TY - JOUR AU - Yin, Kathleen AU - Laranjo, Liliana AU - Tong, Ly Huong AU - Lau, YS Annie AU - Kocaballi, Baki A. AU - Martin, Paige AU - Vagholkar, Sanjyot AU - Coiera, Enrico PY - 2019/06/17 TI - Context-Aware Systems for Chronic Disease Patients: Scoping Review JO - J Med Internet Res SP - e10896 VL - 21 IS - 6 KW - self-care KW - medical informatics KW - mobile applications KW - chronic disease KW - self-management N2 - Background: Context-aware systems, also known as context-sensitive systems, are computing applications designed to capture, interpret, and use contextual information and provide adaptive services according to the current context of use. Context-aware systems have the potential to support patients with chronic conditions; however, little is known about how such systems have been utilized to facilitate patient work. Objective: This study aimed to characterize the different tasks and contexts in which context-aware systems for patient work were used as well as to assess any existing evidence about the impact of such systems on health-related process or outcome measures. Methods: A total of 6 databases (MEDLINE, EMBASE, CINAHL, ACM Digital, Web of Science, and Scopus) were scanned using a predefined search strategy. Studies were included in the review if they focused on patients with chronic conditions, involved the use of a context-aware system to support patients? health-related activities, and reported the evaluation of the systems by the users. Studies were screened by independent reviewers, and a narrative synthesis of included studies was conducted. Results: The database search retrieved 1478 citations; 6 papers were included, all published from 2009 onwards. The majority of the papers were quasi-experimental and involved pilot and usability testing with a small number of users; there were no randomized controlled trials (RCTs) to evaluate the efficacy of a context-aware system. In the included studies, context was captured using sensors or self-reports, sometimes involving both. Most studies used a combination of sensor technology and mobile apps to deliver personalized feedback. A total of 3 studies examined the impact of interventions on health-related measures, showing positive results. Conclusions: The use of context-aware systems to support patient work is an emerging area of research. RCTs are needed to evaluate the effectiveness of context-aware systems in improving patient work, self-management practices, and health outcomes in chronic disease patients. UR - http://www.jmir.org/2019/6/e10896/ UR - http://dx.doi.org/10.2196/10896 UR - http://www.ncbi.nlm.nih.gov/pubmed/31210138 ID - info:doi/10.2196/10896 ER - TY - JOUR AU - Bjornestad, Jone AU - Hegelstad, Velden Wenche Ten AU - Berg, Henrik AU - Davidson, Larry AU - Joa, Inge AU - Johannessen, Olav Jan AU - Melle, Ingrid AU - Stain, J. Helen AU - Pallesen, Ståle PY - 2019/06/28 TI - Social Media and Social Functioning in Psychosis: A Systematic Review JO - J Med Internet Res SP - e13957 VL - 21 IS - 6 KW - psychosis KW - schizophrenia KW - social media KW - social functioning KW - measures KW - assessment KW - systematic review N2 - Background: Individuals with psychosis are heavy consumers of social media. It is unknown to what degree measures of social functioning include measures of online social activity. Objective: To examine the inclusion of social media activity in measures of social functioning in psychosis and ultrahigh risk (UHR) for psychosis. Methods: Two independent authors conducted a search using the following electronic databases: Epistemonikos, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE, Embase, and PsycINFO. The included articles were required to meet all of the following criteria: (1) an empirical study published in the English language in a peer-reviewed journal; (2) the study included a measure of objective or subjective offline (ie, non-Web-mediated contact) and/or online social functioning (ie, Web-mediated contact); (3) the social functioning measure had to be used in samples meeting criteria (ie, Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases) for a psychotic disorder or UHR for psychosis; and (4) the study was published between January 2004 and February 2019. Facebook was launched as the first large-scale social media platform in 2004 and, therefore, it is highly improbable that studies conducted prior to 2004 would have included measures of social media activity. Results: The electronic search resulted in 11,844 distinct articles. Full-text evaluation was conducted on 719 articles, of which 597 articles met inclusion criteria. A total of 58 social functioning measures were identified. With some exceptions, reports on reliability and validity were scarce, and only one measure integrated social media social activity. Conclusions: The ecological validity of social functioning measures is challenged by the lack of assessment of social media activity, as it fails to reflect an important aspect of the current social reality of persons with psychosis. Measures should be revised to include social media activity and thus avoid the clinical consequences of inadequate assessment of social functioning. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42017058514; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017058514 UR - http://www.jmir.org/2019/6/e13957/ UR - http://dx.doi.org/10.2196/13957 UR - http://www.ncbi.nlm.nih.gov/pubmed/31254338 ID - info:doi/10.2196/13957 ER - TY - JOUR AU - Colicchio, K. Tiago AU - Cimino, J. James AU - Del Fiol, Guilherme PY - 2019/06/03 TI - Unintended Consequences of Nationwide Electronic Health Record Adoption: Challenges and Opportunities in the Post-Meaningful Use Era JO - J Med Internet Res SP - e13313 VL - 21 IS - 6 KW - meaningful use KW - medical informatics applications KW - adoption UR - https://www.jmir.org/2019/6/e13313/ UR - http://dx.doi.org/10.2196/13313 UR - http://www.ncbi.nlm.nih.gov/pubmed/31162125 ID - info:doi/10.2196/13313 ER - TY - JOUR AU - Schofield, Penelope AU - Shaw, Tim AU - Pascoe, Michaela PY - 2019/06/04 TI - Toward Comprehensive Patient-Centric Care by Integrating Digital Health Technology With Direct Clinical Contact in Australia JO - J Med Internet Res SP - e12382 VL - 21 IS - 6 KW - health care KW - health KW - eHealth N2 - Background: There is an escalating crisis in health care, locally and internationally. The current health care model is unable to meet the increasing health care demands. Objective: The aim of this study was to reconceptualize the provision of health care to produce better outcomes at no greater cost, by placing individuals in the position of authority to direct their own care, in a personalized, integrated health care system. Methods: In this study, we used the Australian health care system as a model. We reviewed the current landscape of digital health in Australia and discussed how electronic medical records (EMRs) can be further developed into a personalized, integrated health care system. Results: Some components of an EMR and digital health system are already being used in Australia, but the systems are not linked. A personalized, integrated health care model that is responsive to consumer needs requires not just a passive repository of medical information; it would require a team approach, including the government, health care funders, industries, consumers and advocacy groups, health care professionals, community groups, and universities. Conclusions: Implementation of a personalized, integrated health care system can result in reduced pressure on the current health care system, and it can result in the delivery of best-practice health care, regardless of location. Importantly, a personalized, integrated health care system could serve as an education platform, ?upskilling? not only clinicians but also, more importantly, patients and carers by providing them with accurate information about their condition, treatment options, medications, and management strategies. By proposing personalized, integrated health care, we offer an intelligent model of health care that is ubiquitous, efficient, and continuously improving. UR - https://www.jmir.org/2019/6/e12382/ UR - http://dx.doi.org/10.2196/12382 UR - http://www.ncbi.nlm.nih.gov/pubmed/31165713 ID - info:doi/10.2196/12382 ER - TY - JOUR AU - Yu, Xiaochu AU - Han, Wei AU - Jiang, Jingmei AU - Wang, Yipeng AU - Xin, Shijie AU - Wu, Shizheng AU - Sun, Hong AU - Wang, Zixing AU - Zhao, Yupei PY - 2019/06/24 TI - Key Issues in the Development of an Evidence-Based Stratified Surgical Patient Safety Improvement Information System: Experience From a Multicenter Surgical Safety Program JO - J Med Internet Res SP - e13576 VL - 21 IS - 6 KW - surgery KW - patient safety KW - information system KW - risk factors KW - evidence-based practice UR - http://www.jmir.org/2019/6/e13576/ UR - http://dx.doi.org/10.2196/13576 UR - http://www.ncbi.nlm.nih.gov/pubmed/31237241 ID - info:doi/10.2196/13576 ER - TY - JOUR AU - Sawyer, Alyssa AU - Kaim, Amy AU - Le, Huynh-Nhu AU - McDonald, Denise AU - Mittinty, Murthy AU - Lynch, John AU - Sawyer, Michael PY - 2019/06/04 TI - The Effectiveness of an App-Based Nurse-Moderated Program for New Mothers With Depression and Parenting Problems (eMums Plus): Pragmatic Randomized Controlled Trial JO - J Med Internet Res SP - e13689 VL - 21 IS - 6 KW - mobile phone KW - infant KW - mother-child relations KW - postnatal depression KW - randomized controlled trial N2 - Background: Postnatal depression and caregiving difficulties adversely affect mothers, infants, and later childhood development. In many countries, resources to help mothers and infants are limited. Online group?based nurse-led interventions have the potential to help address this problem by providing large numbers of mothers with access to professional and peer support during the postnatal period. Objective: This study tested the effectiveness of a 4-month online group?based nurse-led intervention delivered when infants were aged 2 to 6 months as compared with standard care outcomes. Methods: The study was a block randomized control trial. Mothers were recruited at the time they were contacted for the postnatal health check offered to all mothers in South Australia. Those who agreed to participate were randomly assigned to the intervention or standard care. The overall response rate was 63.3% (133/210). Primary outcomes were the level of maternal depressive symptoms assessed with the Edinburgh Postnatal Depression Scale (EPDS) and quality of maternal caregiving assessed using the Parenting Stress Index (PSI; competence and attachment subscales), the Parenting Sense of Competence Scale (PSCS), and the Nursing Child Assessment Satellite Training Scale. Assessments were completed at baseline (mean child age 4.9 weeks [SD 1.4]) and again when infants were aged 8 and 12 months. Results: Outcomes were evaluated using linear generalized estimating equations adjusting for postrandomization group differences in demographic characteristics and the outcome score at baseline. There were no significant differences in the intervention and standard care groups in scores on the PSI competence subscale (P=.69) nor in the PSCS (P=.11). Although the group by time interaction suggested there were differences over time between the EPDS and PSI attachment subscale scores in the intervention and standard care groups (P=.001 and P=.04, respectively), these arose largely because the intervention group had stable scores over time whereas the standard care group showed some improvements between baseline and 12 months. Mothers engaged well with the intervention with at least 60% (43/72) of mothers logging-in once per week during the first 11 weeks of the intervention. The majority of mothers also rated the intervention as helpful and user-friendly. Conclusions: Mothers reported that the intervention was helpful, and the app was described as easy to use. As such, it appears that support for mothers during the postnatal period, provided using mobile phone technology, has the potential to be an important addition to existing services. Possible explanations for the lack of differences in outcomes for the 2 groups in this study are the failure of many mothers to use key components of the intervention and residual differences between the intervention and standard care groups post randomization. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001732471; http://www.ANZCTR.org.au/ACTRN12616001732471.aspx (archived on WebCite as http://www.webcitation.org/77zo30GDw) UR - https://www.jmir.org/2019/6/e13689/ UR - http://dx.doi.org/10.2196/13689 UR - http://www.ncbi.nlm.nih.gov/pubmed/31165715 ID - info:doi/10.2196/13689 ER - TY - JOUR AU - Danaher, G. Brian AU - Tyler, S. Milagra AU - Crowley, C. Ryann AU - Brendryen, Håvar AU - Seeley, R. John PY - 2019/06/06 TI - Outcomes and Device Usage for Fully Automated Internet Interventions Designed for a Smartphone or Personal Computer: The MobileQuit Smoking Cessation Randomized Controlled Trial JO - J Med Internet Res SP - e13290 VL - 21 IS - 6 KW - tobacco KW - smoking KW - internet KW - eHealth KW - mHealth KW - smartphone KW - device N2 - Background: Many best practice smoking cessation programs use fully automated internet interventions designed for nonmobile personal computers (desktop computers, laptops, and tablets). A relatively small number of smoking cessation interventions have been designed specifically for mobile devices such as smartphones. Objective: This study examined the efficacy and usage patterns of two internet-based best practices smoking cessation interventions. Methods: Overall, 1271 smokers who wanted to quit were randomly assigned to (1) MobileQuit (designed for?and constrained its use to?mobile devices, included text messaging, and embodied tunnel information architecture) or (2) QuitOnline (designed for nonmobile desktop or tablet computers, did not include text messages, and used a flexible hybrid matrix-hierarchical information architecture). Primary outcomes included self-reported 7-day point-prevalence smoking abstinence at 3- and 6-month follow-up assessments. Program visits were unobtrusively assessed (frequency, duration, and device used for access). Results: Significantly more MobileQuit participants than QuitOnline participants reported quitting smoking. Abstinence rates using intention-to-treat analysis were 20.7% (131/633) vs 11.4% (73/638) at 3 months, 24.6% (156/633) vs 19.3% (123/638) at 6 months, and 15.8% (100/633) vs 8.8% (56/638) for both 3 and 6 months. Using Complete Cases, MobileQuit?s advantage was significant at 3 months (45.6% [131/287] vs 28.4% [73/257]) and the combined 3 and 6 months (40.5% [100/247] vs 25.9% [56/216]) but not at 6 months (43.5% [156/359] vs 34.4% [123/329]). Participants in both conditions reported their program was usable and helpful. MobileQuit participants visited their program 5 times more frequently than did QuitOnline participants. Consistent with the MobileQuit?s built-in constraint, 89.46% (8820/9859) of its visits were made on an intended mobile device, whereas 47.72% (691/1448) of visits to QuitOnline used an intended nonmobile device. Among MobileQuit participants, 76.0% (459/604) used only an intended mobile device, 23.0% (139/604) used both mobile and nonmobile devices, and 0.1% (6/604) used only a nonmobile device. Among QuitOnline participants, 31.3% (137/438) used only the intended nonmobile devices, 16.7% (73/438) used both mobile and nonmobile devices, and 52.1% (228/438) used only mobile devices (primarily smartphones). Conclusions: This study provides evidence for optimizing intervention design for smartphones over a usual care internet approach in which interventions are designed primarily for use on nonmobile devices such as desktop computers, laptops. or tablets. We propose that future internet interventions should be designed for use on all of the devices (multiple screens) that users prefer. We forecast that the approach of designing internet interventions for mobile vs nonmobile devices will be replaced by internet interventions that use a single Web app designed to be responsive (adapt to different screen sizes and operating systems), share user data across devices, embody a pervasive information architecture, and complemented by text message notifications. Trial Registration: ClinicalTrials.gov NCT01952236; https://clinicaltrials.gov/ct2/show/NCT01952236 (Archived by WebCite at http://www.webcitation.org/6zdSxqbf8) UR - https://www.jmir.org/2019/6/e13290/ UR - http://dx.doi.org/10.2196/13290 UR - http://www.ncbi.nlm.nih.gov/pubmed/31172967 ID - info:doi/10.2196/13290 ER - TY - JOUR AU - Stragier, Jeroen AU - Vandewiele, Gilles AU - Coppens, Paulien AU - Ongenae, Femke AU - Van den Broeck, Wendy AU - De Turck, Filip AU - De Marez, Lieven PY - 2019/06/07 TI - Data Mining in the Development of Mobile Health Apps: Assessing In-App Navigation Through Markov Chain Analysis JO - J Med Internet Res SP - e11934 VL - 21 IS - 6 KW - eHealth KW - mHealth KW - Markov Chain KW - log data KW - data analytics N2 - Background: Mobile apps generate vast amounts of user data. In the mobile health (mHealth) domain, researchers are increasingly discovering the opportunities of log data to assess the usage of their mobile apps. To date, however, the analysis of these data are often limited to descriptive statistics. Using data mining techniques, log data can offer significantly deeper insights. Objective: The purpose of this study was to assess how Markov Chain and sequence clustering analysis can be used to find meaningful usage patterns of mHealth apps. Methods: Using the data of a 25-day field trial (n=22) of the Start2Cycle app, an app developed to encourage recreational cycling in adults, a transition matrix between the different pages of the app was composed. From this matrix, a Markov Chain was constructed, enabling intuitive user behavior analysis. Results: Through visual inspection of the transitions, 3 types of app use could be distinguished (route tracking, gamification, and bug reporting). Markov Chain?based sequence clustering was subsequently used to demonstrate how clusters of session types can otherwise be obtained. Conclusions: Using Markov Chains to assess in-app navigation presents a sound method to evaluate use of mHealth interventions. The insights can be used to evaluate app use and improve user experience. UR - https://www.jmir.org/2019/6/e11934/ UR - http://dx.doi.org/10.2196/11934 UR - http://www.ncbi.nlm.nih.gov/pubmed/31237838 ID - info:doi/10.2196/11934 ER - TY - JOUR AU - Eichenberg, Christiane AU - Schott, Markus PY - 2019/6/10 TI - Use of Web-Based Health Services in Individuals With and Without Symptoms of Hypochondria: Survey Study JO - J Med Internet Res SP - e10980 VL - 21 IS - 6 KW - hypochondria KW - eHealth KW - anxiety KW - survey N2 - Background: An increasing number of people consult physicians because of distressing information found online. Cyberchondria refers to the phenomenon of health anxiety because of online health information. Objective: This study aimed to examine online health research of individuals with and without symptoms of hypochondria and their impact on health anxiety as well as behavior. Methods: An online survey was conducted. Demographic data, health-related internet use, and general health behavior were assessed. The illness attitude scale was used to record symptoms of hypochondria. Results: The final sample consisted of N=471 participants. More than 40% (188/471) of participants showed at least some symptoms of hypochondria. Participants with symptoms of hypochondria used the internet more frequently for health-related purposes and also frequented more online services than individuals without symptoms. Most online health services were rated as more reliable by individuals with symptoms of hypochondria. Changes to behavior such as doctor hopping or ordering nonprescribed medicine online were considered more likely by individuals with symptoms of hypochondria. Conclusions: Results show that individuals with symptoms of hypochondria do not turn to online research as a result of lacking alternatives but rather consult health services on- as well as offline. UR - https://www.jmir.org/2019/6/e10980/ UR - http://dx.doi.org/10.2196/10980 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199311 ID - info:doi/10.2196/10980 ER - TY - JOUR AU - Moberg, Christine AU - Niles, Andrea AU - Beermann, Dale PY - 2019/6/8 TI - Guided Self-Help Works: Randomized Waitlist Controlled Trial of Pacifica, a Mobile App Integrating Cognitive Behavioral Therapy and Mindfulness for Stress, Anxiety, and Depression JO - J Med Internet Res SP - e12556 VL - 21 IS - 6 KW - mHealth KW - anxiety KW - depression KW - stress KW - cognitive behavioral therapy KW - smartphone app N2 - Background: Despite substantial improvements in technology and the increased demand for technology-enabled behavioral health tools among consumers, little progress has been made in easing the burden of mental illness. This may be because of the inherent challenges of conducting traditional clinical trials in a rapidly evolving technology landscape. Objective: This study sought to validate the effectiveness of Pacifica, a popular commercially available app for the self-management of mild-to-moderate stress, anxiety, and depression. Methods: A total of 500 adults with mild-to-moderate anxiety or depression were recruited from in-app onboarding to participate in a randomized waitlist controlled trial of Pacifica. We conducted an all-virtual study, recruiting, screening, and randomizing participants through a Web-based participant portal. Study participants used the app for 1 month, with no level of use required, closely mimicking real-world app usage. Participants in the waitlist group were given access to the app after 1 month. Measurements included self-reported symptoms of stress, anxiety, depression, and self-efficacy. We performed an intent-to-treat analysis to examine the interactive effects of time and condition. Results: We found significant interactions between time and group. Participants in the active condition demonstrated significantly greater decreases in depression, anxiety, and stress and increases in self-efficacy. Although we did not find a relationship between overall engagement with the app and symptom improvement, participants who completed relatively more thought record exercises sustained improvements in their symptoms through the 2-month follow-up to a greater degree than those who completed fewer. In addition, we found that participants who reported concomitantly taking psychiatric medications during the trial benefitted less from the