TY - JOUR AU - Pugatch, Jillian AU - Grenen, Emily AU - Surla, Stacy AU - Schwarz, Mary AU - Cole-Lewis, Heather PY - 2018/03/21 TI - Information Architecture of Web-Based Interventions to Improve Health Outcomes: Systematic Review JO - J Med Internet Res SP - e97 VL - 20 IS - 3 KW - information architecture KW - systematic review KW - health outcomes KW - behavior change KW - health behavior N2 - Background: The rise in usage of and access to new technologies in recent years has led to a growth in digital health behavior change interventions. As the shift to digital platforms continues to grow, it is increasingly important to consider how the field of information architecture (IA) can inform the development of digital health interventions. IA is the way in which digital content is organized and displayed, which strongly impacts users? ability to find and use content. While many information architecture best practices exist, there is a lack of empirical evidence on the role it plays in influencing behavior change and health outcomes. Objective: Our aim was to conduct a systematic review synthesizing the existing literature on website information architecture and its effect on health outcomes, behavioral outcomes, and website engagement. Methods: To identify all existing information architecture and health behavior literature, we searched articles published in English in the following databases (no date restrictions imposed): ACM Digital Library, CINAHL, Cochrane Library, Google Scholar, Ebsco, and PubMed. The search terms used included information terms (eg, information architecture, interaction design, persuasive design), behavior terms (eg, health behavior, behavioral intervention, ehealth), and health terms (eg, smoking, physical activity, diabetes). The search results were reviewed to determine if they met the inclusion and exclusion criteria created to identify empirical research that studied the effect of IA on health outcomes, behavioral outcomes, or website engagement. Articles that met inclusion criteria were assessed for study quality. Then, data from the articles were extracted using a priori categories established by 3 reviewers. However, the limited health outcome data gathered from the studies precluded a meta-analysis. Results: The initial literature search yielded 685 results, which was narrowed down to three publications that examined the effect of information architecture on health outcomes, behavioral outcomes, or website engagement. One publication studied the isolated impact of information architecture on outcomes of interest (ie, website use and engagement; health-related knowledge, attitudes, and beliefs; and health behaviors), while the other two publications studied the impact of information architecture, website features (eg, interactivity, email prompts, and forums), and tailored content on these outcomes. The paper that investigated IA exclusively found that a tunnel IA improved site engagement and behavior knowledge, but it decreased users? perceived efficiency. The first study that did not isolate IA found that the enhanced site condition improved site usage but not the amount of content viewed. The second study that did not isolate IA found that a tailored site condition improved site usage, behavior knowledge, and some behavior outcomes. Conclusions: No clear conclusion can be made about the relationship between IA and health outcomes, given limited evidence in the peer-reviewed literature connecting IA to behavioral outcomes and website engagement. Only one study reviewed solely manipulated IA, and we therefore recommend improving the scientific evidence base such that additional empirical studies investigate the impact of IA in isolation. Moreover, information from the gray literature and expert opinion might be identified and added to the evidence base, in order to lay the groundwork for hypothesis generation to improve empirical evidence on information architecture and health and behavior outcomes. UR - http://www.jmir.org/2018/3/e97/ UR - http://dx.doi.org/10.2196/jmir.7867 UR - http://www.ncbi.nlm.nih.gov/pubmed/29563076 ID - info:doi/10.2196/jmir.7867 ER - TY - JOUR AU - Yeung, Douglas PY - 2018/03/19 TI - Social Media as a Catalyst for Policy Action and Social Change for Health and Well-Being: Viewpoint JO - J Med Internet Res SP - e94 VL - 20 IS - 3 KW - social media KW - health policy KW - health promotion KW - health knowledge, attitudes, practice KW - social change UR - http://www.jmir.org/2018/3/e94/ UR - http://dx.doi.org/10.2196/jmir.8508 UR - http://www.ncbi.nlm.nih.gov/pubmed/29555624 ID - info:doi/10.2196/jmir.8508 ER - TY - JOUR AU - Swinkels, Sophia Ilse Catharina AU - Huygens, Johanna Martine Wilhelmina AU - Schoenmakers, M. Tim AU - Oude Nijeweme-D'Hollosy, Wendy AU - van Velsen, Lex AU - Vermeulen, Joan AU - Schoone-Harmsen, Marian AU - Jansen, JFM Yvonne AU - van Schayck, CP Onno AU - Friele, Roland AU - de Witte, Luc PY - 2018/03/29 TI - Lessons Learned From a Living Lab on the Broad Adoption of eHealth in Primary Health Care JO - J Med Internet Res SP - e83 VL - 20 IS - 3 KW - telemedicine KW - primary health care KW - implementation KW - patient involvement KW - entrepreneurship KW - health personnel KW - policy makers N2 - Background: Electronic health (eHealth) solutions are considered to relieve current and future pressure on the