@Article{info:doi/10.2196/jmir.6581, author="Lokman, Suzanne and Leone, S. Stephanie and Sommers-Spijkerman, Marion and van der Poel, Agnes and Smit, Filip and Boon, Brigitte", title="Complaint-Directed Mini-Interventions for Depressive Complaints: A Randomized Controlled Trial of Unguided Web-Based Self-Help Interventions", journal="J Med Internet Res", year="2017", month="Jan", day="04", volume="19", number="1", pages="e4", keywords="prevention", keywords="depression", keywords="Internet-based intervention", keywords="randomized controlled trial", abstract="Background: Prevention of depression is important due to the substantial burden of disease associated with it. To this end, we developed a novel, brief, and low-threshold Web-based self-help approach for depressive complaints called complaint-directed mini-interventions (CDMIs). These CDMIs focus on highly prevalent complaints that are demonstrably associated with depression and have a substantial economic impact: stress, sleep problems, and worry. Objective: The aim was to evaluate the effectiveness of the Web-based self-help CDMIs in a sample of adults with mild-to-moderate depressive symptoms compared to a wait-list control group. Methods: A two-armed randomized controlled trial was conducted. An open recruitment strategy was used. Participants were randomized to either the Web-based CDMIs or the no-intervention wait-list control group. The CDMIs are online, unguided, self-help interventions, largely based on cognitive behavioral techniques, which consist of 3 to 4 modules with up to 6 exercises per module. Participants are free to choose between the modules and exercises. Assessments, using self-report questionnaires, took place at baseline and at 3 and 6 months after baseline. The control group was given access to the intervention following the 3-month assessment. The primary goal of the CDMIs is to reduce depressive complaints. The primary outcome of the study was a reduction in depressive complaints as measured by the Inventory of Depressive Symptomatology Self-Report (IDS-SR). Secondary outcomes included reductions in stress, worry, sleep problems, and anxiety complaints, and improvements in well-being. Data were analyzed using linear mixed models. Results: In total, 329 participants enrolled in the trial, of which 165 were randomized to the intervention group and 164 to the control group. Approximately three-quarters of the intervention group actually created an account. Of these participants, 91.3\% (116/127) logged into their chosen CDMI at least once during the 3-month intervention period (median 3, range 0-166). After 3 months, there was a significant reduction in depressive symptomatology for participants in the intervention group compared to participants in the wait-list control group (reduction in depression: mean --4.47, 95\% CI --6.54 to --2.40; Cohen d=--0.70). Furthermore, significant effects were observed for sleep problems, worry, anxiety, and well-being, with effect sizes ranging from --0.29 to --0.40. The intervention did not significantly reduce stress. At 6-month follow-up, the improvements in the intervention group were generally sustained. Conclusions: This study shows that the online self-help CDMIs have a positive impact on various mental health outcomes. Future research should focus on which specific strategies may boost adherence, and increase the reach of the CDMIs among people with low socioeconomic status. ClinicalTrial: Netherlands Trial Register (NTR): NTR4612; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4612 (Archived by WebCite at http://www.webcitation.org/6n4PVYddM) ", doi="10.2196/jmir.6581", url="http://www.jmir.org/2017/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/28052840" } @Article{info:doi/10.2196/jmir.6644, author="Graham, Leigh Meredith and Strawderman, S. Myla and Demment, Margaret and Olson, Marie Christine", title="Does Usage of an eHealth Intervention Reduce the Risk of Excessive Gestational Weight Gain? Secondary Analysis From a Randomized Controlled Trial", journal="J Med Internet Res", year="2017", month="Jan", day="09", volume="19", number="1", pages="e6", keywords="Internet", keywords="obesity", keywords="weight gain", keywords="pregnancy", abstract="Background: Excessive gestational weight gain (GWG) contributes to the development of obesity in mother and child. Internet-based interventions have the potential for delivering innovative and interactive options for prevention of excessive GWG to large numbers of people. Objective: The objective of this study was to create a novel measure of Internet-based intervention usage patterns and examine whether usage of an Internet-based intervention is associated with reduced risk of excessive GWG. Methods: The website featured blogs, local resources, articles, frequently asked questions (FAQs), and events that were available to women inboth the intervention and control arm. Weekly reminders to use the website and to highlight new content were emailed to participants in both arms. Only intervention arm participants had access to the weight gain tracker and diet and physical activity goal-setting tools. A total of 1335 (898 intervention and 437 control) relatively diverse and healthy pregnant women were randomly assigned to the intervention arm or control arm. Usage patterns were examined for both intervention and control arm participants using latent class analysis. Regression analyses were used to estimate the association between usage patterns and three GWG outcomes: excessive total GWG, excessive GWG rate, and GWG. Results: Five usage patterns best characterized the usage of the intervention by intervention arm participants. Three usage patterns best characterized control arm participants' usage. Control arm usage patterns were not associated with excessive GWG, whereas intervention arm usage patterns were associated with excessive GWG. Conclusions: The control and intervention arm usage pattern characterization is a unique methodological contribution to process evaluations for self-directed Internet-based interventions. In the intervention arm some usage patterns were associated with GWG outcomes. ClinicalTrial: ClinicalTrials.gov; Clinical Trials Number: NCT01331564; https://clinicaltrials.gov/ct2/show/NCT01331564 (Archived by WebCite at http://www.webcitation/6nI9LuX9w) ", doi="10.2196/jmir.6644", url="http://www.jmir.org/2017/1/e6/", url="http://www.ncbi.nlm.nih.gov/pubmed/28069560" } @Article{info:doi/10.2196/jmir.6601, author="Muller, Ingrid and Rowsell, Alison and Stuart, Beth and Hayter, Victoria and Little, Paul and Ganahl, Kristin and M{\"u}ller, Gabriele and Doyle, Gerardine and Chang, Peter and Lyles, R. Courtney and Nutbeam, Don and Yardley, Lucy", title="Effects on Engagement and Health Literacy Outcomes of Web-Based Materials Promoting Physical Activity in People With Diabetes: An International Randomized Trial", journal="J Med Internet Res", year="2017", month="Jan", day="23", volume="19", number="1", pages="e21", keywords="health literacy", keywords="digital intervention", keywords="diabetes", keywords="quantitative trial", keywords="physical activity", abstract="Background: Developing accessible Web-based materials to support diabetes self-management in people with lower levels of health literacy is a continuing challenge. Objective: The objective of this international study was to develop a Web-based intervention promoting physical activity among people with type 2 diabetes to determine whether audiovisual presentation and interactivity (quizzes, planners, tailoring) could help to overcome the digital divide by making digital interventions accessible and effective for people with all levels of health literacy. This study also aimed to determine whether these materials can improve health literacy outcomes for people with lower levels of health literacy and also be effective for people with higher levels of health literacy. Methods: To assess the impact of interactivity and audiovisual features on usage, engagement, and health literacy outcomes, we designed two versions of a Web-based intervention (one interactive and one plain-text version of the same content) to promote physical activity in people with type 2 diabetes. We randomly assigned participants from the United Kingdom, Austria, Germany, Ireland, and Taiwan to either an interactive or plain-text version of the intervention in English, German, or Mandarin. Intervention usage was objectively recorded by the intervention software. Self-report measures were taken at baseline and follow-up (immediately after participants viewed the intervention) and included measures of health literacy, engagement (website satisfaction and willingness to recommend the intervention to others), and health literacy outcomes (diabetes knowledge, enablement, attitude, perceived behavioral control, and intention to undertake physical activity). Results: In total, 1041 people took part in this study. Of the 1005 who completed health literacy information, 268 (26.67\%) had intermediate or low levels of health literacy. The interactive intervention overall did not produce better outcomes than did the plain-text version. Participants in the plain-text intervention group looked at significantly more sections of the intervention (mean difference --0.47, 95\% CI --0.64 to --0.30, P<.001), but this did not lead to better outcomes. Health literacy outcomes, including attitudes and intentions to engage in physical activity, significantly improved following the intervention for participants in both intervention groups. These improvements were similar across higher and lower health literacy levels and in all countries. Participants in the interactive intervention group had acquired more diabetes knowledge (mean difference 0.80, 95\% CI 0.65-0.94, P<.001). Participants from both groups reported high levels of website satisfaction and would recommend the website to others. Conclusions: Following established practice for simple, clear design and presentation and using a person-based approach to intervention development, with in-depth iterative feedback from users, may be more important than interactivity and audiovisual presentations when developing accessible digital health interventions to improve health literacy outcomes. ClinicalTrial: International Standard Randomized Controlled Trial Number (ISRCTN): 43587048; http://www.isrctn.com/ISRCTN43587048. (Archived by WebCite at http://www.webcitation.org/6nGhaP9bv) ", doi="10.2196/jmir.6601", url="http://www.jmir.org/2017/1/e21/", url="http://www.ncbi.nlm.nih.gov/pubmed/28115299" } @Article{info:doi/10.2196/jmir.6486, author="Smith, J. Robert and Crutchley, Patrick and Schwartz, Andrew H. and Ungar, Lyle and Shofer, Frances and Padrez, A. Kevin and Merchant, M. Raina", title="Variations in Facebook Posting Patterns Across Validated Patient Health Conditions: A Prospective Cohort Study", journal="J Med Internet Res", year="2017", month="Jan", day="6", volume="19", number="1", pages="e7", keywords="Facebook", keywords="depression", keywords="natural language processing", keywords="social media", abstract="Background: Social media is emerging as an insightful platform for studying health. To develop targeted health interventions involving social media, we sought to identify the patient demographic and disease predictors of frequency of posting on Facebook. Objective: The aims were to explore the language topics correlated with frequency of social media use across a cohort of social media users within a health care setting, evaluate the differences in the quantity of social media postings across individuals with different disease diagnoses, and determine if patients could accurately predict their own levels of social media engagement. Methods: Patients seeking care at a single, academic, urban, tertiary care emergency department from March to October 2014 were queried on their willingness to share data from their Facebook accounts and electronic medical records (EMRs). For each participant, the total content of Facebook posts was extracted. Using the latent Dirichlet allocation natural language processing technique, Facebook language topics were correlated with frequency of Facebook use. The mean number of Facebook posts over 6 months prior to enrollment was then compared across validated health outcomes in the sample. Results: A total of 695 patients consented to provide access to their EMR and social media data. Significantly correlated language topics among participants with the highest quartile of posts contained health terms, such as ``cough,'' ``headaches,'' and ``insomnia.'' When adjusted for demographics, individuals with a history of depression had significantly higher posts (mean 38, 95\% CI 28-50) than individuals without a history of depression (mean 22, 95\% CI 19-26, P=.001). Except for depression, across prevalent health outcomes in the sample (hypertension, diabetes, asthma), there were no significant posting differences between individuals with or without each condition. Conclusions: High-frequency posters in our sample were more likely to post about health and to have a diagnosis of depression. The direction of causality between depression and social media use requires further evaluation. Our findings suggest that patients with depression may be appropriate targets for health-related interventions on social media. ", doi="10.2196/jmir.6486", url="http://www.jmir.org/2017/1/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/28062392" } @Article{info:doi/10.2196/jmir.6645, author="Mohr, C. David and Tomasino, Noth Kathryn and Lattie, G. Emily and Palac, L. Hannah and Kwasny, J. Mary and Weingardt, Kenneth and Karr, J. Chris and Kaiser, M. Susan and Rossom, C. Rebecca and Bardsley, R. Leland and Caccamo, Lauren and Stiles-Shields, Colleen and Schueller, M. Stephen", title="IntelliCare: An Eclectic, Skills-Based App Suite for the Treatment of Depression and Anxiety", journal="J Med Internet Res", year="2017", month="Jan", day="05", volume="19", number="1", pages="e10", keywords="mHealth", keywords="eHealth", keywords="mobile health", keywords="depression", keywords="anxiety", abstract="Background: Digital mental health tools have tended to use psychoeducational strategies based on treatment orientations developed and validated outside of digital health. These features do not map well to the brief but frequent ways that people use mobile phones and mobile phone apps today. To address these challenges, we developed a suite of apps for depression and anxiety called IntelliCare, each developed with a focused goal and interactional style. IntelliCare apps prioritize interactive skills training over education and are designed for frequent but short interactions. Objective: The overall objective of this study was to pilot a coach-assisted version of IntelliCare and evaluate its use and efficacy at reducing symptoms of depression and anxiety. Methods: Participants, recruited through a health care system, Web-based and community advertising, and clinical research registries, were included in this single-arm trial if they had elevated symptoms of depression or anxiety. Participants had access to the 14 IntelliCare apps from Google Play and received 8 weeks of coaching on the use of IntelliCare. Coaching included an initial phone call plus 2 or more texts per week over the 8 weeks, with some participants receiving an additional brief phone call. Primary outcomes included the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. Participants were compensated up to US \$90 for completing all assessments; compensation was not for app use or treatment engagement. Results: Of the 99 participants who initiated treatment, 90.1\% (90/99) completed 8 weeks. Participants showed substantial reductions in the PHQ-9 and GAD-7 (P<.001). Participants used the apps an average of 195.4 (SD 141) times over the 8 weeks. The average length of use was 1.1 (SD 2.1) minutes, and 95\% of participants downloaded 5 or more of the IntelliCare apps. Conclusions: This study supports the IntelliCare framework of providing a suite of skills-focused apps that can be used frequently and briefly to reduce symptoms of depression and anxiety. The IntelliCare system is elemental, allowing individual apps to be used or not used based on their effectiveness and utility, and it is eclectic, viewing treatment strategies as elements that can be applied as needed rather than adhering to a singular, overarching, theoretical model. Trial Registration: Clinicaltrials.gov NCT02176226; http://clinicaltrials.gov/ct2/show/NCT02176226 (Archived by WebCite at http://www.webcitation/6mQZuBGk1) ", doi="10.2196/jmir.6645", url="http://www.jmir.org/2017/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/28057609" } @Article{info:doi/10.2196/jmir.6269, author="Bennett-Levy, James and Singer, Judy and DuBois, Simon and Hyde, Kelly", title="Translating E-Mental Health Into Practice: What Are the Barriers and Enablers to E-Mental Health Implementation by Aboriginal and Torres Strait Islander Health Professionals?", journal="J Med Internet Res", year="2017", month="Jan", day="11", volume="19", number="1", pages="e1", keywords="e-mental health", keywords="indigenous populations", keywords="Aboriginal and Torres Strait Islander peoples", keywords="professional supervision", keywords="professional consultation", keywords="service implementation", keywords="health education", keywords="mobile apps", abstract="Background: With increasing evidence for the effectiveness of e-mental health interventions for enhancing mental health and well-being, a growing challenge is how to translate promising research findings into service delivery contexts. A 2012 e-mental health initiative by the Australian Federal Government (eMHPrac) has sought to address the issue through several strategies, one of which has been to train different health professional workforces in e-mental health (e-MH). Objective: The aim of the study was to report on the barriers and enablers of e-MH uptake in a cohort of predominantly Aboriginal and Torres Strait Islander health professionals (21 Indigenous, 5 non-Indigenous) who occupied mainly support or case management roles within their organizations. Methods: A 3- or 2-day e-MH training program was followed by up to 5 consultation sessions (mean 2.4 sessions) provided by the 2 trainers. The trainer-consultants provided written reports on each of the 30 consultation sessions for 7 consultation groups. They were also interviewed as part of the study. The written reports and interview data were thematically analyzed by 2 members of the research team. Results: Uptake of e-MH among the consultation group was moderate (22\%-30\% of participants). There were significant organizational barriers to uptake resulting from procedural and administrative problems, demanding workloads, prohibitive policies, and a lack of fit between the organizational culture and the introduction of new technologies. Personal barriers included participant beliefs about the applicability of e-MH to certain populations, and workers' lack of confidence and skills. However, enthusiastic managers and tech-savvy champions could provide a counter-balance as organizational enablers of e-MH; and the consultation sessions themselves appear to have enhanced skills and confidence, shifted attitudes to new technologies, and seeded a perception that e-MH could be a valuable health education resource. Conclusions: A conclusion from the program was that it was important to match e-MH training and resources to work roles. In the latter stages of the consultation sessions, the Aboriginal and Torres Strait Islander health professionals responded very positively to YouTube video clips and apps with a health education dimension. Therapy-oriented apps and programs may fit less well within the scope of practice of some