app, as measured by the symptoms of anxiety and stress. Conclusions: This study provides evidence that Pacifica, a popular commercially available self-help app, is effective in reducing self-reported symptoms of depression, anxiety, and stress, particularly among individuals who utilize thought records and are not taking psychiatric medication. Trial Registration: ClinicalTrials.gov NCT03333707; https://clinicaltrials.gov/ct2/show/NCT03333707 (Archived by WebCite at http://www.webcitation.org/78YE07ADB) UR - https://www.jmir.org/2019/6/e12556/ UR - http://dx.doi.org/10.2196/12556 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199319 ID - info:doi/10.2196/12556 ER - TY - JOUR AU - Sanders, A. Christopher AU - Schueller, M. Stephen AU - Parks, C. Acacia AU - Howell, T. Ryan PY - 2019/6/8 TI - Understanding Long-Term Trajectories in Web-Based Happiness Interventions: Secondary Analysis From Two Web-Based Randomized Trials JO - J Med Internet Res SP - e13253 VL - 21 IS - 6 KW - cluster analysis KW - depression KW - happiness KW - random allocation N2 - Background: A critical issue in understanding the benefits of Web-based interventions is the lack of information on the sustainability of those benefits. Sustainability in studies is often determined using group-level analyses that might obscure our understanding of who actually sustains change. Person-centric methods might provide a deeper knowledge of whether benefits are sustained and who tends to sustain those benefits. Objective: The aim of this study was to conduct a person-centric analysis of longitudinal outcomes, examining well-being in participants over the first 3 months following a Web-based happiness intervention. We predicted we would find distinct trajectories in people?s pattern of response over time. We also sought to identify what aspects of the intervention and the individual predicted an individual?s well-being trajectory. Methods: Data were gathered from 2 large studies of Web-based happiness interventions: one in which participants were randomly assigned to 1 of 14 possible 1-week activities (N=912) and another wherein participants were randomly assigned to complete 0, 2, 4, or 6 weeks of activities (N=1318). We performed a variation of K-means cluster analysis on trajectories of life satisfaction (LS) and affect balance (AB). After clusters were identified, we used exploratory analyses of variance and logistic regression models to analyze groups and compare predictors of group membership. Results: Cluster analysis produced similar cluster solutions for each sample. In both cases, participant trajectories in LS and AB fell into 1 of 4 distinct groups. These groups were as follows: those with high and static levels of happiness (n=118, or 42.8%, in Sample 1; n=306, or 52.8%, in Sample 2), those who experienced a lasting improvement (n=74, or 26.8% in Sample 1; n=104, or 18.0%, in Sample 2), those who experienced a temporary improvement but returned to baseline (n=37, or 13.4%, in Sample 1; n=82, or 14.2%, in Sample 2), and those with other trajectories (n=47, or 17.0%, in Sample 1; n=87, or 15.0% in Sample 2). The prevalence of depression symptoms predicted membership in 1 of the latter 3 groups. Higher usage and greater adherence predicted sustained rather than temporary benefits. Conclusions: We revealed a few common patterns of change among those completing Web-based happiness interventions. A noteworthy finding was that many individuals began quite happy and maintained those levels. We failed to identify evidence that the benefit of any particular activity or group of activities was more sustainable than any others. We did find, however, that the distressed portion of participants was more likely to achieve a lasting benefit if they continued to practice, and adhere to, their assigned Web-based happiness intervention. UR - http://www.jmir.org/2019/6/e13253/ UR - http://dx.doi.org/10.2196/13253 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199342 ID - info:doi/10.2196/13253 ER - TY - JOUR AU - Zwerenz, Rüdiger AU - Baumgarten, Carlotta AU - Dahn, Ingo AU - Labitzke, Nicole AU - Schwarting, Andreas AU - Rudolph, Matthias AU - Ferdinand, Peter AU - Dederichs-Masius, Ute AU - Beutel, E. Manfred PY - 2019/06/18 TI - Implementation of a Web-Based Work-Related Psychological Aftercare Program Into Clinical Routine: Results of a Longitudinal Observational Study JO - J Med Internet Res SP - e12285 VL - 21 IS - 6 KW - aftercare KW - internet KW - mental health KW - psychotherapeutic processes KW - return to work KW - occupational stress KW - health plan implementation N2 - Background: As inpatient medical rehabilitation serves to promote work ability, vocational reintegration is a crucial outcome. However, previous Web-based trials on coping with work-related stress have been limited to Web-based recruitment of study participants. Objective: The aim of our study was to evaluate the implementation of an empirically supported transdiagnostic psychodynamic Web-based aftercare program GSA (Gesund und Stressfrei am Arbeitsplatz [Healthy and stress-less at the workplace])-Online plus into the clinical routine of inpatient medical rehabilitation, to identify characteristics of patients who have received the recommendation for GSA-Online plus, and to determine helpfulness of the intervention and satisfaction of the participants as well as improvement in quality of life and mental health status of the regular users of GSA-Online plus. Methods: GSA-Online plus was prescribed by physicians at termination of orthopedic psychosomatic inpatient rehabilitation. Participants? use of the program, work-related attitudes, distress, and quality of life were assessed on the Web. Results: In 2 rehabilitation centers, 4.4% (112/2562) of rehabilitants got a recommendation for GSA-Online plus during inpatient rehabilitation. Compared with usual person aftercare, the Web-based aftercare program was rarely recommended by physicians. Recommendations were made more frequently in psychosomatic (69/1172, 5.9%) than orthopedic (43/1389, 3.1%) rehabilitation (?21=11.845, P=.001, Cramér V=?0.068) and to younger patients (P=.004, d=0.28) with longer inpatient treatment duration (P<.001, r=?0.12) and extended sick leaves before inpatient medical rehabilitation (P=.004; Cramér V=0.072). Following recommendation, 77% (86/112) of rehabilitants participated in Web-based aftercare. Completers (50/86, 58%) reported statistically significant improvements between discharge of inpatient treatment and the end of the aftercare program for subjective work ability (P=.02, d=0.41), perceived stress (P=.01, d=?0.38), functioning (P=.002, d=?0.60), and life satisfaction (P=.008, d=0.42). Conclusions: Physicians? recommendations of Web-based aftercare are well accepted by patients who derive considerable benefits from participation. However, a low rate of prescription compared with other usual aftercare options points to barriers among physicians to prescribing Web-based aftercare. UR - http://www.jmir.org/2019/6/e12285/ UR - http://dx.doi.org/10.2196/12285 UR - http://www.ncbi.nlm.nih.gov/pubmed/31215515 ID - info:doi/10.2196/12285 ER - TY - JOUR AU - Watson, L. Noreen AU - Heffner, L. Jaimee AU - Mull, E. Kristin AU - McClure, B. Jennifer AU - Bricker, B. Jonathan PY - 2019/06/19 TI - Comparing Treatment Acceptability and 12-Month Cessation Rates in Response to Web-Based Smoking Interventions Among Smokers Who Do and Do Not Screen Positive for Affective Disorders: Secondary Analysis JO - J Med Internet Res SP - e13500 VL - 21 IS - 6 KW - smoking KW - smoking cessation KW - affective disorders KW - anxiety KW - depression KW - eHealth KW - Web intervention KW - co-occurring disorders N2 - Background: Web-based cessation programs are now common for intervening with smokers. However, it remains unclear how acceptable or effective these interventions are among people with affective disorders and symptoms (ADS; eg, depression and anxiety). Research examining this is extremely limited, with mixed results on cessation rates. Additional large studies are needed to more fully understand whether Web-based interventions are similarly used and equally effective among people with and without affective disorder symptomology. If not, more targeted Web-based interventions may be required. Objective: The goal of the research was to compare Web-based treatment acceptability (defined by satisfaction and use) and 12-month cessation outcomes between smokers with and without ADS. Methods: Participants (N=2512) were adult smokers enrolled in a randomized, comparative effectiveness trial of two Web-based smoking interventions designed for the general population of smokers. At baseline, participants reported demographic and smoking characteristics and completed measures assessing ADS. Participants were then classified into subgroups based on their self-reported ADS?either into a no ADS group or into six nonmutually exclusive subgroups: depression, posttraumatic stress disorder (PTSD), panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and more than one ADS. Surveys at 12 months postrandomization included subjective ratings of treatment acceptability and self-reported smoking cessation. Treatment use (ie, number of log-ins and total duration of exposure) was assessed via automated records. Results: Relative to the no ADS group, all six ADS subgroups reported significantly greater satisfaction with their assigned Web treatment program, but they spent less time logged in than those with no ADS. For number of log-ins, a treatment arm by ADS group interaction was observed across all ADS subgroups except GAD, suggesting that relative to the no ADS group, they logged in less to one website but not the other. At the 12-month follow-up, abstinence rates in the no ADS group (153/520, 29.42%) were significantly higher than for participants who screened positive for depression (306/1267, 24.15%; P=.03), PTSD (294/1215, 24.19%; P=.03), PD (229/1003, 23.83%; P=.009), and two or more ADS (323/1332, 24.25%; P=.03). Post hoc analyses suggest the lower quit rates may be associated with differences in baseline nicotine dependence and levels of commitment to resist smoking in difficult situations. Website use did not explain the differential abstinence rates. Conclusions: Despite reporting higher levels of treatment satisfaction, most smokers with ADS used their assigned intervention less often and had lower quit rates than smokers with no ADS at treatment onset. The results support the need for developing more targeted interventions for smokers with ADS. Trial registration: Clinical Trials.gov NCT01812278; https://clinicaltrials.gov/ct2/show/NCT01812278 (Archived by WebCite at http://www.webcitation.org/78L9cNdG4) UR - https://www.jmir.org/2019/6/e13500/ UR - http://dx.doi.org/10.2196/13500 UR - http://www.ncbi.nlm.nih.gov/pubmed/31219052 ID - info:doi/10.2196/13500 ER - TY - JOUR AU - Neil-Sztramko, E. Sarah AU - Smith-Turchyn, Jenna AU - Richardson, Julie AU - Dobbins, Maureen PY - 2019/06/20 TI - A Mobility-Focused Knowledge Translation Randomized Controlled Trial to Improve Physical Activity: Process Evaluation of the Move4Age Study JO - J Med Internet Res SP - e13965 VL - 21 IS - 6 KW - process evaluation KW - physical activity KW - health information KW - mobility KW - older adults KW - knowledge translation N2 - Background: Maintaining physical activity and physical function is important for healthy aging. We recently completed a randomized controlled trial of a targeted knowledge translation (KT) intervention delivered through the McMaster Optimal Aging Portal with the goal to increase physical activity and physical mobility in middle-aged and older adults, with results reported elsewhere. Objective: The purpose of this process evaluation study is to explore which KT strategies were used by both intervention and control group participants, as well as the intervention groups? engagement, satisfaction, and perceived usefulness of the targeted KT intervention. Methods: Data on engagement with the intervention materials were gathered quantitatively through Google Analytics and Hootsuite throughout the intervention. Qualitative data were collected through a combination of open-ended surveys and qualitative interviews with a subset of participants at the end of the study to further understand engagement, satisfaction, and usefulness of the KT strategies. Results: Throughout the intervention period, engagement with content delivered through weekly emails was highest, and participants rated email content most favorably in both surveys and interviews. Participants were generally satisfied with the intervention, noting the ease of participating and the distillation of information in an easy-to-access format being beneficial features. Participants who did not find the intervention useful were those with already high levels of baseline physical activity or physical function and those who were looking for more specific or individualized content. Conclusions: This process evaluation provides insight into our randomized controlled trial findings and provides information that can be used to improve future online KT interventions. Trial Registration: ClinicalTrials.gov NCT02947230; https://clinicaltrials.gov/ct2/show/nct02947230 (Archived by WebCite at http://www.webcitation.org/78t4tR8tM) UR - http://www.jmir.org/2019/6/e13965/ UR - http://dx.doi.org/10.2196/13965 UR - http://www.ncbi.nlm.nih.gov/pubmed/31223121 ID - info:doi/10.2196/13965 ER - TY - JOUR AU - Rockwood, Kenneth AU - Sanon Aigbogun, Myrlene AU - Stanley, Justin AU - Wong, Helen AU - Dunn, Taylor AU - Chapman, T. Chère A. AU - Howlett, E. Susan AU - Miguelez, Maia AU - McGarrigle, Lisa AU - Baker, A. Ross PY - 2019/06/28 TI - The Symptoms Targeted for Monitoring in a Web-Based Tracking Tool by Caregivers of People With Dementia and Agitation: Cross-Sectional Study JO - J Med Internet Res SP - e13360 VL - 21 IS - 6 KW - Alzheimer disease KW - dementia KW - agitation KW - neuropsychiatric symptoms KW - internet KW - caregiver N2 - Background: In people with dementia, neuropsychiatric symptoms (NPSs), especially agitation, are associated with worse quality of life and caregiver burden. As NPSs may vary with illness severity, knowledge of how people with dementia and their caregivers describe and rate the importance of agitation symptoms can improve the understanding of the clinical meaningfulness of the manifestations of agitation. The internet provides new opportunities to better understand patient experiences, as patients and caregivers increasingly look to Web-based platforms as a means of managing symptoms. Objective: The aim of this study was to examine Web-based reports from a dementia symptom website to better understand the symptoms of agitation and explore how they are being targeted for monitoring by caregivers of people with dementia. Methods: The Dementia Guide website hosts a Web-based database used by caregivers (97%) and people with dementia (3%). From its 61 dementia symptoms, users can select relevant symptoms that they deem important to monitor or track the effects of treatment. We employed a staging algorithm to determine if individuals had mild cognitive impairment (MCI) or mild, moderate, or severe dementia. Agitation was defined using terms consistent with the International Psychogeriatrics Association?s provisional consensus definition. We compared the proportion of people with NPSs and agitation across stages of dementia severity and studied how many agitation-defining descriptors were selected, and how often they occurred, by stage. Results: As of March 2017, 4121 people had used the tracking tool, of whom 2577 provided sufficient data to allow disease severity staging. NPSs were tracked by 2127/2577 (82.54%) and agitation by 1898/2577 (73.65%). The proportion in whom agitation was tracked increased with increasing cognitive impairment: 68.5% (491/717) in people with MCI, and 72.50% (754/1040), 73.3% (378/516), and 90.5% (275/304) in mild, moderate, and severe dementia, respectively (?23=54.9; P<.001). The number of NPS and agitation descriptors selected also increased with severity (median number of NPSs=1, 2, 2, and 3 for MCI, mild, moderate, and severe dementia, respectively, Kruskal-Wallis H Test H3=250.47; P<.001; median number of agitation descriptors=1, 2, 3, and 4, H3=146.11; P<.001). Conclusions: NPSs and agitation are common targets for tracking over the course of dementia and appear more frequently with increasing disease severity. These common and distressing symptoms represent clinically meaningful targets in treating people with dementia. UR - https://www.jmir.org/2019/6/e13360/ UR - http://dx.doi.org/10.2196/13360 UR - http://www.ncbi.nlm.nih.gov/pubmed/31254339 ID - info:doi/10.2196/13360 ER - TY - JOUR AU - Balakrishnan, S. Ashwin AU - Nguyen, G. Hao AU - Shinohara, Katsuto AU - Au Yeung, Reuben AU - Carroll, R. Peter AU - Odisho, Y. Anobel PY - 2019/6/2 TI - A Mobile Health Intervention for Prostate Biopsy Patients Reduces Appointment Cancellations: Cohort Study JO - J Med Internet Res SP - e14094 VL - 21 IS - 6 KW - text messaging KW - appointments and schedules KW - mHealth KW - quality improvement KW - urology KW - prostate neoplasm N2 - Background: Inadequate patient education and preparation for office-based procedures often leads to delayed care, poor patient satisfaction, and increased costs to the health care system. We developed and deployed a mobile health (mHealth) reminder and education program for patients scheduled for transrectal prostate biopsy. Objective: We aimed to evaluate the impact of an mHealth reminder and education program on appointment cancellation rates, communication frequency, and patient satisfaction. Methods: We developed a text message (SMS, short message service)?based program with seven reminders containing links to Web-based content and surveys sent over an 18-day period (14 days before through 3 days after prostate biopsy). Messages contained educational content, reminders, and readiness questionnaires. Demographic information, appointment cancellations or change data, and patient/provider communication events were collected for 6 months before and after launching the intervention. Patient satisfaction was evaluated in the postintervention cohort. Results: The preintervention (n=473) and postintervention (n=359) cohorts were composed of men of similar median age and racial/ethnic distribution living a similar distance from clinic. The postintervention cohort had significantly fewer canceled or rescheduled appointments (33.8% vs 21.2%, P<.001) and fewer same-day cancellations (3.8% vs 0.5%, P<.001). There was a significant increase in preprocedural telephone calls (0.6 vs 0.8 calls per patient, P=.02) in the postintervention cohort, but not a detectable change in postprocedural calls. The mean satisfaction with the program was 4.5 out of 5 (SD 0.9). Conclusions: An mHealth periprocedural outreach program significantly lowered appointment cancellation and rescheduling and was associated with high patient satisfaction scores with a slight increase in preprocedural telephone calls. This led to fewer underused procedure appointments and high patient satisfaction. UR - https://www.jmir.org/2019/6/e14094/ UR - http://dx.doi.org/10.2196/14094 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199294 ID - info:doi/10.2196/14094 ER - TY - JOUR AU - Pérez-Jover, Virtudes AU - Sala-González, Marina AU - Guilabert, Mercedes AU - Mira, Joaquín José PY - 2019/06/18 TI - Mobile Apps for Increasing Treatment Adherence: Systematic Review JO - J Med Internet Res SP - e12505 VL - 21 IS - 6 KW - mobile health KW - medication alert systems KW - medication adherence N2 - Background: It is estimated that 20% to 50% of patients do not take their medication correctly, and this leads to increased morbidity and inefficacy of therapeutic approaches. Fostering treatment adherence is a priority objective for all health systems. The growth of mobile apps to facilitate therapeutic adherence has significantly increased in recent years. However, the effectiveness of the apps for this purpose has not been evaluated. Objective: This study aimed to analyze whether mobile apps are perceived as useful for managing medication at home and if they actually contribute to increasing treatment adherence in patients. Methods: We carried out a systematic review of research published using Scopus, Cochrane Library, ProQuest, and MEDLINE databases and analyzed the information about their contribution to increasing therapeutic adherence and the perceived usefulness of mobile apps. This review examined studies published between 2000 and 2017. Results: Overall, 11 studies fulfilled the inclusion criteria. The sample sizes of these studies varied between 16 and 99 participants. In addition, 7 studies confirmed that the mobile app increased treatment adherence. In 5 of them, the before and after adherence measures suggested significant statistical improvements, when comparing self-reported adherence and missed dose with a percentage increase ranging between 7% and 40%. The users found mobile apps easy to use and useful for managing their medication. The patients were mostly satisfied with their use, with an average score of 8.1 out of 10. Conclusions: The use of mobile apps helps increase treatment adherence, and they are an appropriate method for managing medication at home. UR - http://www.jmir.org/2019/6/e12505/ UR - http://dx.doi.org/10.2196/12505 UR - http://www.ncbi.nlm.nih.gov/pubmed/31215517 ID - info:doi/10.2196/12505 ER - TY - JOUR AU - Chu, Kar-Hai AU - Majmundar, Anuja AU - Allem, Jon-Patrick AU - Soto, W. Daniel AU - Cruz, Boley Tess AU - Unger, B. Jennifer PY - 2019/06/04 TI - Tobacco Use Behaviors, Attitudes, and Demographic Characteristics of Tobacco Opinion Leaders and Their Followers: Twitter Analysis JO - J Med Internet Res SP - e12676 VL - 21 IS - 6 KW - tobacco KW - social media KW - online social networking KW - peer influence KW - social networking N2 - Background: Tobacco-related content on social media is generated and propagated by opinion leaders on the Web who disseminate messages to others in their network, including followers, who then continue to spread the information. Opinion leaders can exert powerful influences on their followers? knowledge, attitudes, and behaviors; yet, little is known about the demographic characteristics and tobacco use behavior of tobacco opinion leaders on the Web and their followers, compared with general Twitter users. Objective: In this study, we hypothesized that opinion leaders use more tobacco products and have higher nicotine dependence than the other 2 groups (eg, followers