sustainability of primary health care systems. However, evidence of the effectiveness of eHealth in daily practice is missing. Furthermore, eHealth solutions are often not implemented structurally after a pilot phase, even if successful during this phase. Although many studies on barriers and facilitators were published in recent years, eHealth implementation still progresses only slowly. To further unravel the slow implementation process in primary health care and accelerate the implementation of eHealth, a 3-year Living Lab project was set up. In the Living Lab, called eLabEL, patients, health care professionals, small- and medium-sized enterprises (SMEs), and research institutes collaborated to select and integrate fully mature eHealth technologies for implementation in primary health care. Seven primary health care centers, 10 SMEs, and 4 research institutes participated. Objective: This viewpoint paper aims to show the process of adoption of eHealth in primary care from the perspective of different stakeholders in a qualitative way. We provide a real-world view on how such a process occurs, including successes and failures related to the different perspectives. Methods: Reflective and process-based notes from all meetings of the project partners, interview data, and data of focus groups were analyzed systematically using four theoretical models to study the adoption of eHealth in primary care. Results: The results showed that large-scale implementation of eHealth depends on the efforts of and interaction and collaboration among 4 groups of stakeholders: patients, health care professionals, SMEs, and those responsible for health care policy (health care insurers and policy makers). These stakeholders are all acting within their own contexts and with their own values and expectations. We experienced that patients reported expected benefits regarding the use of eHealth for self-management purposes, and health care professionals stressed the potential benefits of eHealth and were interested in using eHealth to distinguish themselves from other care organizations. In addition, eHealth entrepreneurs valued the collaboration among SMEs as they were not big enough to enter the health care market on their own and valued the collaboration with research institutes. Furthermore, health care insurers and policy makers shared the ambition and need for the development and implementation of an integrated eHealth infrastructure. Conclusions: For optimal and sustainable use of eHealth, patients should be actively involved, primary health care professionals need to be reinforced in their management, entrepreneurs should work closely with health care professionals and patients, and the government needs to focus on new health care models stimulating innovations. Only when all these parties act together, starting in local communities with a small range of eHealth tools, the potential of eHealth will be enforced. UR - http://www.jmir.org/2018/3/e83/ UR - http://dx.doi.org/10.2196/jmir.9110 UR - http://www.ncbi.nlm.nih.gov/pubmed/29599108 ID - info:doi/10.2196/jmir.9110 ER - TY - JOUR AU - Valle, G. Carmina AU - Queen, L. Tara AU - Martin, A. Barbara AU - Ribisl, M. Kurt AU - Mayer, K. Deborah AU - Tate, F. Deborah PY - 2018/03/01 TI - Optimizing Tailored Communications for Health Risk Assessment: A Randomized Factorial Experiment of the Effects of Expectancy Priming, Autonomy Support, and Exemplification JO - J Med Internet Res SP - e63 VL - 20 IS - 3 KW - health communication KW - feedback KW - eHealth KW - health risk assessment KW - health behavior KW - intention KW - self-efficacy KW - personal autonomy N2 - Background: Health risk assessments with tailored feedback plus health education have been shown to be effective for promoting health behavior change. However, there is limited evidence to guide the development and delivery of online automated tailored feedback. Objective: The goal of this study was to optimize tailored feedback messages for an online health risk assessment to promote enhanced user engagement, self-efficacy, and behavioral intentions for engaging in healthy behaviors. We examined the effects of three theory-based message factors used in developing tailored feedback messages on levels of engagement, self-efficacy, and behavioral intentions. Methods: We conducted a randomized factorial experiment to test three different components of tailored feedback messages: tailored expectancy priming, autonomy support, and use of an exemplar. Individuals (N=1945) were recruited via Amazon Mechanical Turk and randomly assigned to one of eight different experimental conditions within one of four behavioral assessment and feedback modules (tobacco use, physical activity [PA], eating habits, and weight). Participants reported self-efficacy and behavioral intentions pre- and postcompletion of an online health behavior assessment with tailored feedback. Engagement and message perceptions were assessed at follow-up. Results: For the tobacco module, there was a significant main effect of the exemplar factor (P=.04); participants who received exemplar messages (mean 3.31, SE 0.060) rated their self-efficacy to quit tobacco higher than those who did not receive exemplar messages (mean 3.14, SE 0.057). There was a three-way interaction between the effect of message conditions on self-efficacy to quit tobacco (P=.02), such that messages with tailored priming and an exemplar had the greatest impact on self-efficacy to quit tobacco. Across PA, eating habits, and weight modules, there was a three-way interaction among conditions on self-efficacy (P=.048). The highest self-efficacy scores were reported among those who were in the standard priming condition and received both autonomy supportive and exemplar messages. In the PA module, autonomy supportive messages had a stronger effect on self-efficacy for PA in the standard priming condition. For PA, eating habits, and weight-related behaviors, the main effect of exemplar messages on behavioral intentions was in the hypothesized direction but did not reach statistical significance (P=.08). When comparing the main effects of different message conditions, there were no differences in engagement and message perceptions. Conclusions: Findings suggest that tailored feedback messages that use exemplars helped improve self-efficacy related to tobacco cessation, PA, eating habits, and weight control. Combining standard priming and autonomy supportive message components shows potential for optimizing tailored feedback for tobacco cessation and PA behaviors. UR - https://www.jmir.org/2018/3/e63/ UR - http://dx.doi.org/10.2196/jmir.7613 UR - http://www.ncbi.nlm.nih.gov/pubmed/29496652 ID - info:doi/10.2196/jmir.7613 ER - TY - JOUR AU - Turner, ME Katy AU - Zienkiewicz, K. Adam AU - Syred, Jonathan AU - Looker, J. Katharine AU - de Sa, Joia AU - Brady, Michael AU - Free, Caroline AU - Holdsworth, Gillian AU - Baraitser, Paula PY - 2018/03/07 TI - Web-Based Activity Within a Sexual Health Economy: Observational Study JO - J Med Internet Res SP - e74 VL - 20 IS - 3 KW - sexually transmitted diseases KW - testing KW - internet KW - self-sampling N2 - Background: Regular testing for sexually transmitted infections (STIs) is important to maintain sexual health. Self-sampling kits ordered online and delivered in the post may increase access, convenience, and cost-effectiveness. Sexual health economies may target limited resources more effectively by signposting users toward Web-based or face-to-face services according to clinical need. Objective: The aim of this paper was to investigate the impact of two interventions on testing activity across a whole sexual health economy: (1) the introduction of open access Web-based STI testing services and (2) a clinic policy of triage and signpost online where users without symptoms who attended clinics for STI testing were supported to access the Web-based service instead. Methods: Data on attendances at all specialist public sexual health providers in an inner-London area were collated into a single database. Each record included information on user demographics, service type accessed, and clinical activity provided, including test results. Clinical activity was categorized as a simple STI test (could be done in a clinic or online), a complex visit (requiring face-to-face consultation), or other. Results: Introduction of Web-based services increased total testing activity across the whole sexual health economy by 18.47% (from 36,373 to 43,091 in the same 6-month period?2014-2015 and 2015-2016), suggesting unmet need for testing in the area. Triage and signposting shifted activity out of the clinic onto the Web-based service, with simple STI testing in the clinic decreasing from 16.90% (920/5443) to 12.25% (511/4172) of total activity, P<.001, and complex activity in the clinic increasing from 69.15% (3764/5443) to 74.86% (3123/4172) of total activity, P<.001. This intervention created a new population of online users with different demographic and clinical profiles from those who use Web-based services spontaneously. Some triage and signposted users (29.62%, 375/1266) did not complete the Web-based testing process, suggesting the potential for missed diagnoses. Conclusions: This evaluation shows that users can effectively be transitioned from face-to-face to Web-based services and that this introduces a new population to Web-based service use and changes the focus of clinic-based activity. Further development is underway to optimize the triage and signposting process to support test completion. UR - https://www.jmir.org/2018/3/e74/ UR - http://dx.doi.org/10.2196/jmir.8101 UR - http://www.ncbi.nlm.nih.gov/pubmed/29514776 ID - info:doi/10.2196/jmir.8101 ER - TY - JOUR AU - Painter, Lynn Stefanie AU - Ahmed, Rezwan AU - Kushner, F. Robert AU - Hill, O. James AU - Lindquist, Richard AU - Brunning, Scott AU - Margulies, Amy PY - 2018/03/13 TI - Expert Coaching in Weight Loss: Retrospective Analysis JO - J Med Internet Res SP - e92 VL - 20 IS - 3 KW - body mass index KW - coaching KW - feedback KW - obesity KW - overweight KW - weight loss KW - weight reduction program N2 - Background: Providing coaches as part of a weight management program is a common practice to increase participant engagement and weight loss success. Understanding coach and participant interactions and how these interactions impact weight loss success needs to be further explored for coaching best practices. Objective: The purpose of this study was to analyze the coach and participant interaction in a 6-month weight loss intervention administered by Retrofit, a personalized weight management and Web-based disease prevention solution. The study specifically examined