workforces, including this one. We suggest that researchers broaden their focus and definitions of e-MH and give rather more weight to e-MH's health education possibilities. Developing criteria for evaluating apps and YouTube videos may empower a rather greater section of health workforce to use e-MH with their clients. ", doi="10.2196/jmir.6269", url="http://www.jmir.org/2017/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/28077347" } @Article{info:doi/10.2196/jmir.5780, author="Zhan, Yongcheng and Liu, Ruoran and Li, Qiudan and Leischow, James Scott and Zeng, Dajun Daniel", title="Identifying Topics for E-Cigarette User-Generated Contents: A Case Study From Multiple Social Media Platforms", journal="J Med Internet Res", year="2017", month="Jan", day="20", volume="19", number="1", pages="e24", keywords="electronic cigarettes", keywords="topic modeling", keywords="Latent Dirichlet Allocation", keywords="social media", keywords="infodemiology", abstract="Background: Electronic cigarette (e-cigarette) is an emerging product with a rapid-growth market in recent years. Social media has become an important platform for information seeking and sharing. We aim to mine hidden topics from e-cigarette datasets collected from different social media platforms. Objective: This paper aims to gain a systematic understanding of the characteristics of various types of social media, which will provide deep insights into how consumers and policy makers effectively use social media to track e-cigarette-related content and adjust their decisions and policies. Methods: We collected data from Reddit (27,638 e-cigarette flavor-related posts from January 1, 2011, to June 30, 2015), JuiceDB (14,433 e-juice reviews from June 26, 2013 to November 12, 2015), and Twitter (13,356 ``e-cig ban''-related tweets from January, 1, 2010 to June 30, 2015). Latent Dirichlet Allocation, a generative model for topic modeling, was used to analyze the topics from these data. Results: We found four types of topics across the platforms: (1) promotions, (2) flavor discussions, (3) experience sharing, and (4) regulation debates. Promotions included sales from vendors to users, as well as trades among users. A total of 10.72\% (2,962/27,638) of the posts from Reddit were related to trading. Promotion links were found between social media platforms. Most of the links (87.30\%) in JuiceDB were related to Reddit posts. JuiceDB and Reddit identified consistent flavor categories. E-cigarette vaping methods and features such as steeping, throat hit, and vapor production were broadly discussed both on Reddit and on JuiceDB. Reddit provided space for policy discussions and majority of the posts (60.7\%) holding a negative attitude toward regulations, whereas Twitter was used to launch campaigns using certain hashtags. Our findings are based on data across different platforms. The topic distribution between Reddit and JuiceDB was significantly different (P<.001), which indicated that the user discussions focused on different perspectives across the platforms. Conclusions: This study examined Reddit, JuiceDB, and Twitter as social media data sources for e-cigarette research. These mined findings could be further used by other researchers and policy makers. By utilizing the automatic topic-modeling method, the proposed unified feedback model could be a useful tool for policy makers to comprehensively consider how to collect valuable feedback from social media. ", doi="10.2196/jmir.5780", url="http://www.jmir.org/2017/1/e24/", url="http://www.ncbi.nlm.nih.gov/pubmed/28108428" } @Article{info:doi/10.2196/jmir.5970, author="Nordin, Catharina and Michaelson, Peter and Eriksson, K. Margareta and Gard, Gunvor", title="It's About Me: Patients' Experiences of Patient Participation in the Web Behavior Change Program for Activity in Combination With Multimodal Pain Rehabilitation", journal="J Med Internet Res", year="2017", month="Jan", day="18", volume="19", number="1", pages="e22", keywords="interview", keywords="pain", keywords="patient participation", keywords="qualitative research", keywords="Web-based intervention", abstract="Background: Patients' participation in their health care is recognized as a key component in high-quality health care. Persons with persistent pain are recommended treatments with a cognitive approach from a biopsychosocial explanation of pain, in which a patient's active participation in their rehabilitation is in focus. Web-based interventions for pain management have the potential to increase patient participation by enabling persons to play a more active role in rehabilitation. However, little is known about patients' experiences of patient participation in Web-based interventions in clinical practice. Objective: The objective of our study was to explore patients' experiences of patient participation in a Web Behavior Change Program for Activity (Web-BCPA) in combination with multimodal rehabilitation (MMR) among patients with persistent pain in primary health care. Methods: Qualitative interviews were conducted with 15 women and 4 men, with a mean age of 45 years. Data were analyzed with qualitative content analysis. Results: One theme, ``It's about me,'' and 4 categories, ``Take part in a flexible framework of own priority,'' ``Acquire knowledge and insights,'' ``Ways toward change,'' and ``Personal and environmental conditions influencing participation,'' were developed. Patient participation was depicted as being confirmed in an individualized and structured rehabilitation framework of one's own choice. Being confirmed was fundamental to patient participation in the interaction with the Web-BCPA and with the health care professionals in MMR. To acquire knowledge and insights about pain and their life situation, through self-reflection in the solitary work in the Web-BCPA and through feedback from the health care professionals in MMR, was experienced as patient participation by the participants. Patient participation was described as structured ways to reach their goals of behavior change, which included analyzing resources and restrictions, problem solving, and evaluation. The individual's emotional and cognitive resources and restrictions, as well as health care professionals and significant others' attitudes and behavior influenced patient participation in the rehabilitation. To some extent there were experiences of restrained patient participation through the great content of the Web-BCPA. Conclusions: Patient participation was satisfactory in the Web-BCPA in combination with MMR. The combined treatment was experienced to increase patient participation in the rehabilitation. Being confirmed through self-identification and finding the content of the Web-BCPA trustworthy was emphasized. Patient participation was experienced as a learning process leading to new knowledge and insights. Higher user control regarding the timing of the Web-BCPA and therapist guidance of the content may further increase patient participation in the combined treatment. ", doi="10.2196/jmir.5970", url="http://www.jmir.org/2017/1/e22/", url="http://www.ncbi.nlm.nih.gov/pubmed/28100440" } @Article{info:doi/10.2196/jmir.5729, author="Tan, Swee-Lin Sharon and Goonawardene, Nadee", title="Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review", journal="J Med Internet Res", year="2017", month="Jan", day="19", volume="19", number="1", pages="e9", keywords="Internet", keywords="information seeking", keywords="physician-patient relations", keywords="health information", abstract="Background: With online health information becoming increasingly popular among patients, concerns have been raised about the impact of patients' Internet health information-seeking behavior on their relationship with physicians. Therefore, it is pertinent to understand the influence of online health information on the patient-physician relationship. Objective: Our objective was to systematically review existing research on patients' Internet health information seeking and its influence on the patient-physician relationship. Methods: We systematically searched PubMed and key medical informatics, information systems, and communication science journals covering the period of 2000 to 2015. Empirical articles that were in English were included. We analyzed the content covering themes in 2 broad categories: factors affecting patients' discussion of online findings during consultations and implications for the patient-physician relationship. Results: We identified 18 articles that met the inclusion criteria and the quality requirement for the review. The articles revealed barriers, facilitators, and demographic factors that influence patients' disclosure of online health information during consultations and the different mechanisms patients use to reveal these findings. Our review also showed the mechanisms in which online information could influence patients' relationship with their physicians. Conclusions: Results of this review contribute to the understanding of the patient-physician relationship of Internet-informed patients. Our main findings show that Internet health information seeking can improve the patient-physician relationship depending on whether the patient discusses the information with the physician and on their prior relationship. As patients have better access to health information through the Internet and expect to be more engaged in health decision making, traditional models of the patient-provider relationship and communication strategies must be revisited to adapt to this changing demographic. ", doi="10.2196/jmir.5729", url="http://www.jmir.org/2017/1/e9/", url="http://www.ncbi.nlm.nih.gov/pubmed/28104579" } @Article{info:doi/10.2196/jmir.6575, author="Cox, Anna and Lucas, Grace and Marcu, Afrodita and Piano, Marianne and Grosvenor, Wendy and Mold, Freda and Maguire, Roma and Ream, Emma", title="Cancer Survivors' Experience With Telehealth: A Systematic