and general Twitter users) and that followers?those who spread messages by opinion leaders?would more likely be in demographic groups that are vulnerable to tobacco marketing influence (eg, young adults and lower educational attainment). Methods: We constructed the social networks of people who tweet about tobacco and categorized them using a combination of social network and Twitter metrics. To understand the characteristics of tobacco opinion leaders and their followers, we conducted a survey of tobacco opinion leaders, their followers, and general Twitter users. The sample included 347 opinion leaders, 567 followers, and 519 general users. The opinion leaders had a median of 1000 followers, whereas followers and general users had fewer than 600 followers. Results: Opinion leaders were more likely than their followers to report past month use of tobacco products; followers, in turn, were more likely to report past month use of these products than general Twitter users. The followers appeared to be an especially vulnerable group; they tended to be younger (mean age 22.4 years) and have lower education compared with the opinion leaders and general users. Conclusions: Followers of Twitter tobacco opinion leaders are a vulnerable group that might benefit from antitobacco education to counter the protobacco communications they see on social media. UR - https://www.jmir.org/2019/6/e12676/ UR - http://dx.doi.org/10.2196/12676 UR - http://www.ncbi.nlm.nih.gov/pubmed/31165716 ID - info:doi/10.2196/12676 ER - TY - JOUR AU - Malik, S. Faisal AU - Panlasigui, Neil AU - Gritton, Jesse AU - Gill, Harsimrat AU - Yi-Frazier, P. Joyce AU - Moreno, A. Megan PY - 2019/5/30 TI - Adolescent Perspectives on the Use of Social Media to Support Type 1 Diabetes Management: Focus Group Study JO - J Med Internet Res SP - e12149 VL - 21 IS - 6 KW - type 1 diabetes KW - adolescents KW - social media KW - qualitative research N2 - Background: A majority of adolescents report the use of some form of social media, and many prefer to communicate via social networking sites. Social media may offer new opportunities in diabetes management, particularly in terms of how health care teams provide tailored support and treatment to adolescents with diabetes. Objective: The aim of this study was to explore the experiences and perspectives of adolescents with type 1 diabetes on the feasibility of social media use as a tool to collaboratively manage their diabetes with their diabetes care team. Methods: Focus groups of adolescents with type 1 diabetes were conducted in the Seattle metropolitan area in Washington State. Semistructured questions were used to elicit views around the preferred means of communication with the adolescents? diabetes care team, how to best support diabetes self-management, and how social media could be used outside of the clinic setting by the diabetes care team to engage with adolescents with type 1 diabetes. Focus groups were audio recorded and transcribed verbatim. Qualitative content analysis was carried out, and emergent themes were subsequently mapped onto 4 domains of feasibility, which included acceptability, demand, implementation, and practicality. Results: Participants included 45 adolescents with type 1 diabetes (mean age 15.9, SD 1.7 years; 58% male; diabetes duration mean 6.2, SD 3.6 years; 76% on insulin pumps; 49% wore continuous glucose monitors; 93% reported use of social media; 84% used smartphones as the primary means for social media access). A total of 7 major topics were identified and mapped onto areas consistent with our focus on feasibility. For acceptability and demand, participants expressed how communication over social media could help facilitate (1) improved communication outside of clinic visits to optimize diabetes management, (2) independence in diabetes self-management, (3) connection to other youth with diabetes for additional diabetes support, and (4) delivery of more timely and personalized care. Addressing implementation and practicality, participants shared the need to (1) ensure patient privacy, (2) maintain professional nature of provider-patient relationship, and (3) recognize that social media is not currently used for medical care by youth with diabetes. Conclusions: Adolescents with type 1 diabetes expressed interest in the use of social media as a tool to support diabetes management and increase engagement with their diabetes care team. Specific implementation measures around privacy and professionalism should be considered when developing a social media intervention to facilitate communication between adolescents and care teams. UR - https://www.jmir.org/2019/6/e12149/ UR - http://dx.doi.org/10.2196/12149 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199310 ID - info:doi/10.2196/12149 ER - TY - JOUR AU - Shimoga, V. Sandhya AU - Erlyana, Erlyana AU - Rebello, Vida PY - 2019/06/18 TI - Associations of Social Media Use With Physical Activity and Sleep Adequacy Among Adolescents: Cross-Sectional Survey JO - J Med Internet Res SP - e14290 VL - 21 IS - 6 KW - adolescent KW - social media KW - exercise KW - sleep N2 - Background: Adolescents? use of social media, which has increased considerably in the past decade, has both positive and negative influences on adolescents? health and health behaviors. As social media is the most prominent communication tool of choice for adolescents, it is important to understand the relationship between the frequency of social media use and health behaviors among this population. Objective: The objective of our study was to examine the associations between the frequency of social media use and physical activity and sleep adequacy among middle and high school students. Methods: We used data from the Monitoring the Future survey (2014 and 2015), a nationally representative, annual, cross-sectional survey of American 8th-, 10th-, and 12th-grade students (N=43,994). Health behaviors examined were frequency of vigorous physical activity and frequency of getting 7 hours of sleep (never/seldom, sometimes, and every day/nearly every day). We measured frequency of social media use using a Likert-like scale (never, a few times a year, 1-2 times a month, once a week, or every day). Multivariable generalized ordered logistic regressions examined the association of social media use with different levels of physical activity and sleep. We estimated marginal effects (MEs) for the main independent variable (social media use frequency) by holding all other variables at their observed values. Results: The study population comprised 51.13% (21,276/42,067) female students, 37.48% (17,160/43,994) from the South, and 80.07% (34,953/43,994) from a metropolitan area, with 76.90% (33,831/43,994) reporting using social media every day. Among physically active students, frequent social media use was associated with a higher likelihood of vigorous daily exercise (ME 50.1%, 95% CI 49.2%-51.0%). Among sedentary students, frequent social media use was associated with a lower likelihood of vigorous daily exercise (ME 15.8%, 95% CI 15.1%-16.4%). Moderately active students who used social media once or twice a month had the highest likelihood of reporting vigorous daily exercise (ME 42.0%, 95% CI 37.6%-46.3%). Among those who normally got adequate sleep, daily social media users were least likely to report adequate sleep (ME 41.3%, 95% CI 40.4%-42.1%). Among those who were usually sleep deprived, daily social media users were more likely to report adequate sleep (ME 18.3%, 95% CI 17.6%-19.0%). Conclusions: Regular social media use every day was associated with a reinforcement of health behaviors at both extremes of health behaviors, whereas a medium intensity of social media use was associated with the highest levels of physical activity and lowest sleep adequacy among those with moderate health behaviors. Hence, finding an optimal level of social media use that is beneficial to a variety of health behaviors would be most beneficial to adolescents who are in the middle of the health behavior spectrum. UR - http://www.jmir.org/2019/6/e14290/ UR - http://dx.doi.org/10.2196/14290 UR - http://www.ncbi.nlm.nih.gov/pubmed/31215512 ID - info:doi/10.2196/14290 ER - TY - JOUR AU - Pearson, Carly AU - Swindale, Rosanna AU - Keighley, Peter AU - McKinlay, Ruth Alison AU - Ridsdale, Leone PY - 2019/06/19 TI - Not Just a Headache: Qualitative Study About Web-Based Self-Presentation and Social Media Use by People With Migraine JO - J Med Internet Res SP - e10479 VL - 21 IS - 6 KW - migraine KW - internet KW - social media KW - eHealth KW - social support KW - self-management KW - qualitative research N2 - Background: To help with a long-term but invisible medical condition such as migraine, many people seek information and support on social media. The effect of using social media for people with migraine is not fully understood and remains to be investigated. Objective: The aim of this study was to describe how people with migraine use social media and how social media use affects their identity and sense of self. Methods: A total of 20 participants who experienced migraine were recruited via migraine-specific charities. Semistructured interviews were conducted with questions based on a topic guide. Interviews were transcribed verbatim, and transcripts were analyzed using thematic analysis. Results: People with migraine are using social media to obtain information to better understand their condition and treatment options. Social media offers instant access to continuous information and social support. This exchange of social support and information was viewed as mutually beneficial. Participants viewed social media as an outlet to vent frustrations and validate the migraine experience. Several participants pointed out that the invisible and episodic nature of migraine can lead to societal misunderstanding of the impact and or severity of their condition. Some participants masked their online migraine-related behavior using different sites or closed online groups to control who saw their migraine-related content. Participating in closed social media groups sometimes changed Web-based behavior in other areas of the platform. This illustrates the complex relationship between migraine, social media, and identity. Conclusions: How migraine is part of an individual?s identity and how this is represented online can vary. Social media can provide people who experience migraine with instant and continuous access to support and information, from a group of empathic others with similar lived experiences. Social media is used to validate the illness experience, as well as provide reassurance and help reduce feelings of isolation. UR - http://www.jmir.org/2019/6/e10479/ UR - http://dx.doi.org/10.2196/10479 UR - http://www.ncbi.nlm.nih.gov/pubmed/31219049 ID - info:doi/10.2196/10479 ER - TY - JOUR AU - Cho, Hyunyi AU - Li, Wenbo AU - Shen, Lijiang AU - Cannon, Julie PY - 2019/06/27 TI - Mechanisms of Social Media Effects on Attitudes Toward E-Cigarette Use: Motivations, Mediators, and Moderators in a National Survey of Adolescents JO - J Med Internet Res SP - e14303 VL - 21 IS - 6 KW - adolescents KW - e-cigarettes KW - motivation KW - affordances KW - agency KW - realism KW - self-expression KW - social comparison KW - social learning KW - social media KW - filter KW - uses and gratifications N2 - Background: Exposure to risk behavior on social media is associated with risk behavior tendencies among adolescents, but research on the mechanisms underlying the effects of social media exposure is sparse. Objective: This study aimed to investigate the motivations of social media use and the mediating and moderating mechanisms of their effects on attitude toward electronic cigarette (e-cigarette) use among adolescents. Methods: Using data from a national sample survey of adolescents (age=14-17 years, N=594), we developed and validated a social media use motivation scale. We examined the roles of motivations in the effect of social media use on risk exposure and risk attitude. Results: Motivations for social media use included agency, self-expression, realism, social learning, social comparison, and filter. These motivations were associated differentially with the frequency of use of Facebook, Instagram, Snapchat, and YouTube. Frequency of social media use was positively associated with exposure to e-cigarette messages across the four platforms (Ps<.001). Exposure to e-cigarette messages on Instagram (P=.005) and Snapchat (P=.03) was positively associated with attitude toward e-cigarette use. Perceived social media realism moderated the effects of e-cigarette message exposure such that when realism was high, the exposure effect was amplified, but when realism was low, the effect was mitigated (P<.001). A three-way interaction effect (P=.02) among exposure, social learning motivation, and social norm on attitude toward e-cigarette use was found. When perceived social norm was high, the moderating effect of social learning motivation on e-cigarette use attitude was amplified, but when social norm was low, the social learning motivation effect was attenuated. Conclusions: Because perceived social media realism moderates the effect of exposure to e-cigarette messages on attitude toward e-cigarette use, future intervention efforts should address the realism perceptions. The three-way interaction among exposure, social learning motivation, and social norm indicates the importance of addressing both the online and offline social environments of adolescents. The social media use motivation scale, reflecting perceived affordances, is broadly applicable. Understanding social media use motivations is important, as they indirectly influence attitude toward e-cigarette use via frequency of social media use and/or frequency of exposure to e-cigarette messages on social media. UR - http://www.jmir.org/2019/6/e14303/ UR - http://dx.doi.org/10.2196/14303 UR - http://www.ncbi.nlm.nih.gov/pubmed/31250830 ID - info:doi/10.2196/14303 ER - TY - JOUR AU - Liu, Sam AU - Chen, Brian AU - Kuo, Alex PY - 2019/06/03 TI - Monitoring Physical Activity Levels Using Twitter Data: Infodemiology Study JO - J Med Internet Res SP - e12394 VL - 21 IS - 6 KW - physical activity KW - social media KW - internet KW - Twitter messaging KW - population surveillance KW - public health N2 - Background: Social media technology such as Twitter allows users to share their thoughts, feelings, and opinions online. The growing body of social media data is becoming a central part of infodemiology research as these data can be combined with other public health datasets (eg, physical activity levels) to provide real-time monitoring of psychological and behavior outcomes that inform health behaviors. Currently, it is unclear whether Twitter data can be used to monitor physical activity levels. Objective: The aim of this study was to establish the feasibility of using Twitter data to monitor physical activity levels by assessing whether the frequency and sentiment of physical activity?related tweets were associated with physical activity levels across the United States. Methods: Tweets were collected from Twitter?s application programming interface (API) between January 10, 2017 and January 2, 2018. We used Twitter's garden hose method of collecting tweets, which provided a random sample of approximately 1% of all tweets with location metadata falling within the United States. Geotagged tweets were filtered. A list of physical activity?related hashtags was collected and used to further classify these geolocated tweets. Twitter data were merged with physical activity data collected as part of the Behavioral Risk Factor Surveillance System. Multiple linear regression models were fit to assess the relationship between physical activity?related tweets and physical activity levels by county while controlling for population and socioeconomic status measures. Results: During the study period, 442,959,789 unique tweets were collected, of which 64,005,336 (14.44%) were geotagged with latitude and longitude coordinates. Aggregated data were obtained for a total of 3138 counties in the United States. The mean county-level percentage of physically active individuals was 74.05% (SD 5.2) and 75.30% (SD 4.96) after adjusting for age. The model showed that the percentage of physical activity?related tweets was significantly associated with physical activity levels (beta=.11; SE 0.2; P<.001) and age-adjusted physical activity (beta=.10; SE 0.20; P<.001) on a county level while adjusting for both Gini index and education level. However, the overall explained variance of the model was low (R2=.11). The sentiment of the physical activity?related tweets was not a significant predictor of physical activity level and age-adjusted physical activity on a county level after including the Gini index and education level in the model (P>.05). Conclusions: Social media data may be a valuable tool for public health organizations to monitor physical activity levels, as it can overcome the time lag in the reporting of physical activity epidemiology data faced by traditional research methods (eg, surveys and observational studies). Consequently, this tool may have the potential to help public health organizations better mobilize and target physical activity interventions. UR - https://www.jmir.org/2019/6/e12394/ UR - http://dx.doi.org/10.2196/12394 UR - http://www.ncbi.nlm.nih.gov/pubmed/31162126 ID - info:doi/10.2196/12394 ER - TY - JOUR AU - On, Jeongah AU - Park, Hyeoun-Ae AU - Song, Tae-Min PY - 2019/6/7 TI - Sentiment Analysis of Social Media on Childhood Vaccination: Development of an Ontology JO - J Med Internet Res SP - e13456 VL - 21 IS - 6 KW - social media KW - vaccination KW - health information interoperability KW - semantics N2 - Background: Although vaccination rates are above the threshold for herd immunity in South Korea, a growing number of parents have expressed concerns about the safety of vaccines. It is important to understand these concerns so that we can maintain high vaccination rates. Objective: The aim of this study was to develop a childhood vaccination ontology to serve as a framework for collecting and analyzing social data on childhood vaccination and to use this ontology for identifying concerns about and sentiments toward childhood vaccination from social data. Methods: The domain and scope of the ontology were determined by developing competency questions. We checked if existing ontologies and conceptual frameworks related to vaccination can be reused for the childhood vaccination ontology. Terms were collected from clinical practice guidelines, research papers, and posts on social media platforms. Class concepts were extracted from these terms. A class hierarchy was developed using a top-down approach. The ontology was evaluated in terms of description logics, face and content validity, and coverage. In total, 40,359 Korean posts on childhood vaccination were collected from 27 social media channels between January and December 2015. Vaccination issues were identified and classified using the second-level class concepts of the ontology. The sentiments were classified in 3 ways: positive, negative or neutral. Posts were analyzed using frequency, trend, logistic regression, and association rules. Results: Our childhood vaccination ontology comprised 9 superclasses with 137 subclasses and 431 synonyms for class, attribute, and value concepts. Parent?s health belief appeared in 53.21% (15,709/29,521) of posts and positive sentiments appeared in 64.08% (17,454/27,236) of posts. Trends in sentiments toward vaccination were affected by news about vaccinations. Posts with parents? health belief, vaccination availability, and vaccination policy were associated with positive sentiments, whereas posts with experience of vaccine adverse events were associated with negative sentiments. Conclusions: The childhood vaccination ontology developed in this study was useful for collecting and analyzing social data on childhood vaccination. We expect that practitioners and researchers in the field of childhood vaccination could use our ontology to identify concerns about and sentiments toward childhood vaccination from social data. UR - http://www.jmir.org/2019/6/e13456/ UR - http://dx.doi.org/10.2196/13456 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199290 ID - info:doi/10.2196/13456 ER - TY - JOUR AU - Leis, Angela AU - Ronzano, Francesco AU - Mayer, A. Miguel AU - Furlong, I. Laura AU - Sanz, Ferran PY - 2019/06/27 TI - Detecting Signs of Depression in Tweets in Spanish: Behavioral and Linguistic Analysis JO - J Med Internet Res SP - e14199 VL - 21 IS - 6 KW - depression KW - social media KW - mental health KW - text mining N2 - Background: Mental disorders have become a major concern in public health, and they are one of the main causes of the overall disease burden worldwide. Social media platforms allow us to observe the activities, thoughts, and feelings of people?s daily lives, including those of patients suffering from mental disorders. There are studies that have analyzed the influence of mental disorders, including depression, in the behavior of social media users, but they have been usually focused on messages written in English. Objective: The study aimed to identify the linguistic features of tweets in Spanish and the behavioral patterns of Twitter users who generate them, which could suggest signs of depression. Methods: This study was developed in 2 steps. In the first step, the selection of users and the compilation of tweets were performed. A total of 3 datasets of tweets were created, a depressive users dataset (made up of the timeline of 90 users who explicitly mentioned that they suffer from depression), a depressive tweets dataset (a manual selection of tweets from the previous users, which included expressions indicative of depression), and a control dataset (made up of the timeline of 450 randomly selected users). In the second step, the comparison and analysis of the 3 datasets of tweets were carried out. Results: In comparison with the control dataset, the depressive users are less active in posting tweets, doing it more frequently between 23:00 and 6:00 (P<.001). The percentage of nouns used by the control dataset almost doubles that of the depressive users (P<.001). By contrast, the use of verbs is more common in the depressive users dataset (P<.001). The first-person singular pronoun was by far the most used in the depressive users dataset (80%), and the first- and the second-person plural pronouns were the least frequent (0.4% in both cases), this distribution being different from that of the control dataset (P<.001). Emotions