perceived quality of internet health information, decision-making preference, and physician-patient concordance, using an empirical study based on the self-determination theory. Methods: A research model was established, including 1 independent variable (physician-patient communication), 3 mediators (perceived quality of internet health information, decision-making preference, and physician-patient concordance), 1 dependent variable (patient compliance), and 4 control variables (age, gender, living area, and education level). Furthermore, a Web-based survey involving 423 valid responses was conducted in China to collect data, and structural equation modeling and partial least squares were adopted to analyze data and test the hypotheses. Results: The questionnaire response rate was 79.2% (487/615) and the validity rate was 86.9% (423/487); reliability and validity are acceptable. The communication between physicians and patients in OHCs positively affects patient compliance through the mediation of the perceived quality of internet health information, decision-making preference, and physician-patient concordance. Moreover, physician-patient communication exhibits similar impacts on the perceived quality of internet health information, decision-making preference, and physician-patient concordance. Patients? decision-making preference shows the weakest impact on patient compliance compared with the other 2 mediators. Ultimately, all 3 mediators play a partially mediating role between physician-patient communication and patient compliance. Conclusions: We conclude that physician-patient communication in OHCs exhibits a positive impact on patient compliance; thus, patient compliance can be improved by guiding physician-patient communication in OHCs. Furthermore, our findings suggest that physicians can share high-quality health information with patients, discuss benefits, risks, and costs of treatment options with patients, encourage patients to express their attitudes and participate in health-related decision making, and strengthen the emotional connection with patients in OHCs, thereby decreasing patients? misunderstanding of information and increasing concordance between physicians and patients. OHCs are required to not only strengthen the management of their published health information quality but also understand users? actual attitudes toward information quality and then try to reduce the gap between the perceived and actual quality of information. UR - http://www.jmir.org/2019/5/e12891/ UR - http://dx.doi.org/10.2196/12891 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094342 ID - info:doi/10.2196/12891 ER - TY - JOUR AU - Easton, Katherine AU - Potter, Stephen AU - Bec, Remi AU - Bennion, Matthew AU - Christensen, Heidi AU - Grindell, Cheryl AU - Mirheidari, Bahman AU - Weich, Scott AU - de Witte, Luc AU - Wolstenholme, Daniel AU - Hawley, S. Mark PY - 2019/05/30 TI - A Virtual Agent to Support Individuals Living With Physical and Mental Comorbidities: Co-Design and Acceptability Testing JO - J Med Internet Res SP - e12996 VL - 21 IS - 5 KW - COPD KW - chronic obstructive pulmonary disease KW - mental health KW - comorbidity KW - chronic illness KW - self-management KW - artificial intelligence KW - virtual systems KW - computer-assisted therapy KW - chatbot KW - conversational agent N2 - Background: Individuals living with long-term physical health conditions frequently experience co-occurring mental health problems. This comorbidity has a significant impact on an individual?s levels of emotional distress, health outcomes, and associated health care utilization. As health care services struggle to meet demand and care increasingly moves to the community, digital tools are being promoted to support patients to self-manage their health. One such technology is the autonomous virtual agent (chatbot, conversational agent), which uses artificial intelligence (AI) to process the user?s written or spoken natural language and then to select or construct the corresponding appropriate responses. Objective: This study aimed to co-design the content, functionality, and interface modalities of an autonomous virtual agent to support self-management for patients with an exemplar long-term condition (LTC; chronic pulmonary obstructive disease [COPD]) and then to assess the acceptability and system content. Methods: We conducted 2 co-design workshops and a proof-of-concept implementation of an autonomous virtual agent with natural language processing capabilities. This implementation formed the basis for video-based scenario testing of acceptability with adults with a diagnosis of COPD and health professionals