Review and Thematic Synthesis", journal="J Med Internet Res", year="2017", month="Jan", day="09", volume="19", number="1", pages="e11", keywords="neoplasms", keywords="telemedicine", keywords="systematic review", keywords="survival", keywords="patient satisfaction", keywords="patient preference", abstract="Background: Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors---individuals living with and beyond cancer---to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are ``complex,'' and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized. Objective: To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group. Methods: Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes. Analytical themes were developed through an iterative process of reflection on, and interpretation of, the descriptive themes within and across studies. Results: Across the 22 included papers, 3 analytical themes emerged, each with 3 descriptive subthemes: (1) influence of telehealth on the disrupted lives of cancer survivors (convenience, independence, and burden); (2) personalized care across physical distance (time, space, and the human factor); and (3) remote reassurance---a safety net of health care professional connection (active connection, passive connection, and slipping through the net). Telehealth interventions represent a convenient approach, which can potentially minimize treatment burden and disruption to cancer survivors' lives. Telehealth interventions can facilitate an experience of personalized care and reassurance for those living with and beyond cancer; however, it is important to consider individual factors when tailoring interventions to ensure engagement promotes benefit rather than burden. Conclusions: Telehealth interventions can provide cancer survivors with independence and reassurance. Future telehealth interventions need to be developed iteratively in collaboration with a broad range of cancer survivors to maximize engagement and benefit. ", doi="10.2196/jmir.6575", url="http://www.jmir.org/2017/1/e11/", url="http://www.ncbi.nlm.nih.gov/pubmed/28069561" } @Article{info:doi/10.2196/jmir.5951, author="Cranen, Karlijn and Groothuis-Oudshoorn, GM Catharina and Vollenbroek-Hutten, MR Miriam and IJzerman, J. Maarten", title="Toward Patient-Centered Telerehabilitation Design: Understanding Chronic Pain Patients' Preferences for Web-Based Exercise Telerehabilitation Using a Discrete Choice Experiment", journal="J Med Internet Res", year="2017", month="Jan", day="20", volume="19", number="1", pages="e26", keywords="patient preference", keywords="patient acceptance of health care", keywords="telerehabilitation", keywords="choice behavior", keywords="decision making", keywords="decision support techniques", keywords="patient compliance", keywords="chronic disease", keywords="exercise therapy", keywords="chronic pain", abstract="Background: Patient-centered design that addresses patients' preferences and needs is considered an important aim for improving health care systems. At present, within the field of pain rehabilitation, patients' preferences regarding telerehabilitation remain scarcely explored and little is known about the optimal combination between human and electronic contact from the patients' perspective. In addition, limited evidence is available about the best way to explore patients' preferences. Therefore, the assessment of patients' preferences regarding telemedicine is an important step toward the design of effective patient-centered care. Objective: To identify which telerehabilitation treatment options patients with chronic pain are most likely to accept as alternatives to conventional rehabilitation and assess which treatment attributes are most important to them. Methods: A discrete choice experiment with 15 choice tasks, combining 6 telerehabilitation treatment characteristics, was designed. Each choice task consisted of 2 hypothetical treatment scenarios and 1 opt-out scenario. Relative attribute importance was estimated using a bivariate probit regression analysis. One hundred and thirty surveys were received, of which 104 were usable questionnaires; thus, resulting in a total of 1547 observations. Results: Physician communication mode, the use of feedback and monitoring technology (FMT), and exercise location were key drivers of patients' treatment preferences (P<.001). Patients were willing to accept less frequent physician consultation offered mainly through video communication, provided that they were offered FMT and some face-to-face consultation and could exercise outside their home environment at flexible exercise hours. Home-based telerehabilitation scenarios with minimal physician supervision were the least preferred. A reduction in health care premiums would make these telerehabilitation scenarios as attractive as conventional clinic-based rehabilitation. Conclusions: ``Intermediate'' telerehabilitation treatments offering FMT, some face-to-face consulting, and a gym-based exercise location should be pursued as promising alternatives to conventional chronic pain rehabilitation. Further research is necessary to explore whether strategies other than health care premium reductions could also increase the value of home telerehabilitation treatment. ", doi="10.2196/jmir.5951", url="http://www.jmir.org/2017/1/e26/", url="http://www.ncbi.nlm.nih.gov/pubmed/28108429" } @Article{info:doi/10.2196/jmir.6571, author="Bashi, Nazli and Karunanithi, Mohanraj and Fatehi, Farhad and Ding, Hang and Walters, Darren", title="Remote Monitoring of Patients With Heart Failure: An Overview of Systematic Reviews", journal="J Med Internet Res", year="2017", month="Jan", day="20", volume="19", number="1", pages="e18", keywords="systematic review", keywords="patient monitoring", keywords="mobile phone", keywords="telemedicine", keywords="heart failure", abstract="Background: Many systematic reviews exist on the use of remote patient monitoring (RPM) interventions to improve clinical outcomes and psychological well-being of patients with heart failure. However, research is broadly distributed from simple telephone-based to complex technology-based interventions. The scope and focus of such evidence also vary widely, creating challenges for clinicians who seek information on the effect of RPM interventions. Objective: The aim of this study was to investigate the effects of RPM interventions on the health outcomes of patients with heart failure by synthesizing review-level evidence. Methods: We searched PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from 2005 to 2015. We screened reviews based on relevance to RPM interventions using criteria developed for this overview. Independent authors screened, selected, and extracted information from systematic reviews. AMSTAR (Assessment of Multiple Systematic Reviews) was used to assess the methodological quality of individual reviews. We used standardized language to summarize results across reviews and to provide final statements about intervention effectiveness. Results: A total of 19 systematic reviews met our inclusion criteria. Reviews consisted of RPM with diverse interventions such as telemonitoring, home telehealth, mobile phone--based monitoring, and videoconferencing. All-cause mortality and heart failure mortality were the most frequently reported outcomes, but others such as quality of life, rehospitalization, emergency department visits, and length of stay were also reported. Self-care and knowledge were less commonly identified. Conclusions: Telemonitoring and home telehealth appear generally effective in reducing heart failure rehospitalization and mortality. Other interventions, including the use of mobile phone--based monitoring and videoconferencing, require further investigation. ", doi="10.2196/jmir.6571", url="http://www.jmir.org/2017/1/e18/", url="http://www.ncbi.nlm.nih.gov/pubmed/28108430" } @Article{info:doi/10.2196/jmir.6583, author="Miller, Soederberg Lisa M. and Beckett, A. Laurel and Bergman, J. Jacqueline and Wilson, D. Machelle and Applegate, A. Elizabeth and Gibson, N. Tanja", title="Developing Nutrition Label Reading Skills: A Web-Based Practice Approach", journal="J Med Internet Res", year="2017", month="Jan", day="13", volume="19", number="1", pages="e16", keywords="nutrition labeling", keywords="dietary habits", keywords="automatic information processing", keywords="food selection", keywords="choice behavior", abstract="Background: Nutrition labels offer the information needed to follow Dietary Guidelines for Americans, yet many individuals use labels infrequently or ineffectively due to limited comprehension and the effort required to use them. Objective: The objective of our study was to develop and test a Web-based label-reading training tool to improve individuals' ability to use labels to select more healthful foods. We were particularly interested in determining whether practice can lead to increased accuracy using labels as well as decreased effort, together reflecting greater efficiency. We compared a basic and an enhanced, prior-knowledge version of the tool that contained an additional component, a brief nutrition tutorial. Methods: Participants were 140 college students with an average age of 20.7 (SD 2.1) years and education 14.6 (SD 1.2) years, who completed 3 sets of practice that were designed to teach them, through repetition and feedback, how to use nutrition labels to select more healthful products. Prior to training, participants in the prior-knowledge group viewed a multimedia nutrition presentation, which those in the basic group did not receive. Mixed-effects models tested for improvement in accuracy and speed with practice, and whether improvements varied by group. Results: The training led to significant increases in average accuracy across the 3 practice sets (averaging 79\% [19/24 questions], 92\% [22/24], 96\% [23/24] respectively, P<.001), as well as decreases in time to complete