the association between different methods of coach-participant interaction and weight loss and tried to understand the level of coaching impact on weight loss outcome. Methods: A retrospective analysis was performed using 1432 participants enrolled from 2011 to 2016 in the Retrofit weight loss program. Participants were males and females aged 18 years or older with a baseline body mass index of ?25 kg/m², who also provided at least one weight measurement beyond baseline. First, a detailed analysis of different coach-participant interaction was performed using both intent-to-treat and completer populations. Next, a multiple regression analysis was performed using all measures associated with coach-participant interactions involving expert coaching sessions, live weekly expert-led Web-based classes, and electronic messaging and feedback. Finally, 3 significant predictors (P<.001) were analyzed in depth to reveal the impact on weight loss outcome. Results: Participants in the Retrofit weight loss program lost a mean 5.14% (SE 0.14) of their baseline weight, with 44% (SE 0.01) of participants losing at least 5% of their baseline weight. Multiple regression model (R2=.158, P<.001) identified the following top 3 measures as significant predictors of weight loss at 6 months: expert coaching session attendance (P<.001), live weekly Web-based class attendance (P<.001), and food log feedback days per week (P<.001). Attending 80% of expert coaching sessions, attending 60% of live weekly Web-based classes, and receiving a minimum of 1 food log feedback day per week were associated with clinically significant weight loss. Conclusions: Participant?s one-on-one expert coaching session attendance, live weekly expert-led interactive Web-based class attendance, and the number of food log feedback days per week from expert coach were significant predictors of weight loss in a 6-month intervention. UR - http://www.jmir.org/2018/3/e92/ UR - http://dx.doi.org/10.2196/jmir.9738 UR - http://www.ncbi.nlm.nih.gov/pubmed/29535082 ID - info:doi/10.2196/jmir.9738 ER - TY - JOUR AU - Wallin, Emma AU - Norlund, Fredrika AU - Olsson, Gustaf Erik Martin AU - Burell, Gunilla AU - Held, Claes AU - Carlsson, Tommy PY - 2018/03/16 TI - Treatment Activity, User Satisfaction, and Experienced Usability of Internet-Based Cognitive Behavioral Therapy for Adults With Depression and Anxiety After a Myocardial Infarction: Mixed-Methods Study JO - J Med Internet Res SP - e87 VL - 20 IS - 3 KW - mental health KW - internet KW - cognitive behavioral therapy KW - computer-assisted therapy KW - myocardial infarction KW - attrition KW - adherence N2 - Background: Knowledge about user experiences may lead to insights about how to improve treatment activity in Internet-based cognitive behavioral therapy (iCBT) to reduce symptoms of depression and anxiety among people with a somatic disease. There is a need for studies conducted alongside randomized trials, to explore treatment activity and user experiences related to such interventions, especially among people with older age who are recruited in routine care. Objective: The aim of the study was to explore treatment activity, user satisfaction, and usability experiences among patients allocated to treatment in the U-CARE Heart study, a randomized clinical trial of an iCBT intervention for treatment of depression and anxiety following a recent myocardial infarction. Methods: This was a mixed methods study where quantitative and qualitative approaches were used. Patients were recruited consecutively from 25 cardiac clinics in Sweden. The study included 117 patients allocated to 14 weeks of an iCBT intervention in the U-CARE Heart study. Quantitative data about treatment activity and therapist communication were collected through logged user patterns, which were analyzed with descriptive statistics. Qualitative data with regard to positive and negative experiences, and suggestions for improvements concerning the intervention, were collected through semistructured interviews with 21 patients in the treatment arm after follow-up. The interviews were analyzed with qualitative manifest content analysis. Results: Treatment activity was low with regard to number of completed modules (mean 0.76, SD 0.93, range 0-5) and completed assignments (mean 3.09, SD 4.05, range 0-29). Most of the participants initiated the introduction module (113/117, 96.6%), and about half (63/117, 53.9%) of all participants completed the introductory module, but only 18 (15.4%, 18/117) continued to work with any of the remaining 10 modules, and each of the remaining modules was completed by 7 or less of the participants. On average, patients sent less than 2 internal messages to their therapist during the intervention (mean 1.42, SD 2.56, range 0-16). Interviews revealed different preferences with regard to the internet-based portal, the content of the treatment program, and the therapist communication. Aspects related to the personal situation and required skills included unpleasant emotions evoked by the intervention, lack of time, and technical difficulties. Conclusions: Patients with a recent myocardial infarction and symptoms of depression and anxiety showed low treatment activity in this guided iCBT intervention with regard to completed modules, completed assignments, and internal messages sent to their therapist. The findings