involved in their care. Results: Adults (n=6) with a diagnosis of COPD and health professionals (n=5) specified 4 priority self-management scenarios for which they would like to receive support: at the time of diagnosis (information provision), during acute exacerbations (crisis support), during periods of low mood (emotional support), and for general self-management (motivation). From the scenario testing, 12 additional adults with COPD felt the system to be both acceptable and engaging, particularly with regard to internet-of-things capabilities. They felt the system would be particularly useful for individuals living alone. Conclusions: Patients did not explicitly separate mental and physical health needs, although the content they developed for the virtual agent had a clear psychological approach. Supported self-management delivered via an autonomous virtual agent was acceptable to the participants. A co-design process has allowed the research team to identify key design principles, content, and functionality to underpin an autonomous agent for delivering self-management support to older adults living with COPD and potentially other LTCs. UR - http://www.jmir.org/2019/5/e12996/ UR - http://dx.doi.org/10.2196/12996 UR - http://www.ncbi.nlm.nih.gov/pubmed/31148545 ID - info:doi/10.2196/12996 ER - TY - JOUR AU - Robinson, Lee Nicole AU - Cottier, Vaughan Timothy AU - Kavanagh, John David PY - 2019/05/10 TI - Psychosocial Health Interventions by Social Robots: Systematic Review of Randomized Controlled Trials JO - J Med Internet Res SP - e13203 VL - 21 IS - 5 KW - social robot KW - healthcare KW - treatment KW - therapy KW - autism spectrum disorder KW - dementia N2 - Background: Social robots that can communicate and interact with people offer exciting opportunities for improved health care access and outcomes. However, evidence from randomized controlled trials (RCTs) on health or well-being outcomes has not yet been clearly synthesized across all health domains where social robots have been tested. Objective: This study aimed to undertake a systematic review examining current evidence from RCTs on the effects of psychosocial interventions by social robots on health or well-being. Methods: Medline, PsycInfo, ScienceDirect, Scopus, and Engineering Village searches across all years in the English language were conducted and supplemented by forward and backward searches. The included papers reported RCTs that assessed changes in health or well-being from interactions with a social robot across at least 2 measurement occasions. Results: Out of 408 extracted records, 27 trials met the inclusion criteria: 6 in child health or well-being, 9 in children with autism spectrum disorder, and 12 with older adults. No trials on adolescents, young adults, or other problem areas were identified, and no studies had interventions where robots spontaneously modified verbal responses based on speech by participants. Most trials were small (total N=5 to 415; median=34), only 6 (22%) reported any follow-up outcomes (2 to 12 weeks; median=3.5) and a single-blind assessment was reported in 8 (31%). More recent trials tended to have greater methodological quality. All papers reported some positive outcomes from robotic interventions, although most trials had some measures that showed no difference or favored alternate treatments. Conclusions: Controlled research on social robots is at an early stage, as is the current range of their applications to health care. Research on social robot interventions in clinical and health settings needs to transition from exploratory investigations to include large-scale controlled trials with sophisticated methodology, to increase confidence in their efficacy. UR - http://www.jmir.org/2019/5/e13203/ UR - http://dx.doi.org/10.2196/13203 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094357 ID - info:doi/10.2196/13203 ER - TY - JOUR AU - Barak Ventura, Roni AU - Nakayama, Shinnosuke AU - Raghavan, Preeti AU - Nov, Oded AU - Porfiri, Maurizio PY - 2019/05/15 TI - The Role of Social Interactions in Motor Performance: Feasibility Study Toward Enhanced Motivation in Telerehabilitation JO - J Med Internet Res SP - e12708 VL - 21 IS - 5 KW - citizen science KW - social interactions KW - telerehabilitation KW - physical therapy N2 - Background: Robot-mediated telerehabilitation has the potential to provide patient-tailored cost-effective rehabilitation. However, compliance with therapy can be a problem that undermines the prospective advantages of telerehabilitation technologies. Lack of motivation has been identified as a major factor that hampers compliance. Exploring various motivational