with mean (SD) values of 8.7 (2.8), 4.6 (1.8), and 4.1 (1.7) seconds, respectively. In block 3, the odds of a correct answer for the prior-knowledge group were 79\% higher (odds ratio, OR=1.79, 95\% CI 1.1-2.9) than those for the basic group (P=.02). There was no significant difference between the groups in block 2 (P=.89). Conclusions: Practice led to improvements in nutrition label reading skills that are indicative of early stages of automatic processing. To the extent that automatic processes are at the core of healthy habit change, this may be an efficient way to improve dietary decision-making. ", doi="10.2196/jmir.6583", url="http://www.jmir.org/2017/1/e16/", url="http://www.ncbi.nlm.nih.gov/pubmed/28087497" } @Article{info:doi/10.2196/jmir.5876, author="Roehrs, Alex and da Costa, Andr{\'e} Cristiano and Righi, Rosa Rodrigo da and de Oliveira, Farias Kleinner Silva", title="Personal Health Records: A Systematic Literature Review", journal="J Med Internet Res", year="2017", month="Jan", day="06", volume="19", number="1", pages="e13", keywords="personal health records", keywords="patient access to records", keywords="mobile health", keywords="electronic health records", keywords="taxonomy", abstract="Background: Information and communication technology (ICT) has transformed the health care field worldwide. One of the main drivers of this change is the electronic health record (EHR). However, there are still open issues and challenges because the EHR usually reflects the partial view of a health care provider without the ability for patients to control or interact with their data. Furthermore, with the growth of mobile and ubiquitous computing, the number of records regarding personal health is increasing exponentially. This movement has been characterized as the Internet of Things (IoT), including the widespread development of wearable computing technology and assorted types of health-related sensors. This leads to the need for an integrated method of storing health-related data, defined as the personal health record (PHR), which could be used by health care providers and patients. This approach could combine EHRs with data gathered from sensors or other wearable computing devices. This unified view of patients' health could be shared with providers, who may not only use previous health-related records but also expand them with data resulting from their interactions. Another PHR advantage is that patients can interact with their health data, making decisions that may positively affect their health. Objective: This work aimed to explore the recent literature related to PHRs by defining the taxonomy and identifying challenges and open questions. In addition, this study specifically sought to identify data types, standards, profiles, goals, methods, functions, and architecture with regard to PHRs. Methods: The method to achieve these objectives consists of using the systematic literature review approach, which is guided by research questions using the population, intervention, comparison, outcome, and context (PICOC) criteria. Results: As a result, we reviewed more than 5000 scientific studies published in the last 10 years, selected the most significant approaches, and thoroughly surveyed the health care field related to PHRs. We developed an updated taxonomy and identified challenges, open questions, and current data types, related standards, main profiles, input strategies, goals, functions, and architectures of the PHR. Conclusions: All of these results contribute to the achievement of a significant degree of coverage regarding the technology related to PHRs. ", doi="10.2196/jmir.5876", url="http://www.jmir.org/2017/1/e13/", url="http://www.ncbi.nlm.nih.gov/pubmed/28062391" } @Article{info:doi/10.2196/jmir.6518, author="Dove, Erica and Astell, J. Arlene", title="The Use of Motion-Based Technology for People Living With Dementia or Mild Cognitive Impairment: A Literature Review", journal="J Med Internet Res", year="2017", month="Jan", day="11", volume="19", number="1", pages="e3", keywords="dementia", keywords="mild cognitive impairment", keywords="technology", keywords="review", abstract="Background: The number of people living with dementia and mild cognitive impairment (MCI) is increasing substantially. Although there are many research efforts directed toward the prevention and treatment of dementia and MCI, it is also important to learn more about supporting people to live well with dementia or MCI through cognitive, physical, and leisure means. While past research suggests that technology can be used to support positive aging for people with dementia or MCI, the use of motion-based technology has not been thoroughly explored with this population. Objective: The aim of this study was to identify and synthesize the current literature involving the use of motion-based technology for people living with dementia or MCI by identifying themes while noting areas requiring further research. Methods: A systematic review of studies involving the use of motion-based technology for human participants living with dementia or MCI was conducted. Results: A total of 31 articles met the inclusion criteria. Five questions are addressed concerning (1) context of use; (2) population included (ie, dementia, MCI, or both); (3) hardware and software selection; (4) use of motion-based technology in a group or individual setting; and (5) details about the introduction, teaching, and support methods applied when using the motion-based technology with people living with dementia or MCI. Conclusions: The findings of this review confirm the potential of motion-based technology to improve the lives of people living with dementia or MCI. The use of this technology also spans across several contexts including cognitive, physical, and leisure; all of which support multidimensional well-being. The literature provides evidence that people living with dementia or MCI can learn how to use this technology and that they enjoy doing so. However, there is a lack of information provided in the literature regarding the introduction, training, and support methods applied when using this form of technology with this population. Future research should address the appropriate introduction, teaching, and support required for people living with dementia or MCI to use the motion-based technology. In addition, it is recommended that the diverse needs of these specific end-users be considered in the design and development of this technology. ", doi="10.2196/jmir.6518", url="http://www.jmir.org/2017/1/e3/", url="http://www.ncbi.nlm.nih.gov/pubmed/28077346" } @Article{info:doi/10.2196/jmir.5816, author="Pappa, Lobo Gisele and Cunha, Oliveira Tiago and Bicalho, Viana Paulo and Ribeiro, Antonio and Couto Silva, Paula Ana and Meira Jr, Wagner and Beleigoli, Rezende Alline Maria", title="Factors Associated With Weight Change in Online Weight Management Communities: A Case Study in the LoseIt Reddit Community", journal="J Med Internet Res", year="2017", month="Jan", day="16", volume="19", number="1", pages="e17", keywords="obesity", keywords="online social media", keywords="weight loss", keywords="user behavior", keywords="topic modeling", abstract="Background: Recent research has shown that of the 72\% of American Internet users who have looked for health information online, 22\% have searched for help to lose or control weight. This demand for information has given rise to many online weight management communities, where users support one another throughout their weight loss process. Whether and how user engagement in online communities relates to weight change is not totally understood. Objective: We investigated the activity behavior and analyze the semantic content of the messages of active users in LoseIt (r/loseit), a weight management community of the online social network Reddit. We then explored whether these features are associated with weight loss in this online social network. Methods: A data collection tool was used to collect English posts, comments, and other public metadata of active users (ie, users with at least one post or comment) on LoseIt from August 2010 to November 2014. Analyses of frequency and intensity of user interaction in the community were performed together with a semantic analysis of the messages, done by a latent Dirichlet allocation method. The association between weight loss and online user activity patterns, the semantics of the messages, and real-world variables was found by a linear regression model using 30-day weight change as the dependent variable. Results: We collected posts and comments of 107,886 unique users. Among these, 101,003 (93.62\%) wrote at least one comment and 38,981 (36.13\%) wrote at least one post. Median percentage of days online was 3.81 (IQR 9.51). The 10 most-discussed semantic topics on posts were related to healthy food, clothing, calorie counting, workouts, looks, habits, support, and unhealthy food. In the subset of 754 users who had gender, age, and 30-day weight change data available, women were predominant and 92.9\% (701/754) lost weight. Female gender, body mass index (BMI) at baseline, high levels of online activity, the number of upvotes received per post, and topics discussed within the community were independently associated with weight change. Conclusions: Our findings suggest that among active users of a weight management community, self-declaration of higher BMI levels (which may represent greater dissatisfaction with excess weight), high online activity, and engagement in discussions that might provide social support are associated with greater weight loss. These findings have the potential to aid health professionals to assist patients in online interventions by focusing efforts on increasing engagement and/or starting discussions on topics of higher impact on weight