related to sadness, anger, and disgust were more common in the depressive users and depressive tweets datasets, with significant differences when comparing these datasets with the control dataset (P<.001). As for negation words, they were detected in 34% and 46% of tweets in among depressive users and in depressive tweets, respectively, which are significantly different from the control dataset (P<.001). Negative polarity was more frequent in the depressive users (54%) and depressive tweets (65%) datasets than in the control dataset (43.5%; P<.001). Conclusions: Twitter users who are potentially suffering from depression modify the general characteristics of their language and the way they interact on social media. On the basis of these changes, these users can be monitored and supported, thus introducing new opportunities for studying depression and providing additional health care services to people with this disorder. UR - http://www.jmir.org/2019/6/e14199/ UR - http://dx.doi.org/10.2196/14199 UR - http://www.ncbi.nlm.nih.gov/pubmed/31250832 ID - info:doi/10.2196/14199 ER - TY - JOUR AU - Li, Yumei AU - Yan, Xiangbin AU - Song, Xiaolong PY - 2019/06/03 TI - Provision of Paid Web-Based Medical Consultation in China: Cross-Sectional Analysis of Data From a Medical Consultation Website JO - J Med Internet Res SP - e12126 VL - 21 IS - 6 KW - e-consultation KW - medical service KW - fee KW - China N2 - Background: Web-based medical consultation, which has been adopted by patients in many countries, requires a large number of doctors to provide services. However, no study has provided an overall picture of the doctors who provide online services. Objective: This study sought to examine doctors? participation in medical consultation practice in an online consultation platform. This paper aimed to address the following questions: (1) which doctors provide Web-based consultation services, (2) how many patients do the doctors get online, and (3) what price do they charge. We further explored the development of market segments in various departments and various provinces. Methods: This study explored the dataset including all doctors providing consultation services in their spare time on a Chinese Web-based consultation platform. We also brought in statistics for doctors providing offline consultations in China. We made use of Bonferroni multiple comparison procedures and z test to compare doctors in each group. Results: There are 88,308 doctors providing Web-based consultation in their spare time on Haodf, accounting for 5.25% (88,308/1,680,062) of all doctors in China as of September 23, 2017. Of these online doctors, 49.9% (44,066/88,308) are high-quality doctors having a title of chief physician or associate chief physician, and 84.8% (74,899/88,308) come from the top, level 3, hospitals. Online doctors had an average workload of 0.38 patients per doctor per day, with an online and offline ratio of 1:14. The average price of online consultation is ¥32.3. The online ratios for the cancer, internal medicine, ophthalmology-otorhinolaryngology, psychiatry, gynecology-obstetrics-pediatrics, dermatology, surgery, and traditional Chinese medicine departments are 16.1% (2,983/18,481), 4.4% (16,231/372,974), 6.3% (8,389/132,725), 9.5% (1,600/16,801), 5.8% (12,955/225,128), 18.0% (3,334/18,481), 10.8% (24,030/223,448), and 3.8% (8,393/22,3448), respectively. Most provinces located in eastern China have more than 4000 doctors online. The online workloads for doctors from most provinces range from 0.3 to 0.4 patients per doctor per day. In most provinces, doctors? charges range from ¥20 to ¥30. Conclusions: Quality doctors are more likely to provide Web-based consultation services, get more patients, and charge higher service fees in an online consultation platform. Policies and promotions could attract more doctors to provide Web-based consultation. The online submarket for the departments of dermatology, psychiatry, and gynecology-obstetrics-pediatrics developed better than other departments such as internal medicine and traditional Chinese medicine. The result could be a reference for policy making to improve the medical system both online and offline. As all the data used for analysis were from a single website, the data might be biased and might not be a representative national sample of China. UR - https://www.jmir.org/2019/6/e12126/ UR - http://dx.doi.org/10.2196/12126 UR - http://www.ncbi.nlm.nih.gov/pubmed/31162129 ID - info:doi/10.2196/12126 ER - TY - JOUR AU - Quinn, Connolly Charlene AU - Chard, Sarah AU - Roth, G. Erin AU - Eckert, Kevin J. AU - Russman, M. Katharine AU - Cross, K. Raymond PY - 2019/06/03 TI - The Telemedicine for Patients With Inflammatory Bowel Disease (TELE-IBD) Clinical Trial: Qualitative Assessment of Participants? Perceptions JO - J Med Internet Res SP - e14165 VL - 21 IS - 6 KW - inflammatory bowel diseases KW - Crohn disease KW - ulcerative colitis KW - qualitative research KW - telemedicine N2 - Background: Inflammatory bowel disease (IBD), comprising Crohn disease and ulcerative colitis, affects 1 to 3 million people in the United States. Telemedicine has shown promise in IBD. The objective of this study, telemedicine for patients with IBD (TELE-IBD), was to compare disease activity and quality of life (QoL) in a 1-year randomized clinical trial of IBD patients receiving telemedicine versus standard care. Treatment groups experienced improvements in disease activity and QoL, but there were no significant differences between groups. Study adherence to the text-based intervention was less than 80%, the targeted goal. Objective: To understand adherence to remote monitoring, the goal of this qualitative assessment was to obtain TELE-IBD trial participants? perceptions, including their recommendations for future monitoring. Methods: In this study, patients attending 3 tertiary referral centers with worsening IBD symptoms in the previous 2 years were eligible for randomization to remote monitoring via SMS text messages (short message service, SMS) every other week, weekly, or standard care. Participants (n=348) were evenly enrolled in the treatment groups, and 259 (74.4%) completed the study. For this study, a purposive sample of adherent (N=15) and nonadherent (N=14) patients was drawn from the TELE-IBD trial population. Adherence was defined as the completion of 80% (278/348) or more of the weekly or every other week self-assessments. Semistructured interviews conducted by phone surveyed (1) the strengths and benefits of TELE-IBD, (2) challenges associated with using TELE-IBD, and (3) how to improve the TELE-IBD intervention. Interviews were recorded, professionally transcribed, and coded based on a priori concepts and emergent themes with the aid of ATLAS.ti, version.7 qualitative data analysis software. Results: Participants' discussions centered on 3 elements of the intervention: (1) self-assessment questions, (2) action plans, and (3) educational messages. Participants also commented on text-based platform, depression and adherence, TELE-IBD system in place of office visit, and their recommendations for future TELE-IBD systems. Adherent and nonadherent participants prefer a flexible system that is personalized, including targeted education messages, and they perceive the intervention as effective in facilitating IBD self-management. Conclusions: Participants identified clear benefits to the TELE-IBD system, including obtaining a better understanding of the disease process, monitoring their symptoms, and feeling connected to their health care provider. Participants? perceptions obtained in this qualitative study will assist in improving the TELE-IBD system to be more responsive to patients with IBD. UR - https://www.jmir.org/2019/6/e14165/ UR - http://dx.doi.org/10.2196/14165 UR - http://www.ncbi.nlm.nih.gov/pubmed/31162128 ID - info:doi/10.2196/14165 ER - TY - JOUR AU - Yang, Rebecca AU - Vigod, N. Simone AU - Hensel, M. Jennifer PY - 2019/5/20 TI - Optional Web-Based Videoconferencing Added to Office-Based Care for Women Receiving Psychotherapy During the Postpartum Period: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e13172 VL - 21 IS - 6 KW - mental health KW - psychotherapy KW - postpartum period KW - videoconferencing N2 - Background: Depression and anxiety during the postpartum period are common, with psychotherapy often being the preferred method of treatment. However, psychological, physical, and social barriers prevent women from receiving appropriate and timely psychotherapy. The option of receiving psychotherapy through videoconferencing (VC) during the postpartum period presents an opportunity for more accessible and flexible care. Objective: The aim of this study was to assess the feasibility, acceptability, and preliminary effectiveness of optional VC added to usual office-based psychotherapy, with a psychotherapist during the postpartum period. Methods: We conducted a pilot randomized controlled trial with 1:1 randomization to office-based care (treatment as usual; TAU) or office-based care with the option of VC (treatment as usual plus videoconferencing; TAU-VC) for psychotherapy during the postpartum period. We assessed the ability to recruit and retain postpartum women into the study from an urban perinatal mental health program offering postpartum psychotherapy, and we evaluated the uptake, acceptability, and satisfaction with VC as an addition to in-person psychotherapy. We also compared therapy attendance using therapist logs and symptoms between treatment groups. Symptoms were assessed at baseline and 3 months postrandomization with the Edinburgh Postnatal Depression Scale, Generalized Anxiety Disorder 7-item, and Parental Stress Scale. Furthermore, 3-month scores were compared between groups with intention-to-treat linear mixed-effects models controlling for baseline score. Results: We enrolled 38 participants into the study, with 19 participants in each treatment group. Attendance data were available for all participants, with follow-up symptom measures available for 25 out of 38 participants (66%). Among the 19 TAU-VC participants, 14 participants (74%) utilized VC at least once. Most participants were highly satisfied with the VC option, and they reported average savings of Can $26 and 2.5 hours in travel and childcare expenses and time per appointment. There were no significant differences between the 2 groups for psychotherapy attendance or symptoms. Conclusions: The option of VC appears to be an acceptable method of receiving psychotherapy for postpartum women, with benefits described in costs and time savings. On the basis of this small pilot sample, there were no significant differences in outcomes between office-based care with or without the option of VC. This study has demonstrated the feasibility of such a program in an urban center, which suggests that a larger study would be beneficial to provide evidence that is more conclusive. UR - https://www.jmir.org/2019/6/e13172/ UR - http://dx.doi.org/10.2196/13172 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199291 ID - info:doi/10.2196/13172 ER - TY - JOUR AU - Greenberg-Worisek, J. Alexandra AU - Kurani, Shaheen AU - Finney Rutten, J. Lila AU - Blake, D. Kelly AU - Moser, P. Richard AU - Hesse, W. Bradford PY - 2019/06/24 TI - Tracking Healthy People 2020 Internet, Broadband, and Mobile Device Access Goals: An Update Using Data From the Health Information National Trends Survey JO - J Med Internet Res SP - e13300 VL - 21 IS - 6 KW - Healthy People 2020 KW - digital divide KW - internet N2 - Background: As the year 2020 approaches, there is a need to evaluate progress toward the United States government?s Healthy People 2020 (HP2020) health information technology and communication objectives to establish baselines upon which Healthy People 2030 objectives can be based. Objective: The aim of this study was to use the National Cancer Institute?s (NCI) Health Information National Trends Survey (HINTS) to benchmark progress toward HP2020 goals related to increasing internet access using broadband, and to assess the state of the digital divide for various sociodemographic groups. Methods: We merged and analyzed data from 8 administrations of HINTS (2003-2017). Descriptive statistics were generated, and predicted marginals were calculated using interaction terms between survey year and selected sociodemographic variables of interest, including age, sex, race and ethnicity, income, education, and geography (rural versus urban), to test for differential change over time. Results: The number of users having access to the internet increased between 2003 and 2014 (63.15% [3982/6358] to 83.41% [2802/3629]); it remained relatively steady from 2014 to 2017 (81.15% [2533/3283]). Broadband access increased between 2003 and 2011 (from 32.83% [1031/3352] to 77.87% [3375/4405]), but has been declining since (55.93% [1364/2487] in 2017). Access via cellular network increased between 2008 and 2017 (from 6.86% [240/4405] to 65.43% [1436/2489]). Statistically significant disparities in overall internet access were noted in the predicted marginals for age, sex, race and ethnicity, income, and education; for age, sex, income, and geography for broadband access; and for age and sex for cellular network. Conclusions: The targets set forth in HP2020 were met for overall internet access and for internet access via cellular network; however, the target was not met for internet access via broadband. Furthermore, although the digital divide persisted by sociodemographic characteristics, the magnitude of many disparities in access decreased over time. UR - http://www.jmir.org/2019/6/e13300/ UR - http://dx.doi.org/10.2196/13300 UR - http://www.ncbi.nlm.nih.gov/pubmed/31237238 ID - info:doi/10.2196/13300 ER - TY - JOUR AU - Luz, Friedemann Christian AU - Berends, S. Matthijs AU - Dik, H. Jan-Willem AU - Lokate, Mariëtte AU - Pulcini, Céline AU - Glasner, Corinna AU - Sinha, Bhanu PY - 2019/5/24 TI - Rapid Analysis of Diagnostic and Antimicrobial Patterns in R (RadaR): Interactive Open-Source Software App for Infection Management and Antimicrobial Stewardship JO - J Med Internet Res SP - e12843 VL - 21 IS - 6 KW - antimicrobial stewardship KW - software KW - hospital records KW - data visualization KW - infection, medical informatics applications N2 - Background: Analyzing process and outcome measures for all patients diagnosed with an infection in a hospital, including those suspected of having an infection, requires not only processing of large datasets but also accounting for numerous patient parameters and guidelines. Substantial technical expertise is required to conduct such rapid, reproducible, and adaptable analyses; however, such analyses can yield valuable insights for infection management and antimicrobial stewardship (AMS) teams. Objective: The aim of this study was to present the design, development, and testing of RadaR (Rapid analysis of diagnostic and antimicrobial patterns in R), a software app for infection management, and to ascertain whether RadaR can facilitate user-friendly, intuitive, and interactive analyses of large datasets in the absence of prior in-depth software or programming knowledge. Methods: RadaR was built in the open-source programming language R, using Shiny, an additional package to implement Web-app frameworks in R. It was developed in the context of a 1339-bed academic tertiary referral hospital to handle data of more than 180,000 admissions. Results: RadaR enabled visualization of analytical graphs and statistical summaries in a rapid and interactive manner. It allowed users to filter patient groups by 17 different criteria and investigate antimicrobial use, microbiological diagnostic use and results including antimicrobial resistance, and outcome in length of stay. Furthermore, with RadaR, results can be stratified and grouped to compare defined patient groups on the basis of individual patient features. Conclusions: AMS teams can use RadaR to identify areas within their institutions that might benefit from increased support and targeted interventions. It can be used for the assessment of diagnostic and therapeutic procedures and for visualizing and communicating analyses. RadaR demonstrated the feasibility of developing software tools for use in infection management and for AMS teams in an open-source approach, thus making it free to use and adaptable to different settings. UR - https://www.jmir.org/2019/6/e12843/ UR - http://dx.doi.org/10.2196/12843 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199325 ID - info:doi/10.2196/12843 ER - TY - JOUR AU - Zhang, Zhongxing AU - Cajochen, Christian AU - Khatami, Ramin PY - 2019/5/11 TI - Social Jetlag and Chronotypes in the Chinese Population: Analysis of Data Recorded by Wearable Devices JO - J Med Internet Res SP - e13482 VL - 21 IS - 6 KW - chronotypes KW - social jetlag KW - wearable devices KW - nap KW - cardiopulmonary coupling KW - sleep KW - big data N2 - Background: Chronotype is the propensity for a person to sleep at a particular time during 24 hours. It is largely regulated by the circadian clock but constrained by work obligations to a specific sleep schedule. The discrepancy between biological and social time can be described as social jetlag (SJL), which is highly prevalent in modern society and associated with health problems. SJL and chronotypes have been widely studied in Western countries but have never been described in China. Objective: We characterized the chronotypes and SJL in mainland China objectively by analyzing a database of Chinese sleep-wake pattern recorded by up-to-date wearable devices. Methods: We analyzed 71,176 anonymous Chinese people who were continuously recorded by wearable devices for at least one week between April and July in 2017. Chronotypes were assessed (N=49,573) by the adjusted mid-point of sleep on free days (MSFsc). Early, intermediate, and late chronotypes were defined by arbitrary cut-offs of MSFsc <3 hours, between 3-5 hours, and >5 hours. In all subjects, SJL was calculated as the difference between mid-points of sleep on free days and work days. The correlations between SJL and age/body mass index/MSFsc were assessed by Pearson correlation. Random forest was used to characterize which factors (ie, age, body mass index, sex, nocturnal and daytime sleep durations, and exercise) mostly contribute to SJL and MSFsc. Results: The mean total sleep duration of this Chinese sample is about 7 hours, with females sleeping on average 17 minutes longer than males. People taking longer naps sleep less during the night, but they have longer total 24-hour sleep durations. MSFsc follows a normal distribution, and the percentages of early, intermediate, and late chronotypes are approximately 26.76% (13,266/49,573), 58.59% (29,045/49,573), and 14.64% (7257/49,573). Adolescents are later types compared to adults. Age is the most important predictor of MSFsc suggested by our random forest model (relative feature importance: 0.772). No gender differences are found in chronotypes. We found that SJL follows a normal distribution and 17.07% (12,151/71,176) of Chinese have SJL longer than 1 hour. Nearly a third (22,442/71,176, 31.53%) of Chinese have SJL<0. The results showed that 53.72% (7127/13,266), 25.46% (7396/29,045), and 12.71% (922/7257) of the early, intermediate, and late chronotypes have SJL<0, respectively. SJL correlates with MSFsc (r=0.54, P<.001) but not with body mass index (r=0.004, P=.30). Random forest model suggests that age, nocturnal sleep, and daytime nap durations are the features contributing to SJL (their relative feature importance is 0.441, 0.349, and 0.204, respectively). Conclusions: Our data suggest a higher proportion of early compared to late chronotypes in Chinese. Chinese have less SJL than the results reported in European populations, and more than half of the early chronotypes have negative SJL. In the Chinese population, SJL is not associated with body mass index. People of later chronotypes and long sleepers suffer more from SJL. UR - https://www.jmir.org/2019/6/e13482/ UR - http://dx.doi.org/10.2196/13482 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199292 ID - info:doi/10.2196/13482 ER - TY - JOUR AU - Li, Jiawei AU - Xu, Qing AU - Shah, Neal AU - Mackey, K. Tim PY - 2019/6/15 TI - A Machine Learning Approach for the Detection and Characterization of Illicit Drug Dealers on Instagram: Model Evaluation Study JO - J Med Internet Res SP - e13803 VL - 21 IS - 6 KW - opioids KW - social media KW - narcotics KW - substance abuse KW - machine learning KW - internet KW - prescription drug abuse KW - artificial intelligence N2 - Background: Social media use is now ubiquitous, but the growth in social media communications has also made it a convenient digital platform for drug dealers selling controlled substances, opioids, and other illicit drugs. Previous studies and news investigations have reported the use of popular social media platforms as conduits for opioid sales. This study uses deep learning to detect illicit drug dealing on the image and video sharing platform Instagram. Objective: The aim of this study was to develop and evaluate a machine learning approach to detect Instagram posts related to illegal internet drug dealing. Methods: In this paper, we describe an approach to detect drug dealers by using a deep learning model on Instagram. We collected Instagram posts using a Web scraper between July 2018 and October 2018 and then compared our deep learning model against 3 different machine learning models (eg, random forest, decision tree, and support vector machine) to assess the performance and accuracy of the model. For our deep learning model, we used the long short-term memory unit in the recurrent neural network to learn the pattern of the text of drug dealing posts. We also manually annotated all posts collected to evaluate our model performance and to characterize drug selling conversations. Results: From the 12,857 posts we collected, we detected 1228 drug dealer posts comprising 267 unique users. We used cross-validation to evaluate the 4 models, with our deep learning model reaching 95% on F1 score and performing better than the other 3 models. We also found that by removing the hashtags in the text, the model had better performance. Detected posts contained hashtags related to several drugs, including the controlled substance Xanax (1078/1228, 87.78%), oxycodone/OxyContin (321/1228, 26.14%), and illicit drugs lysergic acid diethylamide (213/1228, 17.34%) and 3,4-methylenedioxy-methamphetamine (94/1228, 7.65%). We also observed the use of communication applications for suspected drug trading through user comments. Conclusions: Our approach using a combination of Web scraping and deep learning was able to detect illegal online drug sellers on Instagram, with high accuracy. Despite increased scrutiny by regulators and policymakers, the Instagram platform continues to host posts from drug dealers, in violation of federal law. Further action needs to be taken to ensure the safety of social media communities and help put an end to this illicit digital channel of sourcing. UR - http://www.jmir.org/2019/6/e13803/ UR - http://dx.doi.org/10.2196/13803 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199298 ID - info:doi/10.2196/13803 ER - TY - JOUR AU - Cacheda, Fidel AU - Fernandez, Diego AU - Novoa, J. Francisco AU - Carneiro, Victor PY - 2019/6/10 TI - Early Detection of Depression: Social Network Analysis and Random Forest Techniques JO - J Med Internet Res SP - e12554 VL - 21 IS - 6 KW - depression KW - major depressive disorder KW - social media KW - artificial intelligence KW - machine learning N2 - Background: Major depressive disorder (MDD) or depression is among the most prevalent psychiatric disorders, affecting more than 300 million people globally. Early detection is critical for rapid intervention, which can potentially reduce the escalation of the disorder. Objective: This study used data from social media networks to explore various methods of early detection of MDDs based on machine learning. We performed a thorough analysis of the dataset to characterize the subjects? behavior based on different aspects of their writings: textual spreading, time gap, and time span. Methods: We proposed 2 different approaches based on machine learning singleton and dual. The former uses 1 random forest (RF) classifier with 2 threshold functions, whereas the latter uses 2 independent RF classifiers, one to detect depressed subjects and another to identify nondepressed individuals. In both cases, features are defined from textual, semantic, and writing similarities. Results: The evaluation follows a time-aware approach that rewards early detections and penalizes late detections. The results show how a dual model performs significantly better than the singleton model and is able to improve current state-of-the-art detection models by more than 10%. Conclusions: Given the results, we consider that this study can help in the development of new solutions to deal with the early detection of depression on social networks. UR - http://www.jmir.org/2019/6/e12554/ UR - http://dx.doi.org/10.2196/12554 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199323 ID - info:doi/10.2196/12554 ER - TY - JOUR AU - Ogink, AM Paula AU - de Jong, M. Jelske AU - Koeneman, Mats AU - Weenk, Mariska AU - Engelen, JLPG Lucien AU - van Goor, Harry AU - van de Belt, H. Tom AU - Bredie, JH Sebastian PY - 2019/06/19 TI - Feasibility of a New Cuffless Device for Ambulatory Blood Pressure Measurement in Patients With Hypertension: Mixed Methods Study JO - J Med Internet Res SP - e11164 VL - 21 IS - 6 KW - ambulatory blood pressure monitoring KW - home blood pressure monitoring KW - cuffless blood pressure device KW - hypertension N2 - Background: Frequent home blood pressure (BP) measurements result in a better estimation of the true BP. However, traditional cuff-based BP measurements are troublesome for patients. Objective: This study aimed to evaluate the feasibility of a cuffless device for ambulatory systolic blood pressure (SBP) measurement. Methods: This was a mixed method feasibility study in patients with hypertension. Performance of ambulatory SBPs with the device was analyzed quantitatively by intrauser reproducibility and comparability to a classic home BP monitor. Correct use by the patients was checked with video, and user-friendliness was assessed using a validated questionnaire, the System Usability Scale (SUS). Patient experiences were assessed using qualitative interviews. Results: A total of 1020 SBP measurements were performed using the Checkme monitor in 11 patients with hypertension. Duplicate SBPs showed a high intrauser correlation (R=0.86, P<.001). SBPs measured by the Checkme monitor did not correlate well with those of the different home monitors (R=0.47, P=.007). However, the mean SBPs measured by the Checkme and home monitors over the 3-week follow-up were strongly correlated (R=0.75, P=.008). In addition, 36.4% (n=4) of the participants performed the Checkme measurements without any mistakes. The mean SUS score was 86.4 (SD 8.3). The most important facilitator was the ease of using the Checkme monitor. Most important barriers included the absence of diastolic BP and the incidental difficulties in obtaining an SBP result. Conclusions: Given the good intrauser reproducibility, user-friendliness, and patient experience, all of which facilitate patients to perform frequent measurements, cuffless BP monitoring may change the way patients measure their BP at home in the context of ambulant hypertension management. UR - http://www.jmir.org/2019/6/e11164/ UR - http://dx.doi.org/10.2196/11164 UR - http://www.ncbi.nlm.nih.gov/pubmed/31219050 ID - info:doi/10.2196/11164 ER - TY - JOUR AU - Hu, Xiao-Su AU - Nascimento, D. Thiago AU - Bender, C. Mary AU - Hall, Theodore AU - Petty, Sean AU - O?Malley, Stephanie AU - Ellwood, P. Roger AU - Kaciroti, Niko AU - Maslowski, Eric AU - DaSilva, F. Alexandre PY - 2019/06/28 TI - Feasibility of a Real-Time Clinical Augmented Reality and Artificial Intelligence Framework for Pain Detection and Localization From the Brain JO - J Med Internet Res SP - e13594 VL - 21 IS - 6 KW - pain KW - spectroscopy, near-infrared KW - virtual reality KW - artificial intelligence N2 - Background: For many years, clinicians have been seeking for objective pain assessment solutions via neuroimaging techniques, focusing on the brain to detect human pain. Unfortunately, most of those techniques are not applicable in the clinical environment or lack accuracy. Objective: This study aimed to test the feasibility of a mobile neuroimaging-based clinical augmented reality (AR) and artificial intelligence (AI) framework, CLARAi, for objective pain detection and also localization direct from the patient?s brain in real time. Methods: Clinical dental pain was triggered in 21 patients by hypersensitive tooth stimulation with 20 consecutive descending cold stimulations (32°C-0°C). We used a portable optical neuroimaging technology, functional near-infrared spectroscopy, to gauge their cortical activity during evoked acute clinical pain. The data were decoded using a neural network (NN)?based AI algorithm to classify hemodynamic response data into pain and no-pain brain states in real time. We tested the performance of several networks (NN with 7 layers, 6 layers, 5 layers, 3 layers, recurrent NN, and long short-term memory network) upon reorganized data features on pain diction and localization in a simulated real-time environment. In addition, we also tested the feasibility of transmitting the neuroimaging data to an AR device, HoloLens, in the same simulated environment, allowing visualization of the ongoing cortical activity on a 3-dimensional brain template virtually plotted on the patients? head during clinical consult. Results: The artificial neutral network (3-layer NN) achieved an optimal classification accuracy at 80.37% (126,000/156,680) for pain and no pain discrimination, with positive likelihood ratio (PLR) at 2.35. We further explored a 3-class localization task of left/right side pain and no-pain states, and convolutional NN-6 (6-layer NN) achieved highest classification accuracy at 74.23% (1040/1401) with PLR at 2.02. Conclusions: Additional studies are needed to optimize and validate our prototype CLARAi framework for other pains and neurologic disorders. However, we presented an innovative and feasible neuroimaging-based AR/AI concept that can potentially transform the human brain into an objective target to visualize and precisely measure and localize pain in real time where it is most needed: in the doctor?s office. International Registered Report Identifier (IRRID): RR1-10.2196/13594 UR - https://www.jmir.org/2019/6/e13594/ UR - http://dx.doi.org/10.2196/13594 UR - http://www.ncbi.nlm.nih.gov/pubmed/31254336 ID - info:doi/10.2196/13594 ER - TY - JOUR AU - Araujo Almeida, Vanessa AU - Littlejohn, Paula AU - Cop, Irene AU - Brown, Erin AU - Afroze, Rimi AU - Davison, M. Karen PY - 2019/06/28 TI - Comparison of Nutrigenomics Technology Interface Tools for Consumers and Health Professionals: A Sequential Explanatory Mixed Methods Investigation JO - J Med Internet Res SP - e12580 VL - 21 IS - 6 KW - nutrigenomics KW - nutrigenetics KW - genomics KW - epigenomics KW - interface, user-computer N2 - Background: Nutrigenomics forms the basisof personalized nutrition by customizing an individual?s dietaryplan based on the integration of life stage, current health status,and genome information. Some common genes that are includedin nutrition-based multigene test panels include CYP1A2 (rateof caffeine break down), MTHFR (folate usage),NOS3 (risk of elevated triglyceride levels related to omega-3fat intake), and ACE (blood pressure response in related tosodium intake). The complexity of gene test?based personalized nutrition presents barriers to its implementation. Objective: This study aimed to compare a self-driven approach to gene test?based nutrition education versus an integrated practitioner-facilitated method to help develop improved interface tools for personalized nutrition practice. Methods: A sequential, explanatory mixed methods investigation of 55 healthy adults (35 to 55 years) was conducted that included (1) a 9-week randomized controlled trial where participants were randomized to receive a standard nutrition-based gene test report (control; n=19) or a practitioner-facilitated personalized nutrition intervention (intervention; n=36) and (2) an interpretative thematic analysis of focus group interview data. Outcome measures included differences in the diet quality score (Healthy Eating Index?Canadian [HEI-C]; proportion [%] of calories from total fat, saturated fat, and sugar; omega 3 fatty acid intake [grams]; sodium intake [milligrams]); as well as health-related quality of life (HRQoL) scale score. Results: Of the 55 (55/58 enrolled, 95%) participants who completed the study, most were aged between 40 and 51 years (n=37, 67%), were female (n=41, 75%), and earned a high household income (n=32, 58%). Compared with baseline measures, group differences were found for the percentage of calories from total fat (mean difference [MD]=?5.1%; Wilks lambda (?)=0.817, F1,53=11.68; P=.001; eta-squared [?²]=0.183) and saturated fat (MD=?1.7%; ?=0.816; F1,53=11.71; P=.001; ?²=0.18) as well as HRQoL scores (MD=8.1 points; ?=0.914; F1,53=4.92; P=.03; ?²=0.086) compared with week 9 postintervention measures. Interactions of time-by-group assignment were found for sodium intakes (?=0.846; F1,53=9.47; P=.003; ?²=0.15) and HEI-C scores (?=0.660; F1,53=27.43; P<.001; ?²=0.35). An analysis of phenotypic and genotypic information by group assignment found improved total fat (MD=?5%; ?=0.815; F1,51=11.36; P=.001; ?²=0.19) and saturated fat (MD=?1.3%; ?=0.822; F1,51=10.86; P=.002; ?²=0.18) intakes. Time-by-group interactions were found for sodium (?=0.844; F3,51=3.09; P=.04; ?²=0.16); a post hoc analysis showed pre/post differences for those in the intervention group that did (preintervention mean 3611 mg, 95% CI 3039-4182; postintervention mean 2135 mg, 95% CI 1564-2705) and did not have the gene risk variant (preintervention mean 3722 mg, 95% CI 2949-4496; postintervention mean 2071 mg, 95% CI 1299-2843). Pre- and postdifferences related to the Dietary Reference Intakes showed increases in the proportion of intervention participants within the acceptable macronutrient distribution ranges for fat (pre/post mean difference=41.2%; P=.02). Analysis of textual data revealed 3 categories of feedback: (1) translation of nutrition-related gene test information to action; (2) facilitation of eating behavior change, particularly for the macronutrients and sodium; and (3) directives for future personalized nutrition practice. Conclusions: Although improvements were observed in both groups, healthy adults appear to derive more health benefits from practitioner-led personalized nutrition interventions. Further work is needed to better facilitate positive changes in micronutrient intakes. Trial Registration: ClinicalTrials.gov NCT03310814; http://clinicaltrials.gov/ct2/show/NCT03310814 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9846 UR - http://www.jmir.org/2019/6/e12580/ UR - http://dx.doi.org/10.2196/12580 UR - http://www.ncbi.nlm.nih.gov/pubmed/31254340 ID - info:doi/10.2196/12580 ER - TY - JOUR AU - Kong, Grace AU - LaVallee, Heather AU - Rams, Alissa AU - Ramamurthi, Divya AU - Krishnan-Sarin, Suchitra PY - 2019/06/18 TI - Promotion of Vape Tricks on YouTube: Content Analysis JO - J Med Internet Res SP - e12709 VL - 21 IS - 6 KW - e-cigarettes KW - social media KW - marketing N2 - Background: The ability to perform vape tricks (ie, blowing large vapor clouds or shapes like rings) using e-cigarettes appeals to youth. Vape tricks are promoted on social media, but the promotion of vape tricks on social media is not well understood. Objective: The aim of this study was to examine how vape tricks were promoted on YouTube to youth. Methods: Videos on vape tricks that could be accessed by underage youth were identified. The videos were coded for number of views, likes, dislikes, and content (ie, description of vape tricks, e-cigarette devices used for this purpose, video sponsors [private or industry], brand marketing, and contextual characteristics [eg, model characteristics, music, and profanity]). Results: An analysis of 59 sample videos on vape tricks identified 25 distinct vape tricks. These videos had more likes than dislikes (11 to 1 ratio) and a 32,017 median view count. 48% (28/59) of the videos were posted by industry accounts (27% [16/59] provaping organizations, 15% [9/59] online shops, and 3% [2/59] vape shops) and 53% by private accounts (55% [17/31] private users, 26% [8/31] vape enthusiasts, and 19% [6/31] YouTube influencers); 53% (31/59) of the videos promoted a brand of e-cigarette devices, e-liquids, or online/vape shops, and 99% of the devices used for vape tricks were advanced generation devices. The models in the videos were 80.2% (160/198) male, 51.5% white (102/198), and 61.6% (122/198) aged 18 to 24 years; 85% (50/59) of the videos had electronic dance music and hip hop, and 32% (19/59) had profanity. Conclusions: Vape trick videos on YouTube, about half of which were industry sponsored, were accessible to youth. Restrictions of e-cigarette marketing on social media, such as YouTube, are needed. UR - http://www.jmir.org/2019/6/e12709/ UR - http://dx.doi.org/10.2196/12709 UR - http://www.ncbi.nlm.nih.gov/pubmed/31215510 ID - info:doi/10.2196/12709 ER - TY - JOUR AU - McAlearney, Scheck Ann AU - Sieck, J. Cynthia AU - Gaughan, Alice AU - Fareed, Naleef AU - Volney, Jaclyn AU - Huerta, R. Timothy PY - 2019/06/06 TI - Patients? Perceptions of Portal Use Across Care Settings: Qualitative Study JO - J Med Internet Res SP - e13126 VL - 21 IS - 6 KW - patient portals KW - hospitalization KW - medical informatics KW - implementation KW - engagement KW - ambulatory care N2 - Background: Patient portals are a promising instrument to improve patient-centered care, as they provide patients information and tools that can help them better manage their health. The implementation of portals in both the inpatient and outpatient setting gives health care providers an opportunity to support patients both during hospitalization and after discharge. Thus, there is a need to better understand how inpatient and outpatient portals are used across care contexts. Objective: This study aimed to examine patients? perceptions of using inpatient and outpatient portals across the care settings, including how they used the portals and the benefits and concerns associated with portal use. Methods: This study was conducted in a large Midwestern academic medical center consisting of seven hospitals. We interviewed 120 patients who had used an inpatient portal during their hospitalization, at 15 days and 6 months postdischarge, to determine their perspectives of portal use in both hospital and outpatient settings. Interview transcripts were analyzed inductively and deductively by using team coding processes consistent with a grounded theory approach. Results: Interviews focused on three main areas of portal use: experience with the portal features, perceived benefits, and concerns. Responses at 15 days (n=60) and 6 months (n=60) postdischarge were consistent with respect to perceptions about portal use. Patients identified viewing their health information, managing their schedule, and communicating with providers as notable activities. Convenience, access to information, and better engagement in care were indicated as benefits. Concerns were related to technology issues and privacy/security risks. Conclusions: Implementation of inpatient portals as a complement to outpatient portals is increasing and can enable patients to better manage aspects of their care. Although care processes vary substantively across settings, the benefits of convenience, improved access to information, and better engagement in care provide opportunities for portal use across care settings to support patient-centered care. UR - https://www.jmir.org/2019/6/e13126/ UR - http://dx.doi.org/10.2196/13126 UR - http://www.ncbi.nlm.nih.gov/pubmed/31172960 ID - info:doi/10.2196/13126 ER - TY - JOUR AU - Foster, Brody AU - Krasowski, David Matthew PY - 2019/06/28 TI - The Use of an Electronic Health Record Patient Portal to Access Diagnostic Test Results by Emergency Patients at an Academic Medical Center: Retrospective Study JO - J Med Internet Res SP - e13791 VL - 21 IS - 6 KW - consumer health informatics KW - diagnostic imaging KW - electronic health records KW - medical informatics KW - minority groups KW - patient portals KW - proxy KW - user-computer interface N2 - Background: Electronic health record (EHR) patient portals provide a means by which patients can access their health information, including diagnostic test results. Little is known about portal usage by emergency department (ED) patients. Objective: The study aimed to assess patient portal utilization by ED patients at an academic medical center using account activation rates along with the rates of access of diagnostic test results (laboratory results and radiology reports), analyzing the impact of age, gender, and self-reported patient race. Methods: This institutional review board?approved retrospective study was performed at a 60,000-visits-per-year university-based ED. We utilized EHR data reporting tools to examine EHR portal activation and utilization for all patients who had at least one ED encounter with one or more diagnostic tests performed between October 1, 2016, and October 1, 2017. The total dataset for laboratory testing included 208,635 laboratory tests on 25,361 unique patients, of which 9482 (37.39%) had active portal accounts. The total dataset for radiologic imaging included 23,504 radiology studies on 14,455 unique patients, of which 5439 (37.63%) had an active portal account. Results: Overall, 8.90% (18,573/208,635) of laboratory tests and 8.97% (2019/22,504) of radiology reports ordered in the ED were viewed in the patient portal. The highest rates of viewing of laboratory and radiology results were seen for those who were female, were aged 0 to 11 years (parent or guardian viewing by proxy) and 18 to 60 years, and self-reported their race as Caucasian or Asian. The lowest rates were for those who were teenagers, aged older than 81 years, African American/black, and Hispanic/Latino. Infectious disease, urinalysis, and pregnancy testing constituted the highest number of laboratory tests viewed. Magnetic resonance imaging reports were viewed at higher rates than computed tomography or x-ray studies (P<.001). Approximately half of all the diagnostic test results accessed by patients were reviewed within 72 hours of availability in the patient portal (laboratory results: 9904/18,573, 53.32% and radiology reports: 971/2019, 48.1%). On the other extreme, 19.9% (3701/18,573) of laboratory results and 31.6% (639/2019) of radiology reports were viewed more than 2 weeks after availability in the portal. Conclusions: The data highlight the relatively low use of a patient portal by ED patients and existing disparities between patient groups. There can be wide lag time (months) between result/report availability and access by patients. Opportunities for improvement exist for both activation and more robust utilization of patient portals by ED patients. UR - http://www.jmir.org/2019/6/e13791/ UR - http://dx.doi.org/10.2196/13791 UR - http://www.ncbi.nlm.nih.gov/pubmed/31254335 ID - info:doi/10.2196/13791 ER - TY - JOUR AU - Yun, Ke AU - Xu, Junjie AU - Leuba, Sequoia AU - Zhu, Yunyu AU - Zhang, Jing AU - Chu, Zhenxing AU - Geng, Wenqing AU - Jiang, Yongjun AU - Shang, Hong PY - 2019/06/18 TI - Development and Validation of a Personalized Social Media Platform?Based HIV Incidence Risk Assessment Tool for Men Who Have Sex With Men in China JO - J Med Internet Res SP - e13475 VL - 21 IS - 6 KW - HIV KW - risk prediction KW - social media KW - men who have sex with men KW - China N2 - Background: Personalized risk assessments can help medical providers determine targeted populations for counseling and risk reduction interventions. Objective: The objective of this study was to develop a social media platform?based HIV risk prediction tool for men who have sex with men (MSM) in China based on an independent MSM cohort to help medical providers determine target populations for counseling and risk reduction treatments. Methods: A prospective cohort of MSM from Shenyang, China, followed from 2009 to 2016, was used to develop and validate the prediction model. The eligible MSM were randomly assigned to the training and validation dataset, and Cox proportional hazards regression modeling was conducted using predictors for HIV seroconversion selected by the training dataset. Discrimination and calibration were performed, and the related nomogram and social media platform?based HIV risk assessment tool were constructed. Results: The characteristics of the sample between the training dataset and the validation dataset were similar. The risk prediction model identified the following predictors for HIV seroconversion: the main venue used to find male sexual partners, had condomless receptive or insertive anal intercourse, and