interventions, the integration of citizen science activities in robotics-based rehabilitation has been shown to increase patients? motivation to engage in otherwise tedious exercises by tapping into a vast array of intrinsic motivational drivers. Patient engagement can be further enhanced by the incorporation of social interactions. Objective: Herein, we explored the possibility of bolstering engagement in physical therapy by leveraging cooperation among users in an environmental citizen science project. Specifically, we studied how the integration of cooperation into citizen science influences user engagement, enjoyment, and motor performance. Furthermore, we investigated how the degree of interdependence among users, such that is imposed through independent or joint termination (JT), affects participation in citizen science-based telerehabilitation. Methods: We developed a Web-based citizen science platform in which users work in pairs to classify images collected by an aquatic robot in a polluted water canal. The classification was carried out by labeling objects that appear in the images and trashing irrelevant labels. The system was interfaced by a haptic device for fine motor rehabilitation. We recruited 120 healthy volunteers to operate the platform. Of these volunteers, 98 were cooperating in pairs, with 1 user tagging images and the other trashing labels. The other 22 volunteers performed both tasks alone. To vary the degree of interdependence within cooperation, we implemented independent and JTs. Results: We found that users? engagement and motor performance are modulated by their assigned task and the degree of interdependence. Motor performance increased when users were subjected to independent termination (P=.02), yet enjoyment decreased when users were subjected to JT (P=.005). A significant interaction between the type of termination and the task was found to influence productivity (P<.001) as well as mean speed, peak speed, and path length of the controller (P=.01, P=.006, and P<.001, respectively). Conclusions: Depending on the type of termination, cooperation was not always positively associated with engagement, enjoyment, and motor performance. Therefore, enhancing user engagement, satisfaction, and motor performance through cooperative citizen science tasks relies on both the degree of interdependence among users and the perceived nature of the task. Cooperative citizen science may enhance motivation in robotics-based telerehabilitation, if designed attentively. UR - http://www.jmir.org/2019/5/e12708/ UR - http://dx.doi.org/10.2196/12708 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094338 ID - info:doi/10.2196/12708 ER - TY - JOUR AU - Feng, Xiaoyue AU - Zhang, Hao AU - Ren, Yijie AU - Shang, Penghui AU - Zhu, Yi AU - Liang, Yanchun AU - Guan, Renchu AU - Xu, Dong PY - 2019/05/24 TI - The Deep Learning?Based Recommender System ?Pubmender? for Choosing a Biomedical Publication Venue: Development and Validation Study JO - J Med Internet Res SP - e12957 VL - 21 IS - 5 KW - recommender system KW - deep learning KW - convolutional neural network KW - biomedical literature KW - PubMed N2 - Background: It is of great importance for researchers to publish research results in high-quality journals. However, it is often challenging to choose the most suitable publication venue, given the exponential growth of journals and conferences. Although recommender systems have achieved success in promoting movies, music, and products, very few studies have explored recommendation of publication venues, especially for biomedical research. No recommender system exists that can specifically recommend journals in PubMed, the largest collection of biomedical literature. Objective: We aimed to propose a publication recommender system, named Pubmender, to suggest suitable PubMed journals based on a paper?s abstract. Methods: In Pubmender, pretrained word2vec was first used to construct the start-up feature space. Subsequently, a deep convolutional neural network was constructed to achieve a high-level representation of abstracts, and a fully connected softmax model was adopted to recommend the best journals. Results: We collected 880,165 papers from 1130 journals in PubMed Central and extracted abstracts from these papers as an empirical dataset. We compared different recommendation models such as Cavnar-Trenkle on the Microsoft Academic Search (MAS) engine, a collaborative filtering?based recommender system for the digital library of the Association for Computing Machinery (ACM) and CiteSeer. We found the accuracy of our system for the top 10 recommendations to be 87.0%, 22.9%, and 