call attention to the need for researchers to carefully consider the preferences, personal situation, and technical skills of the end users during the development of these interventions. The study indicates several challenges that need to be addressed to improve treatment activity, user satisfaction, and usability in internet-based interventions in this population. UR - http://www.jmir.org/2018/3/e87/ UR - http://dx.doi.org/10.2196/jmir.9690 UR - http://www.ncbi.nlm.nih.gov/pubmed/29549067 ID - info:doi/10.2196/jmir.9690 ER - TY - JOUR AU - Desveaux, Laura AU - Shaw, James AU - Saragosa, Marianne AU - Soobiah, Charlene AU - Marani, Husayn AU - Hensel, Jennifer AU - Agarwal, Payal AU - Onabajo, Nike AU - Bhatia, Sacha R. AU - Jeffs, Lianne PY - 2018/03/16 TI - A Mobile App to Improve Self-Management of Individuals With Type 2 Diabetes: Qualitative Realist Evaluation JO - J Med Internet Res SP - e81 VL - 20 IS - 3 KW - telemedicine KW - diabetes mellitus KW - self-management KW - qualitative research N2 - Background: The increasing use of Web-based solutions for health prevention and promotion presents opportunities to improve self-management and adherence to guideline-based therapy for individuals with type 2 diabetes (T2DM). Despite promising preliminary evidence, many users stop using Web-based solutions due to the burden of data entry, hidden costs, loss of interest, and a lack of comprehensive features. Evaluations tend to focus on effectiveness or impact and fail to evaluate the nuanced variables that may interact to contribute to outcome success (or failure). Objective: This study aimed to evaluate a Web-based solution for improving self-management in T2DM to identify key combinations of contextual variables and mechanisms of action that explain for whom the solution worked best and in what circumstances. Methods: A qualitative realist evaluation was conducted with one-on-one, semistructured telephonic interviews completed at baseline, and again toward the end of the intervention period (3 months). Topics included participants? experiences of using the Web-based solution, barriers and facilitators of self-management, and barriers and facilitators to effective use. Transcripts were analyzed using thematic analysis strategies, after which the key themes were used to develop statements of the relationships between the key contextual factors, mechanisms of action, and impact on the primary outcome (glycated hemoglobin, HbA1c). Results: Twenty-six interviews (14 baseline, 12 follow-up) were completed with 16 participants with T2DM, and the following 3 key groups emerged: the easiest fit, the best fit, and those who failed to activate. Self-efficacy and willingness to engage with the solution facilitated improvement in HbA1c, whereas competing priorities and psychosocial issues created barriers to engagement. Individuals with high baseline self-efficacy who were motivated, took ownership for their actions, and prioritized diabetes management were early and eager adopters of the app and recorded improvements in HbA1c over the intervention period. Individuals with moderate baseline self-efficacy and no competing priorities, who identified gaps in understanding of how their actions influence their health, were slow to adopt use but recorded the greatest improvements in HbA1c. The final group had low baseline self-efficacy and identified a range of psychosocial issues and competing priorities. These participants were uncertain of the benefits of using a Web-based solution to support self-management, ultimately resulting in minimal engagement and no improvement in HbA1c. Conclusions: Self-efficacy, competing priorities, previous behavior change, and beliefs about Web-based solutions interact to determine engagement and impact on the clinical outcomes. Considering the balance of these patient characteristics is likely to help health care providers identify individuals who are apt to benefit from a Web-based solution to support self-management of T2DM. Web-based solutions could be modified to incorporate the existing screening measures to identify individuals who are at risk of suboptimal adherence to inform the provision of additional support(s) as needed. UR - http://www.jmir.org/2018/3/e81/ UR - http://dx.doi.org/10.2196/jmir.8712 UR - http://www.ncbi.nlm.nih.gov/pubmed/29549070 ID - info:doi/10.2196/jmir.8712 ER - TY - JOUR AU - McCall, Cameron Hugh AU - Richardson, G. Chris AU - Helgadottir, Dogg Fjola AU - Chen, S. Frances PY - 2018/03/21 TI - Evaluating a Web-Based Social Anxiety Intervention Among University Students: Randomized Controlled Trial JO - J Med Internet Res SP - e91 VL - 20 IS - 3 KW - social anxiety KW - clinical trial KW - internet KW - cognitive behavior therapy N2 - Background: Treatment rates for social anxiety, a prevalent and potentially debilitating condition, remain among the lowest of all major mental disorders today. Although computer-delivered interventions are well poised to surmount key barriers to the treatment of social anxiety, most are only marginally effective when delivered as stand-alone treatments. A new, Web-based cognitive behavioral therapy (CBT) intervention called Overcome Social Anxiety was recently created to address the limitations of prior computer-delivered interventions. Users of Overcome Social Anxiety are self-directed through various CBT modules