change. ", doi="10.2196/jmir.5816", url="http://www.jmir.org/2017/1/e17/", url="http://www.ncbi.nlm.nih.gov/pubmed/28093378" } @Article{info:doi/10.2196/jmir.5954, author="Berrouiguet, Sofian and Barrig{\'o}n, Luisa Maria and Brandt, A. Sara and Nitzburg, C. George and Ovejero, Santiago and Alvarez-Garcia, Raquel and Carballo, Juan and Walter, Michel and Billot, Romain and Lenca, Philippe and Delgado-Gomez, David and Ropars, Juliette and de la Calle Gonzalez, Ivan and Courtet, Philippe and Baca-Garc{\'i}a, Enrique", title="Ecological Assessment of Clinicians' Antipsychotic Prescription Habits in Psychiatric Inpatients: A Novel Web- and Mobile Phone--Based Prototype for a Dynamic Clinical Decision Support System", journal="J Med Internet Res", year="2017", month="Jan", day="26", volume="19", number="1", pages="e25", keywords="clinical decision-making", keywords="antipsychotic agents", keywords="software", keywords="mobile applications", keywords="off-label use", keywords="prescriptions", abstract="Background: Electronic prescribing devices with clinical decision support systems (CDSSs) hold the potential to significantly improve pharmacological treatment management. Objective: The aim of our study was to develop a novel Web- and mobile phone--based application to provide a dynamic CDSS by monitoring and analyzing practitioners' antipsychotic prescription habits and simultaneously linking these data to inpatients' symptom changes. Methods: We recruited 353 psychiatric inpatients whose symptom levels and prescribed medications were inputted into the MEmind application. We standardized all medications in the MEmind database using the Anatomical Therapeutic Chemical (ATC) classification system and the defined daily dose (DDD). For each patient, MEmind calculated an average for the daily dose prescribed for antipsychotics (using the N05A ATC code), prescribed daily dose (PDD), and the PDD to DDD ratio. Results: MEmind results found that antipsychotics were used by 61.5\% (217/353) of inpatients, with the largest proportion being patients with schizophrenia spectrum disorders (33.4\%, 118/353). Of the 217 patients, 137 (63.2\%, 137/217) were administered pharmacological monotherapy and 80 (36.8\%, 80/217) were administered polytherapy. Antipsychotics were used mostly in schizophrenia spectrum and related psychotic disorders, but they were also prescribed in other nonpsychotic diagnoses. Notably, we observed polypharmacy going against current antipsychotics guidelines. Conclusions: MEmind data indicated that antipsychotic polypharmacy and off-label use in inpatient units is commonly practiced. MEmind holds the potential to create a dynamic CDSS that provides real-time tracking of prescription practices and symptom change. Such feedback can help practitioners determine a maximally therapeutic drug treatment while avoiding unproductive overprescription and off-label use. ", doi="10.2196/jmir.5954", url="http://www.jmir.org/2017/1/e25/", url="http://www.ncbi.nlm.nih.gov/pubmed/28126703" } @Article{info:doi/10.2196/jmir.6380, author="Carlsson, Tommy and Axelsson, Ove", title="Patient Information Websites About Medically Induced Second-Trimester Abortions: A Descriptive Study of Quality, Suitability, and Issues", journal="J Med Internet Res", year="2017", month="Jan", day="10", volume="19", number="1", pages="e8", keywords="consumer health information", keywords="induced abortion", keywords="information literacy", keywords="Internet", keywords="popular works", keywords="second pregnancy trimester", abstract="Background: Patients undergoing medically induced second-trimester abortions feel insufficiently informed and use the Web for supplemental information. However, it is still unclear how people who have experience with pregnancy termination appraise the quality of patient information websites about medically induced second-trimester abortions, whether they consider the websites suitable for patients, and what issues they experience with the websites. Objective: Our objective was to investigate the quality of, suitability of, and issues with patient information websites about medically induced second-trimester abortions and potential differences between websites affiliated with the health care system and private organizations. Methods: We set out to answer the objective by using 4 laypeople who had experience with pregnancy termination as quality assessors. The first 50 hits of 26 systematic searches were screened (N=1300 hits) using search terms reported by the assessors. Of these hits, 48\% (628/1300) were irrelevant and 51\% (667/1300) led to websites about medically induced second-trimester abortions. After correcting for duplicate hits, 42 patient information websites were included, 18 of which were affiliated with the health care system and 24 with private organizations. The 4 assessors systematically assessed the websites with the DISCERN instrument (total score range 16-80), the Ensuring Quality Information for Patients (EQIP) tool (total score range 0-100), as well as questions concerning website suitability and perceived issues. Results: The interrater reliability was 0.8 for DISCERN and EQIP, indicating substantial agreement between the assessors. The total mean score was 36 for DISCERN and 40 for EQIP, indicating poor overall quality. Websites from the health care system had greater total EQIP (45 vs 37, P>.05) and reliability scores (22 vs 20, P>.05). Only 1 website was recommended by all assessors and 57\% (24/42) were rated as very unsuitable by at least one assessor. The most reported issues with the websites involved lack of information (76\%, 32/42), and poor design (36\%, 15/42). Conclusions: The high number of irrelevant hits and poor quality of patient information websites are considerable issues that must be addressed and considered when consulting patients awaiting medically induced second-trimester abortions. In clinical encounters, health professionals should initiate discussions concerning websites about medically induced second-trimester abortions and inform patients about the issues and quality deficits associated with these websites. ", doi="10.2196/jmir.6380", url="http://www.jmir.org/2017/1/e8/", url="http://www.ncbi.nlm.nih.gov/pubmed/28073735" } @Article{info:doi/10.2196/jmir.7056, author="Pauer, Fr{\'e}d{\'e}ric and Litzkendorf, Svenja and G{\"o}bel, Jens and Storf, Holger and Zeidler, Jan and Graf von der Schulenburg, Johann-Matthias", title="Rare Diseases on the Internet: An Assessment of the Quality of Online Information", journal="J Med Internet Res", year="2017", month="Jan", day="18", volume="19", number="1", pages="e23", keywords="health literacy", keywords="rare disesases", keywords="quality indicators", keywords="health information exchange", abstract="Background: The importance of the Internet as a medium for publishing and sharing health and medical information has increased considerably during the last decade. Nonetheless, comprehensive knowledge and information are scarce and difficult to find, especially for rare diseases. Additionally, the quality of health or medical information about rare diseases is frequently difficult to assess for the patients and their family members. Objective: The aim of this study is to assess the quality of information on the Internet about rare diseases. Additionally, the study aims to evaluate if the quality of information on rare diseases varies between different information supplier categories. Methods: A total of 13 quality criteria for websites providing medical information about rare diseases were transferred to a self-disclosure questionnaire. Identified providers of information on the Internet about rare diseases were invited to fill out the questionnaire. The questionnaire contained questions about the information provider in general (eg, supplier category, information category, language, use of quality certificates, and target group) and about quality aspects that reflect the 13 quality criteria. Differences in subgroup analyses were performed using t tests. Results: We identified 693 websites containing information about rare diseases. A total of 123 questionnaires (17.7\%) were completely filled out by the information suppliers. For the remaining identified suppliers (570/693, 82.3\%), the questionnaires were filled out by the authors based on the information available on their website. In many cases, the quality of websites was proportionally low. Furthermore, subgroup analysis showed no statistically significant differences between the quality of information provided by support group/patient organization compared to medical institution (P=.19). The quality of information by individuals (patient/relative) was significantly lower compared to information provided by support group/patient organization (P=.001), medical institution (P=.009), and other associations and sponsoring bodies (P=.001) as well. Conclusions: Overall, the quality of information on the Internet about rare diseases is low. Quality certificates are rarely used and important quality criteria are often not fulfilled completely. Additionally, some information categories are underrepresented (eg, information about psychosocial counseling, social-legal advice, and family planning). Nevertheless, due to the high amount of information provided by support groups, this study shows that these are extremely valuable sources of information for patients suffering from a rare disease and their relatives. ", doi="10.2196/jmir.7056", url="http://www.jmir.org/2017/1/e23/", url="http://www.ncbi.nlm.nih.gov/pubmed/28100442" } @Article{info:doi/10.2196/jmir.6296, author="Walker, M. Daniel and Johnson, Tyler and Ford, W. Eric and Huerta, R. Timothy", title="Trust Me, I'm a Doctor: Examining Changes in How Privacy Concerns Affect Patient Withholding Behavior", journal="J Med Internet Res", year="2017", month="Jan", day="04", volume="19", number="1", pages="e2", keywords="privacy", keywords="electronic health records", keywords="disclosure", keywords="trust", keywords="electronic