196.0% higher than that of MAS, ACM, and CiteSeer, respectively. In addition, we compared our system with Journal Finder and Journal Suggester, which are tools of Elsevier and Springer, respectively, that help authors find suitable journals in their series. The results revealed that the accuracy of our system was 329% higher than that of Journal Finder and 406% higher than that of Journal Suggester for the top 10 recommendations. Our web service is freely available at https://www.keaml.cn:8081/. Conclusions: Our deep learning?based recommender system can suggest an appropriate journal list to help biomedical scientists and clinicians choose suitable venues for their papers. UR - http://www.jmir.org/2019/5/e12957/ UR - http://dx.doi.org/10.2196/12957 UR - http://www.ncbi.nlm.nih.gov/pubmed/31127715 ID - info:doi/10.2196/12957 ER - TY - JOUR AU - O'Donoghue, Odhran AU - Vazirani, A. Anuraag AU - Brindley, David AU - Meinert, Edward PY - 2019/05/10 TI - Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review JO - J Med Internet Res SP - e12426 VL - 21 IS - 5 KW - blockchain KW - interoperability KW - distributed ledger technology KW - scalability KW - health information exchange N2 - Background: A blockchain is a list of records that uses cryptography to make stored data immutable; their use has recently been proposed for electronic medical record (EMR) systems. This paper details a systematic review of trade-offs in blockchain technologies that are relevant to EMRs. Trade-offs are defined as ?a compromise between two desirable but incompatible features.? Objective: This review?s primary research question was: ?What are the trade-offs involved in different blockchain designs that are relevant to the creation of blockchain-based electronic medical records systems?? Methods: Seven databases were systematically searched for relevant articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Papers published from January 1, 2017 to June 15, 2018 were selected. Quality assessments of papers were performed using the Risk Of Bias In Non-randomized Studies?of Interventions (ROBINS-I) tool and the Critical Assessment Skills Programme (CASP) tool. Database searches identified 2885 articles, of which 15 were ultimately included for analysis. Results: A total of 17 trade-offs were identified impacting the design, development, and implementation of blockchain systems; these trade-offs are organized into themes, including business, application, data, and technology architecture. Conclusions: The key findings concluded the following: (1) multiple trade-offs can be managed adaptively to improve EMR utility; (2) multiple trade-offs involve improving the security of blockchain systems at the cost of other features, meaning EMR efficacy highly depends on data protection standards; and (3) multiple trade-offs result in improved blockchain scalability. Consideration of these trade-offs will be important to the specific environment in which electronic medical records are being developed. This review also uses its findings to suggest useful design choices for a hypothetical National Health Service blockchain. International Registered Report Identifier (IRRID): RR2-10.2196/10994 UR - https://www.jmir.org/2019/5/e12426/ UR - http://dx.doi.org/10.2196/12426 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094344 ID - info:doi/10.2196/12426 ER - TY - JOUR AU - Khoong, C. Elaine AU - Cherian, Roy AU - Matta, Y. George AU - Lyles, R. Courtney AU - Schillinger, Dean AU - Ratanawongsa, Neda PY - 2019/05/22 TI - Perspectives of English, Chinese, and Spanish-Speaking Safety-Net Patients on Clinician Computer Use: Qualitative Analysis JO - J Med Internet Res SP - e13131 VL - 21 IS - 5 KW - vulnerable populations KW - electronic health records KW - attitude to computers KW - physician-patient relations KW - communication barriers N2 - Background: Safety-net systems serve patients with limited health literacy and limited English proficiency (LEP) who face communication barriers. However, little is known about how diverse safety-net patients feel about increasing clinician electronic health record (EHR) use. Objective: The aim of this study was to better understand how safety-net patients, including those with LEP, view clinician EHR use. Methods: We conducted focus groups in English, Spanish, and Cantonese (N=37) to elicit patient perspectives on how clinicians use EHRs during clinic visits. Using a grounded theory approach, we coded transcripts to identify key themes. Results: Across multiple language groups, participants accepted multitasking and silent clinician EHR use if focused on their care. However, participants desired more screen