used rush poppers. The model was well calibrated. The bootstrap C-index was 0.75 (95% CI 0.65-0.85) in the training dataset, and 0.60 (95% CI 0.45-0.74) in the validation dataset. The calibration plots showed good agreement between predicted risk and the actual proportion of no HIV infection in both the training and validation datasets. Nomogram and WeChat-based HIV incidence risk assessment tools for MSM were developed. Conclusions: This social media platform?based HIV infection risk prediction tool can be distributed easily, improve awareness of personal HIV infection risk, and stratify the MSM population based on HIV risk, thus informing targeted interventions for MSM at greatest risk for HIV infection. UR - https://www.jmir.org/2019/6/e13475/ UR - http://dx.doi.org/10.2196/13475 UR - http://www.ncbi.nlm.nih.gov/pubmed/31215509 ID - info:doi/10.2196/13475 ER - TY - JOUR AU - Meinert, Edward AU - Alturkistani, Abrar AU - Foley, A. Kimberley AU - Brindley, David AU - Car, Josip PY - 2019/06/04 TI - Examining Cost Measurements in Production and Delivery of Three Case Studies Using E-Learning for Applied Health Sciences: Cross-Case Synthesis JO - J Med Internet Res SP - e13574 VL - 21 IS - 6 KW - education KW - distance education KW - professional education KW - online education KW - online learning KW - costs and cost analysis KW - economics N2 - Background: The World Health Report (2006) by the World Health Organization conveys that a significant increase is needed in global health care resourcing to meet the current and future demand for health professionals. Electronic learning (e-Learning) presents a possible opportunity to change and optimize training by providing a scalable means for instruction, thus reducing the costs for training health professionals and providing patient education. Research literature often suggests that a benefit of e-Learning is its cost-effectiveness compared with face-to-face instruction, yet there is limited evidence with respect to the comparison of design and production costs with other forms of instruction or the establishment of standards pertaining to budgeting for these costs. Objective: To determine the potential cost favorability of e-Learning in contrast to other forms of learning, there must first be an understanding of the components and elements for building an e-Learning course. Without first taking this step, studies lack the essential financial accounting rigor for course planning and have an inconsistent basis for comparison. This study aimed to (1) establish standard ingredients for the cost of e-Learning course production and (2) determine the variance instructional design has on the production costs of e-Learning courses. Methods: This study made use of a cross-case method among 3 case studies using mixed methods, including horizontal budget variance calculation and qualitative interpretation of responses from course designers for budget variance using total quality management themes. The different implementation-specific aspects of these cases were used to establish common principles in the composition of budgets in the production and delivery of an applied health professional e-Learning course. Results: A total of 2 case studies reported significant negative budget variances caused by issues surrounding underreporting of personnel costs, inaccurate resource task estimation, lack of contingency planning, challenges in third-party resource management, and the need to update health-related materials that became outdated during course production. The third study reported a positive budget variance because of the cost efficiency derived from previous implementation, the strong working relationship of the course project team, and the use of iterative project management methods. Conclusions: This research suggests that the delivery costs of an e-Learning course could be underestimated or underreported and identifies factors that could be used to better control budgets. Through consistent management of factors affecting the cost of course production, further research could be undertaken using standard economic evaluation methods to evaluate the advantages of using e-Learning. UR - https://www.jmir.org/2019/6/e13574/ UR - http://dx.doi.org/10.2196/13574 UR - http://www.ncbi.nlm.nih.gov/pubmed/31165718 ID - info:doi/10.2196/13574 ER - TY - JOUR AU - Castro-Sánchez, Enrique AU - Sood, Anuj AU - Rawson, Miles Timothy AU - Firth, Jamie AU - Holmes, Helen Alison PY - 2019/06/04 TI - Forecasting Implementation, Adoption, and Evaluation Challenges for an Electronic Game?Based Antimicrobial Stewardship Intervention: Co-Design Workshop With Multidisciplinary Stakeholders JO - J Med Internet Res SP - e13365 VL - 21 IS - 6 KW - serious games KW - antimicrobial stewardship KW - medical education N2 - Background: Serious games have been proposed to address the lack of engagement and sustainability traditionally affecting interventions aiming to improve optimal antibiotic use among hospital prescribers. Objective: The goal of the research was to forecast gaps in implementation, adoption and evaluation of game-based interventions, and co-design solutions with antimicrobial clinicians and digital and behavioral researchers. Methods: A co-development workshop with clinicians and academics in serious games, antimicrobials, and behavioral sciences was organized to open the International Summit on Serious Health Games in London, United Kingdom, in March 2018. The workshop was announced on social media and online platforms. Attendees were asked to work in small groups provided with a laptop/tablet and the latest version of the game On call: Antibiotics. A workshop leader guided open group discussions around implementation, adoption, and evaluation threats and potential solutions. Workshop summary notes were collated by an observer. Results: There were 29 participants attending the workshop. Anticipated challenges to resolve reflected implementation threats such as an inadequate organizational arrangement to scale and sustain the use of the game, requiring sufficient technical and educational support and a streamlined feedback mechanism that made best use of data arriving from the game. Adoption threats included collective perceptions that a game would be a ludic rather than professional tool and demanding efforts to integrate all available educational solutions so none are seen as inferior. Evaluation threats included the need to combine game metrics with organizational indicators such as antibiotic use, which may be difficult to enable. Conclusions: As with other technology-based interventions, deploying game-based solutions requires careful planning on how to engage and support clinicians in their use and how best to integrate the game and game outputs onto existing workflows. The ludic characteristics of the game may foster perceptions of unprofessionalism among gamers, which would need buffering from the organization. UR - https://www.jmir.org/2019/6/e13365/ UR - http://dx.doi.org/10.2196/13365 UR - http://www.ncbi.nlm.nih.gov/pubmed/31165712 ID - info:doi/10.2196/13365 ER - TY - JOUR AU - Wu, Tailai AU - Deng, Zhaohua AU - Chen, Zhuo AU - Zhang, Donglan AU - Wang, Ruoxi AU - Wu, Xiang PY - 2019/6/7 TI - Predictors of Patients? Intention to Interact With Doctors in Web-Based Health Communities in China: Cross-Sectional Study JO - J Med Internet Res SP - e13693 VL - 21 IS - 6 KW - medical informatics KW - telemedicine KW - patients KW - physicians KW - community network KW - psychological theory KW - social theory N2 - Background: Web-based health communities provide opportunities for doctors and patients to interact with each other and change the traditional communication mode between doctors and patients. However, little is known about the predictors of patients? intention to interact with doctors in Web-based health communities in China. Objective: The purpose of this study was to investigate what are the predictors of patients? intention to interact with doctors in Web-based health communities in China. Methods: On the basis of two-factor theory and service convenience theory, we propose that the attributes of Web-based health communities including ease of use and perceived synchronicity influence patients? intention to interact through convenience of Web-based health communities, whereas the attributes of physical health facilities such as inaccessibility and discontinuity affect patients? intention to interact through inconvenience of physical health facilities. We employed the survey method to validate our hypothesized relationships. Through developing the measurement instruments, we collected 334 valid answers from Web health community users and utilized partial least square to analyze the data. Results: Ease of use (t311=2.924, P=.004) and perceived synchronicity (t311=2.353, P=.019) were found to influence convenience of Web-based health communities significantly, whereas inaccessibility (t311=3.189, P=.002) and discontinuity (t311=3.149, P=.002) were found to impact inconvenience of physical health facilities significantly. Meanwhile, both convenience of Web-based health communities (t311=2.353, P=.019) and inconvenience of physical health facilities (t311=2.787, P=.006) were found to affect patients? intention to interact with doctors in Web-based health communities significantly. Therefore, all the proposed hypotheses were supported. Conclusions: Through including factors from both Web-based health communities and physical health facilities, we can understand patients? intention to interact comprehensively. This study not only contributes to literature of doctor-patient interaction and Web-based health platforms but also provides implications to promote doctor-patient interaction online and offline. UR - http://www.jmir.org/2019/6/e13693/ UR - http://dx.doi.org/10.2196/13693 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199296 ID - info:doi/10.2196/13693 ER - TY - JOUR AU - Foufi, Vasiliki AU - Timakum, Tatsawan AU - Gaudet-Blavignac, Christophe AU - Lovis, Christian AU - Song, Min PY - 2019/6/13 TI - Mining of Textual Health Information from Reddit: Analysis of Chronic Diseases With Extracted Entities and Their Relations JO - J Med Internet Res SP - e12876 VL - 21 IS - 6 KW - social media KW - chronic disease KW - data mining N2 - Background: Social media platforms constitute a rich data source for natural language processing tasks such as named entity recognition, relation extraction, and sentiment analysis. In particular, social media platforms about health provide a different insight into patient?s experiences with diseases and treatment than those found in the scientific literature. Objective: This paper aimed to report a study of entities related to chronic diseases and their relation in user-generated text posts. The major focus of our research is the study of biomedical entities found in health social media platforms and their relations and the way people suffering from chronic diseases express themselves. Methods: We collected a corpus of 17,624 text posts from disease-specific subreddits of the social news and discussion website Reddit. For entity and relation extraction from this corpus, we employed the PKDE4J tool developed by Song et al (2015). PKDE4J is a text mining system that integrates dictionary-based entity extraction and rule-based relation extraction in a highly flexible and extensible framework. Results: Using PKDE4J, we extracted 2 types of entities and relations: biomedical entities and relations and subject-predicate-object entity relations. In total, 82,138 entities and 30,341 relation pairs were extracted from the Reddit dataset. The most highly mentioned entities were those related to oncological disease (2884 occurrences of cancer) and asthma (2180 occurrences). The relation pair anatomy-disease was the most frequent (5550 occurrences), the highest frequent entities in this pair being cancer and lymph. The manual validation of the extracted entities showed a very good performance of the system at the entity extraction task (3682/5151, 71.48% extracted entities were correctly labeled). Conclusions: This study showed that people are eager to share their personal experience with chronic diseases on social media platforms despite possible privacy and security issues. The results reported in this paper are promising and demonstrate the need for more in-depth studies on the way patients with chronic diseases express themselves on social media platforms. UR - http://www.jmir.org/2019/6/e12876/ UR - http://dx.doi.org/10.2196/12876 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199327 ID - info:doi/10.2196/12876 ER - TY - JOUR AU - Kerr, C. Darragh AU - Ornelas, J. India AU - Lilly, M. Michelle AU - Calhoun, Rebecca AU - Meischke, Hendrika PY - 2019/06/19 TI - Participant Engagement in and Perspectives on a Web-Based Mindfulness Intervention for 9-1-1 Telecommunicators: Multimethod Study JO - J Med Internet Res SP - e13449 VL - 21 IS - 6 KW - occupational stress KW - occupational health KW - mental health KW - mindfulness KW - telecommunications N2 - Background: Demanding working conditions and secondary exposure to trauma may contribute to a high burden of stress among 9-1-1 telecommunicators, decreasing their ability to work effectively and efficiently. Web-based mindfulness-based interventions (MBIs) can be effective in reducing stress in similar populations. However, low engagement may limit the effectiveness of the intervention. Objective: The aim of this study was to assess participant engagement in a Web-based MBI designed for 9-1-1 telecommunicators. Specifically, we sought to describe the following: (1) participant characteristics associated with intervention engagement, (2) participant perspectives on engaging with the intervention, and (3) perceived challenges and facilitators to engaging. Methods: We used qualitative and quantitative data from participant surveys (n=149) that were collected to assess the efficacy of the intervention. We conducted descriptive and bivariate analyses to identify associations between demographic, psychosocial, and workplace characteristics and engagement. We conducted a thematic analysis of qualitative survey responses to describe participant experiences with the MBI. Results: We found that no individual participant characteristics were associated with the level of engagement (low vs high number of lessons completed). Participant engagement did vary by the call center (P<.001). We identified the following overarching qualitative themes: (1) the participants perceived benefits of mindfulness practice, (2) the participants perceived challenges to engage with mindfulness and the intervention, and (3) intervention components that facilitated engagement. The participants expressed positive beliefs in the perceived benefits of practicing mindfulness, including increased self-efficacy in coping with stressors and increased empathy with callers. The most commonly cited barriers were work-related, particularly not having time to participate in the intervention at work. Facilitators included shorter meditation practices and the availability of multiple formats and types of intervention content. Conclusions: The findings of this study suggest that efforts to improve intervention engagement should focus on organizational-level factors rather than individual participant characteristics. Future research should explore the effect of mindfulness practice on the efficiency and effectiveness of 9-1-1 telecommunicators at work. Trial Registration: ClinicalTrials.gov NCT02961621; https://clinicaltrials.gov/ct2/show/NCT02961621 UR - http://www.jmir.org/2019/6/e13449/ UR - http://dx.doi.org/10.2196/13449 UR - http://www.ncbi.nlm.nih.gov/pubmed/31219045 ID - info:doi/10.2196/13449 ER - TY - JOUR AU - Asbjørnsen, Aune Rikke AU - Smedsrød, Lien Mirjam AU - Solberg Nes, Lise AU - Wentzel, Jobke AU - Varsi, Cecilie AU - Hjelmesæth, Jøran AU - van Gemert-Pijnen, EWC Julia PY - 2019/06/21 TI - Persuasive System Design Principles and Behavior Change Techniques to Stimulate Motivation and Adherence in Electronic Health Interventions to Support Weight Loss Maintenance: Scoping Review JO - J Med Internet Res SP - e14265 VL - 21 IS - 6 KW - eHealth KW - weight loss maintenance KW - weight loss KW - behavior change KW - persuasive technology KW - review KW - motivation KW - adherence N2 - Background: Maintaining weight after weight loss is a major health challenge, and eHealth (electronic health) solutions may be a way to meet this challenge. Application of behavior change techniques (BCTs) and persuasive system design (PSD) principles in eHealth development may contribute to the design of technologies that positively influence behavior and motivation to support the sustainable health behavior change needed. Objective: This review aimed to identify BCTs and PSD principles applied in eHealth interventions to support weight loss and weight loss maintenance, as well as techniques and principles applied to stimulate motivation and adherence for long-term weight loss maintenance. Methods: A systematic literature search was conducted in PsycINFO, Ovid MEDLINE (including PubMed), EMBASE, Scopus, Web of Science, and AMED, from January 1, 2007 to June 30, 2018. Arksey and O?Malley?s scoping review methodology was applied. Publications on eHealth interventions were included if focusing on weight loss or weight loss maintenance, in combination with motivation or adherence and behavior change. Results: The search identified 317 publications, of which 45 met the inclusion criteria. Of the 45 publications, 11 (24%) focused on weight loss maintenance, and 34 (76%) focused on weight loss. Mobile phones were the most frequently used technology (28/45, 62%). Frequently used wearables were activity trackers (14/45, 31%), as well as other monitoring technologies such as wireless or digital scales (8/45, 18%). All included publications were anchored in behavior change theories. Feedback and monitoring and goals and planning were core behavior change technique clusters applied in the majority of included publications. Social support and associations through prompts and cues to support and maintain new habits were more frequently used in weight loss maintenance than weight loss interventions. In both types of interventions, frequently applied persuasive principles were self-monitoring, goal setting, and feedback. Tailoring, reminders, personalization, and rewards were additional principles frequently applied in weight loss maintenance interventions. Results did not reveal an ideal combination of techniques or principles to stimulate motivation, adherence, and weight loss maintenance. However, the most frequently mentioned individual techniques and principles applied to stimulate motivation were, personalization, simulation, praise, and feedback, whereas associations were frequently mentioned to stimulate adherence. eHealth interventions that found significant effects for weight loss maintenance all applied self-monitoring, feedback, goal setting, and shaping knowledge, combined with a human social support component to support healthy behaviors. Conclusions: To our knowledge, this is the first review examining key BCTs and PSD principles applied in weight loss maintenance interventions compared with those of weight loss interventions. This review identified several techniques and principles applied to stimulate motivation and adherence. Future research should aim to examine which eHealth design combinations can be the most effective in support of long-term behavior change and weight loss maintenance. UR - http://www.jmir.org/2019/6/e14265/ UR - http://dx.doi.org/10.2196/14265 UR - http://www.ncbi.nlm.nih.gov/pubmed/31228174 ID - info:doi/10.2196/14265 ER - TY - JOUR AU - Stellefson, Michael AU - Paige, R. Samantha AU - Alber, M. Julia AU - Chaney, H. Beth AU - Chaney, Don AU - Apperson, Avery AU - Mohan, Arjun PY - 2019/06/06 TI - Association Between Health Literacy, Electronic Health Literacy, Disease-Specific Knowledge, and Health-Related Quality of Life Among Adults With Chronic Obstructive Pulmonary Disease: Cross-Sectional Study JO - J Med Internet Res SP - e12165 VL - 21 IS - 6 KW - COPD KW - eHealth KW - health-related quality of life KW - health literacy KW - patient education KW - health status KW - internet N2 - Background: Despite the relatively high prevalence of low health literacy among individuals living with chronic obstructive pulmonary disease (COPD), limited empirical attention has been paid to the cognitive and health literacy?related skills that can uniquely influence patients? health-related quality of life (HRQoL) outcomes. Objective: The aim of this study was to examine how health literacy, electronic health (eHealth) literacy, and COPD knowledge are associated with both generic and lung-specific HRQoL in people living with COPD. Methods: Adults from the COPD Foundation?s National Research Registry (n=174) completed a cross-sectional Web-based survey that assessed sociodemographic characteristics, comorbidity status, COPD knowledge, health literacy, eHealth literacy, and generic/lung-specific HRQoL. Hierarchical linear regression models were tested to examine the roles of health literacy and eHealth literacy on generic (model 1) and lung-specific (model 2) HRQoL, after accounting for socioeconomic and comorbidity covariates. Spearman rank correlations examined associations between ordinal HRQoL items and statistically significant hierarchical predictor variables. Results: After adjusting for confounding factors, health literacy, eHealth literacy, and COPD knowledge accounted for an additional 9% of variance in generic HRQoL (total adjusted R2=21%; F9,164=6.09, P<.001). Health literacy (b=.08, SE 0.02, 95% CI 0.04-0.12) was the only predictor positively associated with generic HRQoL (P<.001). Adding health literacy, eHealth literacy, and COPD knowledge as predictors explained an additional 7.40% of variance in lung-specific HRQoL (total adjusted R2=26.4%; F8,161=8.59, P<.001). Following adjustment for covariates, both health literacy (b=2.63, SE 0.84, 95% CI 0.96-4.29, P<.001) and eHealth literacy (b=1.41, SE 0.67, 95% CI 0.09-2.73, P<.001) were positively associated with lung-specific HRQoL. Health literacy was positively associated with most lung-specific HRQoL indicators (ie, cough frequency, chest tightness, activity limitation at home, confidence leaving home, sleep quality, and energy level), whereas eHealth literacy was positively associated with 5 of 8 (60%) lung-specific HRQoL indicators. Upon controlling for confounders, COPD knowledge (b=?.56, SE 0.29, 95% CI ?1.22 to ?0.004, P<.05) was inversely