medical records", keywords="personal health information", abstract="Background: As electronic health records (EHRs) become ubiquitous in the health care industry, privacy breaches are increasing and being made public. These breaches may make consumers wary of the technology, undermining its potential to improve care coordination and research. Objective: Given the developing concerns around privacy of personal health information stored in digital format, it is important for providers to understand how views on privacy and security may be associated with patient disclosure of health information. This study aimed to understand how privacy concerns may be shifting patient behavior. Methods: Using a pooled cross-section of data from the 2011 and 2014 cycles of the Health Information and National Trends Survey (HINTS), we tested whether privacy and security concerns, as well as quality perceptions, are associated with the likelihood of withholding personal health information from a provider. A fully interacted multivariate model was used to compare associations between the 2 years, and interaction terms were used to evaluate trends in the factors that are associated with withholding behavior. Results: No difference was found regarding the effect of privacy and security concerns on withholding behavior between 2011 and 2014. Similarly, whereas perceived high quality of care was found to reduce the likelihood of withholding information from a provider in both 2011 (odds ratio [OR] 0.73, 95\% confidence interval [CI] 0.56-0.94) and 2014 (OR 0.61, 95\% CI 0.48-0.76), no difference was observed between years. Conclusions: These findings suggest that consumers' beliefs about EHR privacy and security, the relationship between technology use and quality, and intentions to share information with their health care provider have not changed. These findings are counter to the ongoing discussions about the implications of security failures in other domains. Our results suggest that providers could ameliorate privacy and security by focusing on the care quality benefits EHRs provide. ", doi="10.2196/jmir.6296", url="http://www.jmir.org/2017/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/28052843" } @Article{info:doi/10.2196/jmir.6709, author="van der Vaart, Rosalie and Drossaert, Constance", title="Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills", journal="J Med Internet Res", year="2017", month="Jan", day="24", volume="19", number="1", pages="e27", keywords="digital health literacy skills", keywords="eHealth literacy", keywords="measurement", keywords="validity", keywords="performance-based instrument", abstract="Background: With the digitization of health care and the wide availability of Web-based applications, a broad set of skills is essential to properly use such facilities; these skills are called digital health literacy or eHealth literacy. Current instruments to measure digital health literacy focus only on information gathering (Health 1.0 skills) and do not pay attention to interactivity on the Web (Health 2.0). To measure the complete spectrum of Health 1.0 and Health 2.0 skills, including actual competencies, we developed a new instrument. The Digital Health Literacy Instrument (DHLI) measures operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content, and protecting privacy. Objective: Our objective was to study the distributional properties, reliability, content validity, and construct validity of the DHLI's self-report scale (21 items) and to explore the feasibility of an additional set of performance-based items (7 items). Methods: We used a paper-and-pencil survey among a sample of the general Dutch population, stratified by age, sex, and educational level (T1; N=200). The survey consisted of the DHLI, sociodemographics, Internet use, health status, health literacy and the eHealth Literacy Scale (eHEALS). After 2 weeks, we asked participants to complete the DHLI again (T2; n=67). Cronbach alpha and intraclass correlation analysis between T1 and T2 were used to investigate reliability. Principal component analysis was performed to determine content validity. Correlation analyses were used to determine the construct validity. Results: Respondents (107 female and 93 male) ranged in age from 18 to 84 years (mean 46.4, SD 19.0); 23.0\% (46/200) had a lower educational level. Internal consistencies of the total scale (alpha=.87) and the subscales (alpha range .70-.89) were satisfactory, except for protecting privacy (alpha=.57). Distributional properties showed an approximately normal distribution. Test-retest analysis was satisfactory overall (total scale intraclass correlation coefficient=.77; subscale intraclass correlation coefficient range .49-.81). The performance-based items did not together form a single construct (alpha=.47) and should be interpreted individually. Results showed that more complex skills were reflected in a lower number of correct responses. Principal component analysis confirmed the theoretical structure of the self-report scale (76\% explained variance). Correlations were as expected, showing significant relations with age ($\rho$=--.41, P<.001), education ($\rho$=.14, P=.047), Internet use ($\rho$=.39, P<.001), health-related Internet use ($\rho$=.27, P<.001), health status ($\rho$ range .17-.27, P<.001), health literacy ($\rho$=.31, P<.001), and the eHEALS ($\rho$=.51, P<.001). Conclusions: This instrument can be accepted as a new self-report measure to assess digital health literacy, using multiple subscales. Its performance-based items provide an indication of actual skills but should be studied and adapted further. Future research should examine the acceptability of this instrument in other languages and among different populations. ", doi="10.2196/jmir.6709", url="http://www.jmir.org/2017/1/e27/", url="http://www.ncbi.nlm.nih.gov/pubmed/28119275" } @Article{info:doi/10.2196/jmir.5964, author="Yang, Shu-Ching and Luo, Yi-Fang and Chiang, Chia-Hsun", title="The Associations Among Individual Factors, eHealth Literacy, and Health-Promoting Lifestyles Among College Students", journal="J Med Internet Res", year="2017", month="Jan", day="10", volume="19", number="1", pages="e15", keywords="individual factors", keywords="health-promoting lifestyle", keywords="eHealth literacy", abstract="Background: eHealth literacy is gaining importance for maintaining and promoting health. Studies have found that individuals with high eHealth literacy are more likely to adopt healthy eating, exercise, and sleep behaviors. In addition, previous studies have shown that various individual factors (eg, frequency of seeking information on health issues, degree of health concern, frequency of eating organic food, and students' college major) are associated with eHealth literacy and health-promoting lifestyles. Nevertheless, few studies have explored the associations among individual factors, eHealth literacy, and health-promoting lifestyles among college students. Moreover, there is a lack of studies that focus on eHealth literacy as a predictor of psychological health behaviors. Objective: To examine the associations among various individual factors, eHealth literacy, and health-promoting lifestyles. Methods: The eHealth Literacy Scale is a 12-item instrument designed to measure college students' functional, interactive, and critical eHealth literacy. The Health-promoting Lifestyle Scale is a 23-item instrument developed to measure college students' self-actualization, health responsibility, interpersonal support, exercise, nutrition, and stress management. A nationally representative sample of 556 valid college students in Taiwan was surveyed. A questionnaire was administered to gather the respondents' background information, including the frequency of seeking information on health issues, the frequency of eating organic food, the degree of health concern, and the students' major. We then conducted a multiple regression analysis to examine the associations among individual factors, eHealth literacy, and health-promoting lifestyles. Results: The study found that factors such as medical majors (t550=2.47-7.55, P<.05) and greater concern with health (t550=2.15-9.01, P<.05) predicted college students' 4-6 health-promoting lifestyle dimensions and the 3 dimensions of eHealth literacy. Moreover, critical eHealth literacy positively predicted all 6 health-promoting lifestyle dimensions (t547=2.66-7.28, P<.01), functional literacy positively predicted 2 dimensions (t547=2.32-2.98, P<.05), and interactive literacy predicted only the self-actualization dimension (t547=2.81, P<.01). Conclusions: This study found that participants who majored in medical fields had greater concern with their health and frequently sought health information, exhibited better eHealth literacy, and had a positive health-promoting lifestyle. Moreover, this study showed that college students with a higher critical eHealth literacy engaged better in health-promoting activities than those with functional and interactive literacy. ", doi="10.2196/jmir.5964", url="http://www.jmir.org/2017/1/e15/", url="http://www.ncbi.nlm.nih.gov/pubmed/28073739" } @Article{info:doi/10.2196/jmir.6587, author="Buntrock, Claudia and Berking, Matthias and Smit, Filip and Lehr, Dirk and Nobis, Stephanie and Riper, Heleen and Cuijpers, Pim and Ebert, David", title="Preventing Depression in Adults With Subthreshold Depression: Health-Economic Evaluation Alongside a Pragmatic Randomized Controlled Trial of a Web-Based Intervention", journal="J Med Internet Res", year="2017", month="Jan", day="04", volume="19", number="1", pages="e5", keywords="prevention", keywords="major depressive disorders", keywords="Internet", keywords="early intervention", keywords="cost effectiveness", abstract="Background: Psychological interventions for the prevention of depression might be a cost-effective way to reduce the burden associated