share and eye contact, especially when demonstrating physical concerns. All participants, including LEP participants, wanted clinicians to include them in EHR use. Conclusions: Linguistically diverse patients accept the value of EHR use during outpatient visits but desire more eye contact, verbal warnings before EHR use, and screen-sharing. Safety-net health systems should support clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients. UR - http://www.jmir.org/2019/5/e13131/ UR - http://dx.doi.org/10.2196/13131 UR - http://www.ncbi.nlm.nih.gov/pubmed/31120020 ID - info:doi/10.2196/13131 ER - TY - JOUR AU - Motohashi, Tomomitsu AU - Hirano, Tomonobu AU - Okumura, Kosuke AU - Kashiyama, Makiko AU - Ichikawa, Daisuke AU - Ueno, Taro PY - 2019/05/16 TI - Secure and Scalable mHealth Data Management Using Blockchain Combined With Client Hashchain: System Design and Validation JO - J Med Internet Res SP - e13385 VL - 21 IS - 5 KW - mobile health KW - electronic health records KW - blockchain KW - client hashchain KW - clinical trial N2 - Background: Blockchain is emerging as an innovative technology for secure data management in many areas, including medical practice. A distributed blockchain network is tolerant against network fault, and the registered data are resistant to tampering and revision. The technology has a high affinity with digital medicine like mobile health (mHealth) and provides reliability to the medical data without labor-intensive third-party contributions. On the other hand, the reliability of the medical data is not insured before registration to the blockchain network. Furthermore, there are issues with regard to how the clients' mobile devices should be dealt with and authenticated in the blockchain network in order to avoid impersonation. Objective: The aim of the study was to design and validate an mHealth system that enables the compatibility of the security and scalability of the medical data using blockchain technology. Methods: We designed an mHealth system that sends medical data to the blockchain network via relay servers. The architecture provides scalability and convenience of operation of the system. In order to ensure the reliability of the data from clients' mobile devices, hash values with chain structure (client hashchain) were calculated in the clients' devices and the results were registered on the blockchain network. Results: The system was applied and deployed in mHealth for insomnia treatment. Clinical trials for mHealth were conducted with insomnia patients. Medical data of the recruited patients were successfully registered with the blockchain network via relay servers along with the hashchain calculated on the clients' mobile devices. The correctness of the data was validated by identifying illegal data, which were made by simulating fraudulent access. Conclusions: Our proposed mHealth system, blockchain combined with client hashchain, ensures compatibility of security and scalability in the data management of mHealth medical practice. Trial Registration: UMIN Clinical Trials Registry UMIN000032951; https://upload.umin.ac.jp/cgi-open- bin/ctr_e/ctr_view.cgi?recptno=R000037564 (Archived by WebCite at http://www.webcitation.org/78HP5iFIw) UR - http://www.jmir.org/2019/5/e13385/ UR - http://dx.doi.org/10.2196/13385 UR - http://www.ncbi.nlm.nih.gov/pubmed/31099337 ID - info:doi/10.2196/13385 ER - TY - JOUR AU - Fiske, Amelia AU - Henningsen, Peter AU - Buyx, Alena PY - 2019/05/09 TI - Your Robot Therapist Will See You Now: Ethical Implications of Embodied Artificial Intelligence in Psychiatry, Psychology, and Psychotherapy JO - J Med Internet Res SP - e13216 VL - 21 IS - 5 KW - artificial intelligence KW - robotics KW - ethics KW - psychiatry KW - psychology KW - psychotherapy KW - medicine N2 - Background: Research in embodied artificial intelligence (AI) has increasing clinical relevance for therapeutic applications in mental health services. With innovations ranging from ?virtual psychotherapists? to social robots in dementia care and autism disorder, to robots for sexual disorders, artificially intelligent virtual and robotic agents are increasingly taking on high-level therapeutic interventions that used to be offered exclusively by highly trained, skilled health professionals. In order to enable responsible clinical implementation, ethical and social implications of the increasing use of embodied AI in mental health need to be identified and addressed. Objective: This paper assesses the ethical and social implications of translating embodied AI applications into mental health care across the fields of Psychiatry, Psychology and Psychotherapy. Building