incorporating cognitive restructuring and behavioral experiments. The intervention is personalized to each user?s symptoms, and automatic email reminders and time limits are used to encourage adherence. Objective: The purpose of this study was to conduct a randomized controlled trial to investigate the effectiveness of Overcome Social Anxiety in reducing social anxiety symptoms in a nonclinical sample of university students. As a secondary aim, we also investigated whether Overcome Social Anxiety would increase life satisfaction in this sample. Methods: Following eligibility screening, participants were randomly assigned to a treatment condition or a wait-list control condition. Only those assigned to the treatment condition were given access to Overcome Social Anxiety; they were asked to complete the program within 4 months. The social interaction anxiety scale (SIAS), the fear of negative evaluation scale (FNE), and the quality of life enjoyment and satisfaction questionnaire?short form (Q-LES-Q-SF) were administered to participants from both conditions during baseline and 4-month follow-up lab visits. Results: Over the course of the study, participants assigned to the treatment condition experienced a significant reduction in social anxiety (SIAS: P<.001, Cohen d=0.72; FNE: P<.001, Cohen d=0.82), whereas those assigned to the control condition did not (SIAS: P=.13, Cohen d=0.26; FNE: P=.40, Cohen d=0.14). Additionally, a direct comparison of the average change in social anxiety in the 2 conditions over the course of the study showed that those assigned to the treatment condition experienced significantly more improvement than those assigned to the control condition (SIAS: P=.03, Cohen d=0.56; FNE: P=.001, Cohen d=0.97). Although participants assigned to the treatment condition experienced a slight increase in life satisfaction, as measured by Q-LES-Q-SF scores, and those assigned to the control condition experienced a slight decrease, these changes were not statistically significant (treatment: P=.35, Cohen d=?0.18; control: P=.30, Cohen d=0.18). Conclusions: Our findings indicate that Overcome Social Anxiety is an effective intervention for treating symptoms of social anxiety and that it may have further utility in serving as a model for the development of new interventions. Additionally, our findings provide evidence that contemporary Web-based interventions can be sophisticated enough to benefit users even when delivered as stand-alone treatments, suggesting that further opportunities likely exist for the development of other Web-based mental health interventions. Trial Registration: ClinicalTrials.gov NCT02792127; https://clinicaltrials.gov/ct2/show/record/NCT02792127 (Archived by WebCite at http://www.webcitation.org/6xGSRh7MG) UR - http://www.jmir.org/2018/3/e91/ UR - http://dx.doi.org/10.2196/jmir.8630 UR - http://www.ncbi.nlm.nih.gov/pubmed/29563078 ID - info:doi/10.2196/jmir.8630 ER - TY - JOUR AU - Schembre, M. Susan AU - Liao, Yue AU - Robertson, C. Michael AU - Dunton, Fridlund Genevieve AU - Kerr, Jacqueline AU - Haffey, E. Meghan AU - Burnett, Taylor AU - Basen-Engquist, Karen AU - Hicklen, S. Rachel PY - 2018/03/22 TI - Just-in-Time Feedback in Diet and Physical Activity Interventions: Systematic Review and Practical Design Framework JO - J Med Internet Res SP - e106 VL - 20 IS - 3 KW - health behavior KW - diet KW - exercise KW - task performance and analysis KW - Internet KW - mHealth KW - accelerometer KW - activity monitor KW - self-tracking KW - wearable sensors N2 - Background: The integration of body-worn sensors with mobile devices presents a tremendous opportunity to improve just-in-time behavioral interventions by enhancing bidirectional communication between investigators and their participants. This approach can be used to deliver supportive feedback at critical moments to optimize the attainment of health behavior goals. Objective: The goals of this systematic review were to summarize data on the content characteristics of feedback messaging used in diet and physical activity (PA) interventions and to develop a practical framework for designing just-in-time feedback for behavioral interventions. Methods: Interventions that included just-in-time feedback on PA, sedentary behavior, or dietary intake were eligible for inclusion. Feedback content and efficacy data were synthesized descriptively. Results: The review included 31 studies (15/31, 48%, targeting PA or sedentary behavior only; 13/31, 42%, targeting diet and PA; and 3/31, 10%, targeting diet only). All studies used just-in-time feedback, 30 (97%, 30/31) used personalized feedback, and 24 (78%, 24/31) used goal-oriented feedback, but only 5 (16%, 5/31) used actionable feedback. Of the 9 studies that tested the efficacy of providing feedback to promote behavior change, 4 reported significant improvements in health behavior. In 3 of these 4 studies, feedback was continuously available, goal-oriented, or actionable. Conclusions: Feedback that was continuously available, personalized, and actionable relative to a known behavioral objective was prominent in intervention studies with significant behavior change outcomes. Future research should determine whether all or some of these characteristics are needed to optimize the effect of feedback in just-in-time interventions. UR - http://www.jmir.org/2018/3/e106/ UR - http://dx.doi.org/10.2196/jmir.8701 UR - http://www.ncbi.nlm.nih.gov/pubmed/29567638 ID - info:doi/10.2196/jmir.8701 ER - TY - JOUR AU - Levy, Koch Natalie AU - Orzeck-Byrnes, A. Natasha AU - Aidasani, R. Sneha AU - Moloney, N. Dana AU - Nguyen, H. Lisa AU - Park, Agnes AU - Hu, Lu AU - Langford, T. Aisha AU - Wang, Binhuan AU - Sevick, Ann Mary AU - Rogers, S. Erin PY - 2018/03/19 TI - Transition of a Text-Based Insulin Titration Program From a Randomized Controlled Trial Into Real-World Settings: Implementation Study JO - J Med Internet Res SP - e93 VL - 20 IS - 3 KW - insulin/long-acting/administration & dosage KW - diabetes mellitus, type 2/drug therapy KW - medically underserved area KW - telemedicine KW - healthcare disparities N2 - Background: The Mobile Insulin Titration Intervention (MITI) program helps patients with type 2 diabetes find their correct basal insulin dose without in-person care. Requiring only basic cell phone technology (text messages and phone calls), MITI is highly accessible to patients receiving care in safety-net settings. MITI was shown in a randomized controlled trial (RCT) to be efficacious at a New York City (NYC) safety-net clinic where patients often have challenges coming for in-person care. In 2016, MITI was implemented as usual care at Bellevue Hospital (the site of the original RCT) and at Gouverneur Health (a second NYC safety-net clinic) under 2 different staffing models. Objective: This implementation study examined MITI?s transition into real-world settings. To understand MITI?s flexibility, generalizability, and acceptability among patients and providers, we evaluated whether MITI continued to produce positive outcomes in expanded underserved populations, outside of an RCT setting. Methods: Patients enrolled in MITI received weekday text messages asking for their fasting blood glucose (FBG) values and a weekly titration call. The goal was for patients to reach their optimal insulin dose (OID), defined either as the dose of once-daily basal insulin required to achieve either an FBG of 80-130 mg/dL (4.4-7.2 mmol/L) or as the reaching of the maximum dose of 50 units. After 12 weeks, if OID was not reached, the patients were asked to return to the clinic for in-person care and titration. MITI program outcomes, clinical outcomes, process outcomes, and patient satisfaction were assessed. Results: MITI was successful at both sites, each with a different staffing model. Providers referred 170 patients to the program?129 of whom (75.9%, 129/170) were eligible. Of these, 113 (87.6%, 113/129) enrolled. Moreover, 84.1% (95/113) of patients reached their OID, and they did so in an average of 24 days. Clinical outcomes show that mean FBG levels fell from 209 mg/dL (11.6 mmol/L) to 141 mg/dL (7.8 mmol/L), P<.001. HbA1c levels fell from 11.4% (101 mmol/mol) to 10.0% (86 mmol/mol), P<.001. Process outcomes show that 90.1% of MITI?s text message prompts received a response, nurses connected with patients 81.9% of weeks to provide titration instructions, and 85% of attending physicians made at least one referral to the MITI program. Satisfaction surveys showed that most patients felt comfortable sharing information over text and felt the texts reminded them to take their insulin, check their sugar, and make healthy food choices. Conclusions: This implementation study showed MITI to have continued success after transitioning from an RCT program into real-world settings. MITI showed itself to be flexible and generalizable as it easily fits into a second site staffed by general medical clinic?registered nurses and remained acceptable to patients and staff who had high levels of engagement with the program. UR - http://www.jmir.org/2018/3/e93/ UR - http://dx.doi.org/10.2196/jmir.9515 UR - http://www.ncbi.nlm.nih.gov/pubmed/29555621 ID - info:doi/10.2196/jmir.9515 ER - TY - JOUR AU - Henriksen, André AU - Haugen Mikalsen, Martin AU - Woldaregay, Zebene Ashenafi AU - Muzny, Miroslav AU - Hartvigsen, Gunnar AU - Hopstock, Arnesdatter Laila AU - Grimsgaard, Sameline PY - 2018/03/22 TI - Using Fitness Trackers and Smartwatches to Measure Physical Activity in Research: Analysis of Consumer Wrist-Worn Wearables JO - J Med Internet Res SP - e110 VL - 20 IS - 3 KW - motor activity KW - physical activity KW - fitness trackers KW - heart rate KW - photoplethysmography N2 - Background: New fitness trackers and smartwatches are released to the consumer market every year. These devices are equipped with different sensors, algorithms, and accompanying mobile apps. With recent advances in mobile sensor technology, privately collected physical activity data can be used as an addition to existing methods for health data collection in research. Furthermore, data collected from these devices have possible applications in patient diagnostics and treatment. With an increasing number of diverse brands, there is a need for an overview of device sensor support, as well as device applicability in research projects. Objective: The objective of this study was to examine the availability of wrist-worn fitness wearables and analyze availability of relevant fitness sensors from 2011 to 2017. Furthermore, the study was designed to assess brand usage in research projects, compare common brands in terms of developer access to collected health data, and features to consider when deciding which brand