with depressive disorders. Objective: To evaluate the cost-effectiveness of a Web-based guided self-help intervention to prevent major depressive disorder (MDD) in people with subthreshold depression (sD). Methods: A pragmatic randomized controlled trial was conducted with follow-up at 12 months. Participants were recruited from the general population via a large statutory health insurance company and an open access website. Participants were randomized to a Web-based guided self-help intervention (ie, cognitive-behavioral therapy and problem-solving therapy assisted by supervised graduate students or health care professionals) in addition to usual care or to usual care supplemented with Web-based psycho-education (enhanced usual care). Depression-free years (DFYs) were assessed by blinded diagnostic raters using the telephone-administered Structured Clinical Interview for DSM-IV Axis Disorders at 6- and 12-month follow-up, covering the period to the previous assessment. Costs were self-assessed through a questionnaire. Costs measured from a societal and health care perspective were related to DFYs and quality-adjusted life years (QALYs). Results: In total, 406 participants were enrolled in the trial. The mean treatment duration was 5.84 (SD 4.37) weeks. On average, participants completed 4.93 of 6 sessions. Significantly more DFYs were gained in the intervention group (0.82 vs 0.70). Likewise, QALY health gains were in favor of the intervention, but only statistically significant when measured with the more sensitive SF-6D. The incremental per-participant costs were {\texteuro}136 ({\textsterling}116). Taking the health care perspective and assuming a willingness-to-pay of {\texteuro}20,000 ({\textsterling}17,000), the intervention's likelihood of being cost-effective was 99\% for gaining a DFY and 64\% or 99\% for gaining an EQ-5D or a SF-6D QALY. Conclusions: Our study supports guidelines recommending Web-based treatment for sD and adds that this not only restores health in people with sD, but additionally reduces the risk of developing a MDD. Offering the intervention has an acceptable likelihood of being more cost-effective than enhanced usual care and could therefore reach community members on a wider scale. Trial registration: German Clinical Trials Register: DRKS00004709; http://www.drks.de/DRKS00004709 (Archived by WebCite at http://www.webcitation.org/6kAZVUxy9) ", doi="10.2196/jmir.6587", url="http://www.jmir.org/2017/1/e5/", url="http://www.ncbi.nlm.nih.gov/pubmed/28052841" } @Article{info:doi/10.2196/jmir.7050, author="Chai, R. Peter and Carreiro, Stephanie and Innes, J. Brendan and Rosen, K. Rochelle and O'Cleirigh, Conall and Mayer, H. Kenneth and Boyer, W. Edward", title="Digital Pills to Measure Opioid Ingestion Patterns in Emergency Department Patients With Acute Fracture Pain: A Pilot Study", journal="J Med Internet Res", year="2017", month="Jan", day="13", volume="19", number="1", pages="e19", keywords="medication adherence", keywords="opioid", keywords="digital pills", keywords="digital health", keywords="emergency medicine", keywords="pain management", abstract="Background: Nonadherence to prescribed regimens for opioid analgesic agents contributes to increasing opioid abuse and overdose death. Opioids are frequently prescribed on an as-needed basis, placing the responsibility to determine opioid dose and frequency with the patient. There is wide variability in physician prescribing patterns because of the lack of data describing how patients actually use as-needed opioid analgesics. Digital pill systems have a radiofrequency emitter that directly measures medication ingestion events, and they provide an opportunity to discover the dose, timing, and duration of opioid therapy. Objective: The purpose of this study was to determine the feasibility of a novel digital pill system to measure as-needed opioid ingestion patterns in patients discharged from the emergency department (ED) after an acute bony fracture. Methods: We used a digital pill with individuals who presented to a teaching hospital ED with an acute extremity fracture. The digital pill consisted of a digital radiofrequency emitter within a standard gelatin capsule that encapsulated an oxycodone tablet. When ingested, the gastric chloride ion gradient activated the digital pill, transmitting a radiofrequency signal that was received by a hip-worn receiver, which then transmitted the ingestion data to a cloud-based server. After a brief, hands-on training session in the ED, study participants were discharged home and used the digital pill system to ingest oxycodone prescribed as needed for pain for one week. We conducted pill counts to verify digital pill data and open-ended interviews with participants at their follow-up appointment with orthopedics or at one week after enrollment in the study to determine the knowledge, attitudes, beliefs, and practices regarding digital pills. We analyzed open-ended interviews using applied thematic analysis. Results: We recruited 10 study participants and recorded 96 ingestion events (87.3\%, 96/110 accuracy). Study participants reported being able to operate all aspects of the digital pill system after their training. Two participants stopped using the digital pill, reporting they were in too much pain to focus on the novel technology. The digital pill system detected multiple simultaneous ingestion events by the digital pill system. Participants ingested a mean 8 (SD 5) digital pills during the study period and four participants continued on opioids at the end of the study period. After interacting with the digital pill system in the real world, participants found the system highly acceptable (80\%, 8/10) and reported a willingness to continue to use a digital pill to improve medication adherence monitoring (90\%, 9/10). Conclusions: The digital pill is a feasible method to measure real-time opioid ingestion patterns in individuals with acute pain and to develop real-time interventions if opioid abuse is detected. Deploying digital pills is possible through the ED with a short instructional course. Patients who used the digital pill accepted the technology. ", doi="10.2196/jmir.7050", url="http://www.jmir.org/2017/1/e19/", url="http://www.ncbi.nlm.nih.gov/pubmed/28087496" } @Article{info:doi/10.2196/jmir.6822, author="Yarosh, Svetlana and Schueller, Matthew Stephen", title="``Happiness Inventors'': Informing Positive Computing Technologies Through Participatory Design With Children", journal="J Med Internet Res", year="2017", month="Jan", day="17", volume="19", number="1", pages="e14", keywords="positive computing", keywords="positive psychology", keywords="participatory design", keywords="cooperative inquiry", keywords="children", abstract="Background: Positive psychological interventions for children have typically focused on direct adaptations of interventions developed for adults. As the community moves toward designing positive computing technologies to support child well-being, it is important to use a more participatory process that directly engages children's voices. Objective: Our objectives were, through a participatory design study, to understand children's interpretations of positive psychology concepts, as well as their perspectives on technologies that are best suited to enhance their engagement with practice of well-being skills. Methods: We addressed these questions through a content analysis of 434 design ideas, 51 sketches, and 8 prototype and videos, which emerged from a 14-session cooperative inquiry study with 12 child ``happiness inventors.'' The study was part of a summer learning camp held at the children's middle school, which focused on teaching the invention process, teaching well-being skills drawn from positive psychology and related areas (gratitude, mindfulness, and problem solving), and iterating design ideas for technologies to support these skills. Results: The children's ideas and prototypes revealed specific facets of how they interpreted gratitude (as thanking, being positive, and doing good things), mindfulness (as externally representing thought and emotions, controlling those thoughts and emotions, getting through unpleasant things, and avoiding forgetting something), and problem solving (as preventing bad decisions, seeking alternative solutions, and not dwelling on unproductive thoughts). This process also revealed that children emphasized particular technologies in their solutions. While desktop or laptop solutions were notably lacking, other ideas were roughly evenly distributed between mobile apps and embodied computing technologies (toys, wearables, etc). We also report on desired functionalities and approaches to engagement in the children's ideas, such as a notable emphasis on representing and responding to internal states. Conclusions: Our findings point to promising directions for the design of positive computing technologies targeted at children, with particular emphases on the perspectives, technologies, engagement approaches, and functionalities that appealed to the children in our study. The dual focus of the study on teaching skills while designing technologies is a novel methodology in the design of positive computing technologies intended to increase child well-being. ", doi="10.2196/jmir.6822", url="http://www.jmir.org/2017/1/e14/", url="http://www.ncbi.nlm.nih.gov/pubmed/28096066" } @Article{info:doi/10.2196/jmir.7104, author="Comello, G. Maria Leonora and Qian, Xiaokun and Deal, M. Allison and Ribisl, M. Kurt and Linnan, A. Laura and Tate, F. Deborah", title="Acknowledgment Correction of: Impact of Game-Inspired Infographics on User Engagement and Information Processing in an eHealth Program", journal="J Med Internet Res", year="2017", month="Jan", day="09", volume="19", number="1", pages="e12", doi="10.2196/jmir.7104", url="http://www.jmir.org/2017/1/e12/", url="http://www.ncbi.nlm.nih.gov/pubmed/30578193" }