associated with lung-specific HRQoL. Conclusions: Health literacy, but not eHealth literacy, was positively associated with generic HRQoL. However, both health literacy and eHealth literacy were positively associated with lung-specific HRQoL, with higher COPD knowledge indicative of lower lung-specific HRQoL. These results confirm the importance of considering health and eHealth literacy levels when designing patient education programs for people living with COPD. Future research should explore the impact of delivering interventions aimed at improving eHealth and health literacy among patients with COPD, particularly when disease self-management goals are to enhance HRQoL. UR - https://www.jmir.org/2019/6/e12165/ UR - http://dx.doi.org/10.2196/12165 UR - http://www.ncbi.nlm.nih.gov/pubmed/31172962 ID - info:doi/10.2196/12165 ER - TY - JOUR AU - Block, J. Lorraine AU - Currie, M. Leanne AU - Hardiker, R. Nicholas AU - Strudwick, Gillian PY - 2019/06/26 TI - Visibility of Community Nursing Within an Administrative Health Classification System: Evaluation of Content Coverage JO - J Med Internet Res SP - e12847 VL - 21 IS - 6 KW - World Health Organization KW - classification KW - nursing informatics KW - medical informatics KW - data collection KW - terminology KW - community health services KW - standardized nursing terminology N2 - Background: The World Health Organization is in the process of developing an international administrative classification for health called the International Classification of Health Interventions (ICHI). The purpose of ICHI is to provide a tool for supporting intervention reporting and analysis at a global level for policy development and beyond. Nurses represent the largest resource carrying out clinical interventions in any health system. With the shift in nursing care from hospital to community settings in many countries, it is important to ensure that community nursing interventions are present in any international health information system. Thus, an investigation into the extent to which community nursing interventions were covered in ICHI was needed. Objective: The objectives of this study were to examine the extent to which International Classification for Nursing Practice (ICNP) community nursing interventions were represented in the ICHI administrative classification system, to identify themes related to gaps in coverage, and to support continued advancements in understanding the complexities of knowledge representation in standardized clinical terminologies and classifications. Methods: This descriptive study used a content mapping approach in 2 phases in 2018. A total of 187 nursing intervention codes were extracted from the ICNP Community Nursing Catalogue and mapped to ICHI. In phase 1, 2 coders completed independent mapping activities. In phase 2, the 2 coders compared each list and discussed concept matches until consensus on ICNP-ICHI match and on mapping relationship was reached. Results: The initial percentage agreement between the 2 coders was 47% (n=88), but reached 100% with consensus processes. After consensus was reached, 151 (81%) of the community nursing interventions resulted in an ICHI match. A total of 36 (19%) of community nursing interventions had no match to ICHI content. A total of 100 (53%) community nursing interventions resulted in a broader ICHI code, 9 (5%) resulted in a narrower ICHI code, and 42 (23%) were considered equivalent. ICNP concepts that were not represented in ICHI were thematically grouped into the categories family and caregivers, death and dying, and case management. Conclusions: Overall, the content mapping yielded similar results to other content mapping studies in nursing. However, it also found areas of missing concept coverage, difficulties with interterminology mapping, and further need to develop mapping methods. UR - https://www.jmir.org/2019/6/e12847/ UR - http://dx.doi.org/10.2196/12847 UR - http://www.ncbi.nlm.nih.gov/pubmed/31244480 ID - info:doi/10.2196/12847 ER - TY - JOUR AU - Kranzbühler, Anne-Madeleine AU - Kleijnen, P. Mirella H. AU - Verlegh, J. Peeter W. AU - Teerling, Marije PY - 2019/06/26 TI - When Similarity Beats Expertise?Differential Effects of Patient and Expert Ratings on Physician Choice: Field and Experimental Study JO - J Med Internet Res SP - e12454 VL - 21 IS - 6 KW - decision making KW - choice behavior KW - judgment N2 - Background: Increasing numbers of patients consult Web-based rating platforms before making health care decisions. These platforms often provide ratings from other patients, reflecting their subjective experience. However, patients often lack the knowledge to be able to judge the objective quality of health services. To account for this potential bias, many rating platforms complement patient ratings with more objective expert ratings, which can lead to conflicting signals as these different types of evaluations are not always aligned. Objective: This study aimed to fill the gap on how consumers combine information from 2 different sources?patients or experts?to form opinions and make purchase decisions in a health care context. More specifically, we assessed prospective patients? decision making when considering both types of ratings simultaneously on a Web-based rating platform. In addition, we examined how the influence of patient and expert ratings is conditional upon rating volume (ie, the number of patient opinions). Methods: In a field study, we analyzed a dataset from a Web-based physician rating platform containing clickstream data for more than 5000 US doctors. We complemented this with an experimental lab study consisting of a sample of 112 students from a Dutch university. The average age was 23.1 years, and 60.7% (68/112) of the respondents were female. Results: The field data illustrated the moderating effect of rating volume. If the patient advice was based on small numbers, prospective patients tended to base their selection of a physician on expert rather than patient advice (profile clicks beta=.14, P<.001; call clicks beta=.28, P=.03). However, when the group of patients substantially grew in size, prospective patients started to rely on patients rather than the expert (profile clicks beta=.23, SE=0.07, P=.004; call clicks beta=.43, SE=0.32, P=.10). The experimental study replicated and validated these findings for conflicting patient versus expert advice in a controlled setting. When patient ratings were aggregated from a high number of opinions, prospective patients? evaluations were affected more strongly by patient than expert advice (meanpatient positive/expert negative=3.06, SD=0.94; meanexpert positive/patient negative=2.55, SD=0.89; F1,108=4.93, P=.03). Conversely, when patient ratings were aggregated from a low volume, participants were affected more strongly by expert compared with patient advice (meanpatient positive/expert negative=2.36, SD=0.76; meanexpert positive/patient negative=3.01, SD=0.81; F1,108=8.42, P=.004). This effect occurred despite the fact that they considered the patients to be less knowledgeable than experts. Conclusions: When confronted with information from both sources simultaneously, prospective patients are influenced more strongly by other patients. This effect reverses when the patient rating has been aggregated from a (very) small number of individual opinions. This has important implications for how to present health care provider ratings to prospective patients to aid their decision-making process. UR - http://www.jmir.org/2019/6/e12454/ UR - http://dx.doi.org/10.2196/12454 UR - http://www.ncbi.nlm.nih.gov/pubmed/31244481 ID - info:doi/10.2196/12454 ER - TY - JOUR AU - Li, Siyue AU - Hubner, Austin PY - 2019/06/28 TI - The Impact of Web-Based Ratings on Patient Choice of a Primary Care Physician Versus a Specialist: Randomized Controlled Experiment JO - J Med Internet Res SP - e11188 VL - 21 IS - 6 KW - technical skills KW - interpersonal skills KW - physician ratings KW - physician selection N2 - Background: Physician review websites have empowered prospective patients to acquire information about physicians. However, little is known about how Web-based ratings on different aspects of a physician may affect patients? selection of physicians differently. Objective: The objectives of this study were to examine (1) how patients weigh ratings on a physician?s technical skills and interpersonal skills in their selection of physicians and (2) whether and how people?s choice of a primary care physician versus a specialist is affected differently by Web-based ratings. Methods: A 2×2×2×2 between-subjects experiment was conducted. Over 600 participants were recruited through a crowdsourcing website and randomly assigned to view a mockup physician review Web page that contained information on a physician?s basic information and patients? ratings. After reviewing the Web page, participants were asked to complete a survey on their perceptions of the physician and willingness to seek health care from the physician. Results: The results showed that participants were more willing to choose a physician with higher ratings on technical skills than on interpersonal skills compared with a physician with higher ratings on interpersonal skills than on technical skills, t369.96=22.36, P<.001, Cohen d=1.22. In the selection of different types of physicians, patients were more likely to choose a specialist with higher ratings on technical skills than on interpersonal skills, compared with a primary care physician with the same ratings, F1,521=5.34, P=.021. Conclusions: The findings suggest that people place more weight on technical skills than interpersonal skills in their selection of a physician based on their ratings on the Web. Specifically, people are more likely to make a compromise on interpersonal skills in their choice of a specialist compared with a primary care physician. This study emphasizes the importance of examining Web-based physician ratings in a more nuanced way in relation to the selection of different types of physicians. Trial Registration: ISRCTN Registry ISRCTN91316463; http://www.isrctn.com/ISRCTN91316463 UR - http://www.jmir.org/2019/6/e11188/ UR - http://dx.doi.org/10.2196/11188 UR - http://www.ncbi.nlm.nih.gov/pubmed/31254337 ID - info:doi/10.2196/11188 ER - TY - JOUR AU - Jiang, Xinchan AU - Ming, Wai-Kit AU - You, HS Joyce PY - 2019/06/17 TI - The Cost-Effectiveness of Digital Health Interventions on the Management of Cardiovascular Diseases: Systematic Review JO - J Med Internet Res SP - e13166 VL - 21 IS - 6 KW - telemedicine KW - cardiovascular diseases KW - stroke KW - heart failure KW - myocardial infarction KW - heart attack KW - cost-effectiveness KW - medical economics KW - decision modeling KW - systematic review N2 - Background: With the advancement in information technology and mobile internet, digital health interventions (DHIs) are improving the care of cardiovascular diseases (CVDs). The impact of DHIs on cost-effective management of CVDs has been examined using the decision analytic model?based health technology assessment approach. Objective: The aim of this study was to perform a systematic review of the decision analytic model?based studies evaluating the cost-effectiveness of DHIs on the management of CVDs. Methods: A literature review was conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature Complete, PsycINFO, Scopus, Web of Science, Center for Review and Dissemination, and Institute for IEEE Xplore between 2001 and 2018. Studies were included if the following criteria were met: (1) English articles, (2) DHIs that promoted or delivered clinical interventions and had an impact on patients? cardiovascular conditions, (3) studies that were modeling works with health economic outcomes of DHIs for CVDs, (4) studies that had a comparative group for assessment, and (5) full economic evaluations including a cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis, and cost-consequence analysis. The primary outcome collected was the cost-effectiveness of the DHIs, presented by incremental cost per additional quality-adjusted life year (QALY). The quality of each included study was evaluated using the Consolidated Health Economic Evaluation Reporting Standards. Results: A total of 14 studies met the defined criteria and were included in the review. Among the included studies, heart failure (7/14, 50%) and stroke (4/14, 29%) were two of the most frequent CVDs that were managed by DHIs. A total of 9 (64%) studies were published between 2015 and 2018 and 5 (36%) published between 2011 and 2014. The time horizon was ?1 year in 3 studies (21%), >1 year in 10 studies (71%), and 1 study (7%) did not declare the time frame. The types of devices or technologies used to deliver the health interventions were short message service (1/14, 7%), telephone support (1/14, 7%), mobile app (1/14, 7%), video conferencing system (5/14, 36%), digital transmission of physiologic data (telemonitoring; 5/14, 36%), and wearable medical device (1/14, 7%). The DHIs gained higher QALYs with cost saving in 43% (6/14) of studies and gained QALYs at a higher cost at acceptable incremental cost-effectiveness ratio (ICER) in 57% (8/14) of studies. The studies were classified as excellent (0/14, 0%), good (9/14, 64%), moderate (4/14, 29%), and low (1/14, 7%) quality. Conclusions: This study is the first systematic review of decision analytic model?based cost-effectiveness analyses of DHIs in the management of CVDs. Most of the identified studies were published recently, and the majority of the studies were good quality cost-effectiveness analyses with an adequate duration of time frame. All the included studies found the DHIs to be cost-effective. UR - http://www.jmir.org/2019/6/e13166/ UR - http://dx.doi.org/10.2196/13166 UR - http://www.ncbi.nlm.nih.gov/pubmed/31210136 ID - info:doi/10.2196/13166 ER - TY - JOUR AU - Lindskrog, Signe AU - Christensen, Bang Karl AU - Osborne, H. Richard AU - Vingtoft, Søren AU - Phanareth, Klaus AU - Kayser, Lars PY - 2019/6/2 TI - Relationship Between Patient-Reported Outcome Measures and the Severity of Chronic Obstructive Pulmonary Disease in the Context of an Innovative Digitally Supported 24-Hour Service: Longitudinal Study JO - J Med Internet Res SP - e10924 VL - 21 IS - 6 KW - health literacy KW - empowerment KW - patient reported outcome measures KW - self-reported mental and physical health KW - health literacy questionnaire KW - health education impact questionnaire KW - SF-36 KW - epital living lab KW - chronic obstructive pulmonary disease N2 - Background: Individuals with chronic obstructive pulmonary disease (COPD) live with the burden of a progressive life-threatening condition that is often accompanied by anxiety and depression. The severity of the condition is usually considered from a clinical perspective and characterized according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification of severity (1-4) and a risk assessment (A through D) that focuses on the patient?s symptoms and number of exacerbations, but information about perceived health or ability to manage the condition are rarely included. Objective: We evaluated 3 patient-reported outcome measurements (PROMs) to examine how these can be used to report on individuals with COPD who were supported by a digitally assisted intervention that aims to increase the patient?s management of their condition to improve their well-being. Methods: A total of 93 individuals with COPD were enrolled. At baseline and after 6 and 12 months, we measured self-reported self-management (Health Education Impact Questionnaire, heiQ) and health literacy (Health Literacy Questionnaire, HLQ), and physical and mental health (Short Form-36, SF-36) PROMs were collected. The scores of the 19 PROM dimensions were related to COPD severity, that is, GOLD risk assessment, pulmonary function at entry, and number of exacerbations of a period up to 12 months. The initial PROM scores were also compared with pulmonary function, exacerbations, and GOLD risk assessment to predict the number of contacts within the first 90 days. Results: At baseline, 2 dimensions from heiQ and SF-36 Physical health differed significantly between GOLD risk factor groups, indicating more distress and poorer attitudes and health status with increasing severity (GOLD risk assessment). Pulmonary function (FEV1) was negatively associated with the severity of the condition. After 6 months, we observed an increase in heiQ6 (skill and technique acquisition) and a reduction in emotional distress. The latter effect persisted after 12 months, where heiQ4 (self-monitoring and insight) also increased. HLQ3 (actively managing my health) decreased after 6 and 12 months. The number of exacerbations and the GOLD risk factor assessment predicted the number of contacts during the first 90 days. Furthermore, 2 of the PROMS heiQ6 (skill and technique acquisition) and HLQ8 (ability to find good health information) evaluated at baseline were associated with the number of contacts within the first 90 after enrollment. The pulmonary function was not associated with the number of contacts. Conclusions: Our data suggest that selected dimensions from HLQ, heiQ, and SF-36 can be used as PROMs in relation to COPD to provide researchers and clinicians with greater insight into how this condition affects individuals? ability to understand and manage their condition and perception of their physical and mental health. The PROMs add to the information obtained with the clinical characteristics including the GOLD risk factor assessment. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6506 UR - https://www.jmir.org/2019/6/e10924/ UR - http://dx.doi.org/10.2196/10924 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199320 ID - info:doi/10.2196/10924 ER - TY - JOUR AU - Burns, Kara AU - McBride, A. Craig AU - Patel, Bhaveshkumar AU - FitzGerald, Gerard AU - Mathews, Shane AU - Drennan, Judy PY - 2019/6/13 TI - Creating Consumer-Generated Health Data: Interviews and a Pilot Trial Exploring How and Why Patients Engage JO - J Med Internet Res SP - e12367 VL - 21 IS - 6 KW - patient generated health data KW - patient engagement KW - patient participation KW - mHealth KW - photography N2 - Background: Consumer-generated health data (CGHD) are any clinically relevant data collected by patients or their carers (consumers) that may improve health care outcomes. Like patient experience measures, these data reflect the consumer perspective and is part of a patient-centric agenda. The use of CGHD is believed to enhance diagnosis, patient engagement, and thus foster an improved therapeutic partnership with health care providers. Objective: The aim of this study was to further identify how these data were used by consumers and how it influences engagement via a validated framework. In addition, carer data has not been explored for the purpose of engagement. Methods: Study 1 used interviews with CGHD-experienced patients, carers, and doctors to understand attitudes about data collection and use, developing an ontological framework. Study 2 was a pilot trial with carers (parents) of children undergoing laparoscopic appendectomy. For 10 days carers generated and emailed surgical site photographs to a tertiary children?s hospital. Subsequently, carers were interviewed about the engagement framework. In total, 60 interviews were analyzed using theme and content analysis. Results: This study validates a framework anchored in engagement literature, which categorizes CGHD engagement outcomes into 4 domains: physiological, cognitive, emotional, and behavioral. CGHD use is complex, interconnected, and can be organized into 10 themes within these 4 domains. Conclusions: CGHD can instigate an ecosystem of engagement and provide clinicians with an enhanced therapeutic relationship through an extended view into the patient?s world. In addition to clinical diagnosis and efficient use of health care resources, data offer another tool to manage consumers service experience, especially the emotions associated with the health care journey. Collection and use of data increases consumers sense of reassurance, improves communication with providers, and promotes greater personal responsibility, indicating an empowering consumer process. Finally, it can also improve confidence and satisfaction in the service. UR - http://www.jmir.org/2019/6/e12367/ UR - http://dx.doi.org/10.2196/12367 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199312 ID - info:doi/10.2196/12367 ER - TY - JOUR AU - Hensel, M. Jennifer AU - Shaw, James AU - Ivers, M. Noah AU - Desveaux, Laura AU - Vigod, N. Simone AU - Cohen, Ashley AU - Onabajo, Nike AU - Agarwal, Payal AU - Mukerji, Geetha AU - Yang, Rebecca AU - Nguyen, Megan AU - Bouck, Zachary AU - Wong, Ivy AU - Jeffs, Lianne AU - Jamieson, Trevor AU - Bhatia, Sacha R. PY - 2019/06/04 TI - A Web-Based Mental Health Platform for Individuals Seeking Specialized Mental Health Care Services: Multicenter Pragmatic Randomized Controlled Trial JO - J Med Internet Res SP - e10838 VL - 21 IS - 6 KW - internet KW - mental health KW - anxiety KW - depression N2 - Background: Web-based self-directed mental health applications are rapidly emerging to address health service gaps and unmet needs for information and support. Objective: The aim of this study was to determine if a multicomponent, moderated Web-based mental health application could benefit individuals with mental health symptoms severe enough to warrant specialized mental health care. Methods: A multicenter, pragmatic randomized controlled trial was conducted across several outpatient mental health programs affiliated with 3 hospital programs in Ontario, Canada. Individuals referred to or receiving treatment, aged 16 years or older, with access to the internet and an email address, and having the ability to navigate a Web-based mental health application were eligible. A total of 812 participants were randomized 2:1 to receive immediate (immediate treatment group, ITG) or delayed (delayed treatment group, DTG) access for 3 months to the Big White Wall (BWW), a multicomponent Web-based mental health intervention based in the United Kingdom and New Zealand. The primary outcome was the total score on the Recovery Assessment Scale, revised (RAS-r) which measures mental health recovery. Secondary outcomes were total scores on the Patient Health Questionnaire-9 item (PHQ-9), the Generalized Anxiety Disorder Questionnaire-7 item (GAD-7), the EuroQOL 5-dimension quality of life questionnaire (EQ-5D-5L), and the Community Integration Questionnaire. An exploratory analysis examined the association between actual BWW use (categorized into quartiles) and outcomes