on this analysis, it develops a set of preliminary recommendations on how to address ethical and social challenges in current and future applications of embodied AI. Methods: Based on a thematic literature search and established principles of medical ethics, an analysis of the ethical and social aspects of currently embodied AI applications was conducted across the fields of Psychiatry, Psychology, and Psychotherapy. To enable a comprehensive evaluation, the analysis was structured around the following three steps: assessment of potential benefits; analysis of overarching ethical issues and concerns; discussion of specific ethical and social issues of the interventions. Results: From an ethical perspective, important benefits of embodied AI applications in mental health include new modes of treatment, opportunities to engage hard-to-reach populations, better patient response, and freeing up time for physicians. Overarching ethical issues and concerns include: harm prevention and various questions of data ethics; a lack of guidance on development of AI applications, their clinical integration and training of health professionals; ?gaps? in ethical and regulatory frameworks; the potential for misuse including using the technologies to replace established services, thereby potentially exacerbating existing health inequalities. Specific challenges identified and discussed in the application of embodied AI include: matters of risk-assessment, referrals, and supervision; the need to respect and protect patient autonomy; the role of non-human therapy; transparency in the use of algorithms; and specific concerns regarding long-term effects of these applications on understandings of illness and the human condition. Conclusions: We argue that embodied AI is a promising approach across the field of mental health; however, further research is needed to address the broader ethical and societal concerns of these technologies to negotiate best research and medical practices in innovative mental health care. We conclude by indicating areas of future research and developing recommendations for high-priority areas in need of concrete ethical guidance. UR - https://www.jmir.org/2019/5/e13216/ UR - http://dx.doi.org/10.2196/13216 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094356 ID - info:doi/10.2196/13216 ER - TY - JOUR AU - Divakar, Ushashree AU - Nazeha, Nuraini AU - Posadzki, Pawel AU - Jarbrink, Krister AU - Bajpai, Ram AU - Ho, Yan Andy Hau AU - Campbell, James AU - Feder, Gene AU - Car, Josip PY - 2019/05/23 TI - Digital Education of Health Professionals on the Management of Domestic Violence: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration JO - J Med Internet Res SP - e13868 VL - 21 IS - 5 KW - systematic reviews KW - evidence-based KW - health workforce KW - domestic violence N2 - Background: The World Health Organization states that 35% of women experience domestic violence at least once during their lifetimes. However, approximately 80% of health professionals have never received any training on management of this major public health concern. Objective: The objective of this study was to evaluate the effectiveness of health professions digital education on domestic violence compared to that of traditional ways or no intervention. Methods: Seven electronic databases were searched for randomized controlled trials from January 1990 to August 2017. The Cochrane Handbook guideline was followed, and studies reporting the use of digital education interventions to educate health professionals on domestic violence management were included. Results: Six studies with 631 participants met our inclusion criteria. Meta-analysis of 5 studies showed that as compared to control conditions, digital education may improve knowledge (510 participants and 5 studies; standardized mean difference [SMD] 0.67, 95% CI 0.38-0.95; I2=59%; low certainty evidence), attitudes (339 participants and 3 studies; SMD 0.67, 95% CI 0.25-1.09; I2=68%; low certainty evidence), and self-efficacy (174 participants and 3 studies; SMD 0.47, 95% CI 0.16-0.77; I2=0%; moderate certainty evidence). Conclusions: Evidence of the effectiveness of digital education on health professionals? understanding of domestic violence is promising. However, the certainty of the evidence is predominantly low and merits further research. Given the opportunity of scaled transformative digital education, both further research and implementation within an evaluative context should be prioritized. UR - http://www.jmir.org/2019/5/e13868/ UR - http://dx.doi.org/10.2196/13868 UR - http://www.ncbi.nlm.nih.gov/pubmed/31124462 ID - info:doi/10.2196/13868 ER -