among study completers. Results: Intervention participants achieved small, statistically significant increases in adjusted RAS-r score (4.97 points, 95% CI 2.90 to 7.05), and decreases in PHQ-9 score (?1.83 points, 95% CI ?2.85 to ?0.82) and GAD-7 score (?1.55 points, 95% CI ?2.42 to ?0.70). Follow-up was achieved for 55% (446/812) at 3 months, 48% (260/542) of ITG participants and 69% (186/270) of DTG participants. Only 58% (312/542) of ITG participants logged on more than once. Some higher BWW user groups had significantly greater improvements in PHQ-9 and GAD-7 relative to the lowest use group. Conclusions: The Web-based application may be beneficial; however, many participants did not engage in an ongoing way. This has implications for patient selection and engagement as well as delivery and funding structures for similar Web-based interventions. Trial Registration: ClinicalTrials.gov NCT02896894; https://clinicaltrials.gov/ct2/show/NCT02896894 (Archived by WebCite at http://www.webcitation.org/78LIpnuRO) UR - https://www.jmir.org/2019/6/e10838/ UR - http://dx.doi.org/10.2196/10838 UR - http://www.ncbi.nlm.nih.gov/pubmed/31165710 ID - info:doi/10.2196/10838 ER - TY - JOUR AU - Hackett, Christina AU - Brennan, Kelsey AU - Smith Fowler, Heather AU - Leaver, Chad PY - 2019/06/06 TI - Valuing Citizen Access to Digital Health Services: Applied Value-Based Outcomes in the Canadian Context and Tools for Modernizing Health Systems JO - J Med Internet Res SP - e12277 VL - 21 IS - 6 KW - personal health records KW - patient portals KW - electronic health records KW - patient engagement KW - health care costs KW - cost of illness KW - economic evaluation N2 - Background: In publicly funded health systems, digital health technologies are strategies that aim to improve the quality and safety of health care service delivery and enhance patient experiences and outcomes. In Canada, governments and health organizations have invested in digital health technologies such as personal health records (PHRs) and other electronic service functionalities and innovation across provincial and territorial health systems. Objective: Patients? access to their own information via secure, Web-based PHRs and integrated virtual care services are promising mechanisms for supporting patient engagement in health care. We draw on current evidence to develop an economic model that estimates the demonstrated and potential value of these digital health initiatives. Methods: We first synthesized results from a variety of Canadian and international studies on the outcomes for patients and service providers associated with PHRs across a continuum of services, ranging from viewing information (eg, laboratory results) on the Web to electronic prescription renewal to email or video conferencing with care teams and providers. We then developed a quantitative model of estimated value, grounded in these demonstrated benefits and citizen use (2016-2017). In addition to estimating the costs saved from patient and system perspectives, we used a novel application of a compensating differential approach to assess the value (independent of costs) to society of improved health and well-being resulting from PHR use. Results: Patients? access to a range of digital PHR functions generated value for Canadians and health systems by increasing health system productivity, and improving access to and quality of health care provided. As opportunities increased to interact and engage with health care providers via PHR functions, the marginal value generated by utilization of PHR functionalities also increased. Web-based prescription renewal generated the largest share of the total current value from the patient perspective. From the health systems perspective, Canadians? ability to view their information on the Web was the largest value share. If PHRs were to be implemented with more integrated virtual care services, the value generated from populations with chronic illnesses such as severe and persistent mental illness and diabetes could amount to between Can $800 million and Can $1 billion per year across Canadian health systems. Conclusions: PHRs with higher interactivity could yield substantial potential value from wider implementation in Canada and increased adoption rates in certain target groups?namely, high-frequency health system users and their caregivers. Further research is needed to tie PHR use to health outcomes across PHR functions, care settings, and patient populations. UR - https://www.jmir.org/2019/6/e12277/ UR - http://dx.doi.org/10.2196/12277 UR - http://www.ncbi.nlm.nih.gov/pubmed/31172965 ID - info:doi/10.2196/12277 ER - TY - JOUR AU - Chai, R. Peter AU - Zhang, Haipeng AU - Jambaulikar, D. Guruprasad AU - Boyer, W. Edward AU - Shrestha, Labina AU - Kitmitto, Loay AU - Wickner, G. Paige AU - Salmasian, Hojjat AU - Landman, B. Adam PY - 2019/06/19 TI - An Internet of Things Buttons to Measure and Respond to Restroom Cleanliness in a Hospital Setting: Descriptive Study JO - J Med Internet Res SP - e13588 VL - 21 IS - 6 KW - operations research KW - wireless technology KW - hygiene KW - toilet facilities KW - workflow N2 - Background: Restroom cleanliness is an important factor in hospital quality. Due to its dynamic process, it can be difficult to detect the presence of dirty restrooms that need to be cleaned. Using an Internet of Things (IoT) button can permit users to designate restrooms that need cleaning and in turn, allow prompt response from housekeeping to maintain real-time restroom cleanliness. Objective: This study aimed to describe the deployment of an IoT button?based notification system to measure hospital restroom cleanliness reporting system usage and qualitative feedback from housekeeping staff on IoT button use. Methods: We deployed IoT buttons in 16 hospital restrooms. Over an 8-month period, housekeeping staff received real-time notifications and responded to button presses for restroom cleaning. All button presses were recorded. We reported average button usage by hospital area, time of day, and day of week. We also conducted interviews with housekeeping supervisors and staff to understand their acceptance of and experience with the system. Results: Over 8 months, 1920 requests to clean restrooms in the main hospital lobby and satellite buildings were received. The hospital lobby IoT buttons received over half (N=1055, 55%) of requests for cleaning. Most requests occurred in afternoon hours from 3 PM to midnight. Requests for cleaning remained stable throughout the work week with fewer requests occurring over weekends. IoT button use was sustained throughout the study period. Interviews with housekeeping supervisors and staff demonstrated acceptance of the IoT buttons; actual use was centered around asynchronous communication between supervisors and staff in response to requests to clean restrooms. Conclusions: An IoT button system is a feasible method to generate on-demand request for restroom cleaning that is easy to deploy and that users will consistently engage with. Data from this system have the potential to enable responsive scheduling for restroom service and anticipate periods of high restroom utilization in a hospital. UR - http://www.jmir.org/2019/6/e13588/ UR - http://dx.doi.org/10.2196/13588 UR - http://www.ncbi.nlm.nih.gov/pubmed/31219046 ID - info:doi/10.2196/13588 ER - TY - JOUR AU - Crossley, Morgan Sam Graeme AU - McNarry, Anne Melitta AU - Eslambolchilar, Parisa AU - Knowles, Zoe AU - Mackintosh, Alexandra Kelly PY - 2019/5/31 TI - The Tangibility of Personalized 3D-Printed Feedback May Enhance Youths? Physical Activity Awareness, Goal Setting, and Motivation: Intervention Study JO - J Med Internet Res SP - e12067 VL - 21 IS - 6 KW - behavior change KW - health education KW - feedback KW - self-monitoring KW - accelerometry KW - schools KW - adolescent KW - child N2 - Background: In the United Kingdom, most youth fail to achieve the government guideline of 60 min of moderate to vigorous physical activity (MVPA) daily. Reasons that are frequently cited for the underachievement of this guideline include (1) a lack of awareness of personal physical activity levels (PALs) and (2) a lack of understanding of what activities and different intensities contribute to daily targets of physical activity (PA). Technological advances have enabled novel ways of representing PA data through personalized tangible three-dimensional (3D) models. Objective: The purpose of this study was to investigate the efficacy of 3D-printed models to enhance youth awareness and understanding of and motivation to engage in PA. Methods: A total of 39 primary school children (22 boys; mean age 7.9 [SD 0.3] years) and 58 secondary school adolescents (37 boys; mean age 13.8 [SD 0.3] years) participated in a 7-week fading intervention, whereby participants were given 3D-printed models of their previous week?s objectively assessed PALs at 4 time points. Following the receipt of their 3D model, each participant completed a short semistructured video interview (children, 4.5 [SD 1.2] min; adolescents, 2.2 [SD 0.6] min) to assess their PA awareness, understanding, and motivation. Data were transcribed verbatim and thematically analyzed to enable key emergent themes to be further explored and identified. Results: Analyses revealed that the 3D models enhanced the youths? awareness of and ability to recall and self-evaluate their PA behaviors. By the end of the study, the youths, irrespective of age, were able to correctly identify and relate to the government?s PA guideline represented on the models, despite their inability to articulate the government's guideline through time and intensity. Following the fourth 3D model, 72% (71/97) of the youths used the models as a goal-setting strategy, further highlighting such models as a motivational tool to promote PA. Conclusions: The results suggest that 3D-printed models of PA enhanced the youths? awareness of their PA levels and provided a motivational tool for goal setting, potentially offering a unique strategy for future PA promotion. UR - https://www.jmir.org/2019/6/e12067/ UR - http://dx.doi.org/10.2196/12067 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199322 ID - info:doi/10.2196/12067 ER - TY - JOUR AU - Zheng, Xiaochen AU - Sun, Shengjing AU - Mukkamala, Rao Raghava AU - Vatrapu, Ravi AU - Ordieres-Meré, Joaquín PY - 2019/06/06 TI - Accelerating Health Data Sharing: A Solution Based on the Internet of Things and Distributed Ledger Technologies JO - J Med Internet Res SP - e13583 VL - 21 IS - 6 KW - Internet of Things KW - distributed ledger technologies KW - data sharing KW - health information interoperability KW - IOTA Tangle KW - masked authenticated messaging KW - blockchain KW - intelligent healthcare N2 - Background: Huge amounts of health-related data are generated every moment with the rapid development of Internet of Things (IoT) and wearable technologies. These big health data contain great value and can bring benefit to all stakeholders in the health care ecosystem. Currently, most of these data are siloed and fragmented in different health care systems or public and private databases. It prevents the fulfillment of intelligent health care inspired by these big data. Security and privacy concerns and the lack of ensured authenticity trails of data bring even more obstacles to health data sharing. With a decentralized and consensus-driven nature, distributed ledger technologies (DLTs) provide reliable solutions such as blockchain, Ethereum, and IOTA Tangle to facilitate the health care data sharing. Objective: This study aimed to develop a health-related data sharing system by integrating IoT and DLT to enable secure, fee-less, tamper-resistant, highly-scalable, and granularly-controllable health data exchange, as well as build a prototype and conduct experiments to verify the feasibility of the proposed solution. Methods: The health-related data are generated by 2 types of IoT devices: wearable devices and stationary air quality sensors. The data sharing mechanism is enabled by IOTA?s distributed ledger, the Tangle, which is a directed acyclic graph. Masked Authenticated Messaging (MAM) is adopted to facilitate data communications among different parties. Merkle Hash Tree is used for data encryption and verification. Results: A prototype system was built according to the proposed solution. It uses a smartwatch and multiple air sensors as the sensing layer; a smartphone and a single-board computer (Raspberry Pi) as the gateway; and a local server for data publishing. The prototype was applied to the remote diagnosis of tremor disease. The results proved that the solution could enable costless data integrity and flexible access management during data sharing. Conclusions: DLT integrated with IoT technologies could greatly improve the health-related data sharing. The proposed solution based on IOTA Tangle and MAM could overcome many challenges faced by other traditional blockchain-based solutions in terms of cost, efficiency, scalability, and flexibility in data access management. This study also showed the possibility of fully decentralized health data sharing by replacing the local server with edge computing devices. UR - https://www.jmir.org/2019/6/e13583/ UR - http://dx.doi.org/10.2196/13583 UR - http://www.ncbi.nlm.nih.gov/pubmed/31172963 ID - info:doi/10.2196/13583 ER - TY - JOUR AU - Hawig, David AU - Zhou, Chao AU - Fuhrhop, Sebastian AU - Fialho, S. Andre AU - Ramachandran, Navin PY - 2019/6/14 TI - Designing a Distributed Ledger Technology System for Interoperable and General Data Protection Regulation?Compliant Health Data Exchange: A Use Case in Blood Glucose Data JO - J Med Internet Res SP - e13665 VL - 21 IS - 6 KW - distributed ledger technology KW - directed acyclic graph KW - IOTA KW - IPFS KW - blockchain KW - Masked Authenticated Messaging, MAM KW - mobile health KW - blood glucose KW - diabetes KW - FHIR N2 - Background: Distributed ledger technology (DLT) holds great potential to improve health information exchange. However, the immutable and transparent character of this technology may conflict with data privacy regulations and data processing best practices. Objective: The aim of this paper is to develop a proof-of-concept system for immutable, interoperable, and General Data Protection Regulation (GDPR)?compliant exchange of blood glucose data. Methods: Given that there is no ideal design for a DLT-based patient-provider data exchange solution, we proposed two different variations for our proof-of-concept system. One design was based purely on the public IOTA distributed ledger (a directed acyclic graph-based DLT) and the second used the same public IOTA ledger in combination with a private InterPlanetary File System (IPFS) cluster. Both designs were assessed according to (1) data reversal risk, (2) data linkability risks, (3) processing time, (4) file size compatibility, and (5) overall system complexity. Results: The public IOTA design slightly increased the risk of personal data linkability, had an overall low processing time (requiring mean 6.1, SD 1.9 seconds to upload one blood glucose data sample into the DLT), and was relatively simple to implement. The combination of the public IOTA with a private IPFS cluster minimized both reversal and linkability risks, allowed for the exchange of large files (3 months of blood glucose data were uploaded into the DLT in mean 38.1, SD 13.4 seconds), but involved a relatively higher setup complexity. Conclusions: For the specific use case of blood glucose explored in this study, both designs presented a suitable performance in enabling the interoperable exchange of data between patients and providers. Additionally, both systems were designed considering the latest guidelines on personal data processing, thereby maximizing the alignment with recent GDPR requirements. For future works, these results suggest that the conflict between DLT and data privacy regulations can be addressed if careful considerations are made regarding the use case and the design of the data exchange system. UR - http://www.jmir.org/2019/6/e13665/ UR - http://dx.doi.org/10.2196/13665 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199293 ID - info:doi/10.2196/13665 ER - TY - JOUR AU - Esmaeilzadeh, Pouyan AU - Mirzaei, Tala PY - 2019/06/20 TI - The Potential of Blockchain Technology for Health Information Exchange: Experimental Study From Patients? Perspectives JO - J Med Internet Res SP - e14184 VL - 21 IS - 6 KW - health information exchange KW - patients KW - privacy KW - trust KW - risk KW - perception N2 - Background: Nowadays, a number of mechanisms and tools are being used by health care organizations and physicians to electronically exchange the personal health information of patients. The main objectives of different methods of health information exchange (HIE) are to reduce health care costs, minimize medical errors, and improve the coordination of interorganizational information exchange across health care entities. The main challenges associated with the common HIE systems are privacy concerns, security risks, low visibility of system transparency, and lack of patient control. Blockchain technology is likely to disrupt the current information exchange models utilized in the health care industry. Objective: Little is known about patients? perceptions and attitudes toward the implementation of blockchain-enabled HIE networks, and it is still not clear if patients (as one of the main HIE stakeholders) are likely to opt in to the applications of this technology in HIE initiatives. Thus, this study aimed at exploring the core value of blockchain technology in the health care industry from health care consumers? views. Methods: To recognize the potential applications of blockchain technology in health care practices, we designed 16 information exchange scenarios for controlled Web-based experiments. Overall, 2013 respondents participated in 16 Web-based experiments. Each experiment described an information exchange condition characterized by 4 exchange mechanisms (ie, direct, lookup, patient-centered, and blockchain), 2 types of health information (ie, sensitive vs nonsensitive), and 2 types of privacy policy (weak vs strong). Results: The findings show that there are significant differences in patients? perceptions of various exchange mechanisms with regard to patient privacy concern, trust in competency and integrity, opt-in intention, and willingness to share information. Interestingly, participants hold a favorable attitude toward the implementation of blockchain-based exchange mechanisms for privacy protection, coordination, and information exchange purposes. This study proposed the potentials and limitations of a blockchain-based attempt in the HIE context. Conclusions: The results of this research should be of interest to both academics and practitioners. The findings propose potential limitations of a blockchain-based HIE that should be addressed by health care organizations to exchange personal health information in a secure and private manner. This study can contribute to the research in the blockchain area and enrich the literature on the use of blockchain in HIE efforts. Practitioners can also identify how to leverage the benefit of blockchain to promote HIE initiatives nationwide. UR - http://www.jmir.org/2019/6/e14184/ UR - http://dx.doi.org/10.2196/14184 UR - http://www.ncbi.nlm.nih.gov/pubmed/31223119 ID - info:doi/10.2196/14184 ER - TY - JOUR AU - Chita-Tegmark, Meia AU - Ackerman, M. Janet AU - Scheutz, Matthias PY - 2019/5/19 TI - Effects of Assistive Robot Behavior on Impressions of Patient Psychological Attributes: Vignette-Based Human-Robot Interaction Study JO - J Med Internet Res SP - e13729 VL - 21 IS - 6 KW - robotics KW - emotional intelligence KW - patient-centered care N2 - Background: As robots are increasingly designed for health management applications, it is critical to not only consider the effects robots will have on patients but also consider a patient?s wider social network, including the patient?s caregivers and health care providers, among others. Objective: In this paper we investigated how people evaluate robots that provide care and how they form impressions of the patient the robot cares for, based on how the robot represents the patient. Methods: We have used a vignette-based study, showing participants hypothetical scenarios describing behaviors of assistive robots (patient-centered or task-centered) and measured their influence on people?s evaluations of the robot itself (emotional intelligence [EI], trustworthiness, and acceptability) as well as people?s perceptions of the patient for whom the robot provides care. Results: We found that for scenarios describing a robot that acts in a patient-centered manner, the robot will not only be perceived as having higher EI (P=.003) but will also cause people to form more positive impressions of the patient that the robot cares for (P<.001). We replicated and expanded these results to other domains such as dieting, learning, and job training. Conclusions: These results imply that robots could be used to enhance human-human relationships in the health care context and beyond. UR - https://www.jmir.org/2019/6/e13729/ UR - http://dx.doi.org/10.2196/13729 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199297 ID - info:doi/10.2196/13729 ER - TY - JOUR AU - Padilha, Miguel José AU - Machado, Puga Paulo AU - Ribeiro, Ana AU - Ramos, José AU - Costa, Patrício PY - 2019/06/27 TI - Correction: Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial JO - J Med Internet Res SP - e14155 VL - 21 IS - 6 UR - http://www.jmir.org/2019/6/e14155/ UR - http://dx.doi.org/10.2196/14155 UR - http://www.ncbi.nlm.nih.gov/pubmed/31250834 ID - info:doi/10.2196/14155 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 - 2019/06/27 TI - Addendum to the Acknowledgements: Validity of Online Screening for Autism: Crowdsourcing Study Comparing Paid and Unpaid Diagnostic Tasks JO - J Med Internet Res SP - e14950 VL - 21 IS - 6 UR - http://www.jmir.org/2019/6/e14950/ UR - http://dx.doi.org/10.2196/14950 UR - http://www.ncbi.nlm.nih.gov/pubmed/31250828 ID - info:doi/10.2196/14950 ER - TY - JOUR AU - Wright, Kevin AU - Fisher, Carla AU - Rising, Camella AU - Burke-Garcia, Amelia AU - Afanaseva, Dasha AU - Cai, Xiaomei PY - 2019/06/17 TI - Metadata Correction: Partnering With Mommy Bloggers to Disseminate Breast Cancer Risk Information: Social Media Intervention JO - J Med Internet Res SP - e14158 VL - 21 IS - 6 UR - https://www.jmir.org/2019/6/e14158/ UR - http://dx.doi.org/10.2196/14158 UR - http://www.ncbi.nlm.nih.gov/pubmed/31210137 ID - info:doi/10.2196/14158 ER -