to use in future research. Methods: We searched for devices and brand names in six wearable device databases. For each brand, we identified additional devices on official brand websites. The search was limited to wrist-worn fitness wearables with accelerometers, for which we mapped brand, release year, and supported sensors relevant for fitness tracking. In addition, we conducted a Medical Literature Analysis and Retrieval System Online (MEDLINE) and ClinicalTrials search to determine brand usage in research projects. Finally, we investigated developer accessibility to the health data collected by identified brands. Results: We identified 423 unique devices from 132 different brands. Forty-seven percent of brands released only one device. Introduction of new brands peaked in 2014, and the highest number of new devices was introduced in 2015. Sensor support increased every year, and in addition to the accelerometer, a photoplethysmograph, for estimating heart rate, was the most common sensor. Out of the brands currently available, the five most often used in research projects are Fitbit, Garmin, Misfit, Apple, and Polar. Fitbit is used in twice as many validation studies as any other brands and is registered in ClinicalTrials studies 10 times as often as other brands. Conclusions: The wearable landscape is in constant change. New devices and brands are released every year, promising improved measurements and user experience. At the same time, other brands disappear from the consumer market for various reasons. Advances in device quality offer new opportunities for research. However, only a few well-established brands are frequently used in research projects, and even less are thoroughly validated. UR - http://www.jmir.org/2018/3/e110/ UR - http://dx.doi.org/10.2196/jmir.9157 UR - http://www.ncbi.nlm.nih.gov/pubmed/29567635 ID - info:doi/10.2196/jmir.9157 ER - TY - JOUR AU - Diez-Canseco, Francisco AU - Toyama, Mauricio AU - Ipince, Alessandra AU - Perez-Leon, Silvana AU - Cavero, Victoria AU - Araya, Ricardo AU - Miranda, Jaime J. PY - 2018/3/15 TI - Integration of a Technology-Based Mental Health Screening Program Into Routine Practices of Primary Health Care Services in Peru (The Allillanchu Project): Development and Implementation JO - J Med Internet Res SP - e100 VL - 20 IS - 3 KW - mental health KW - mHealth KW - SMS KW - textmessaging KW - screening KW - mobile health KW - health services research N2 - Background: Despite their high prevalence and significant burden, mental disorders such as depression remain largely underdiagnosed and undertreated. Objective: The aim of the Allillanchu Project was to design, develop, and test an intervention to promote early detection, opportune referral, and access to treatment of patients with mental disorders attending public primary health care (PHC) services in Lima, Peru. Methods: The project had a multiphase design: formative study, development of intervention components, and implementation. The intervention combined three strategies: training of PHC providers (PHCPs), task shifting the detection and referral of mental disorders, and a mobile health (mHealth) component comprising a screening app followed by motivational and reminder short message service (SMS) to identify at-risk patients. The intervention was implemented by 22 PHCPs from five health centers, working in antenatal care, tuberculosis, chronic diseases, and HIV or AIDS services. Results: Over a period of 9 weeks, from September 2015 to November 2015, 733 patients were screened by the 22 PHCPs during routine consultations, and 762 screening were completed in total. The chronic diseases (49.9%, 380/762) and antenatal care services (36.7%, 380/762) had the higher number of screenings. Time constraints and workload were the main barriers to implementing the screening, whereas the use of technology, training, and supervision of the PHCPs by the research team were identified as facilitators. Of the 733 patients, 21.7% (159/733) screened positively and were advised to seek specialized care. Out of the 159 patients with a positive screening result, 127 had a follow-up interview, 72.4% (92/127) reported seeking specialized care, and 55.1% (70/127) stated seeing a specialist. Both patients and PHCPs recognized the utility of the screening and identified some key challenges to its wider implementation. Conclusions: The use of a screening app supported by training and supervision is feasible and uncovers a high prevalence of unidentified psychological symptoms in primary care. To increase its sustainability and utility, this procedure can be incorporated into the routine practices of existing health care services, following tailoring to the resources and features of each service. The early detection of psychological symptoms by a PHCP within a regular consultation, followed by adequate advice and support, can lead to a significant percentage of patients accessing specialized care and reducing the treatment gap of mental disorders. UR - http://www.jmir.org/2018/3/e100/ UR - http://dx.doi.org/10.2196/jmir.9208 UR - http://www.ncbi.nlm.nih.gov/pubmed/29588272 ID - info:doi/10.2196/jmir.9208 ER - TY - JOUR AU - Maben-Feaster, E. Rosalyn AU - Stansfield, Brent R. AU - Opipari, AnneMarie AU - Hammoud, M. Maya PY - 2018/03/12 TI - Evaluating Patient Perspectives of Provider Professionalism on Twitter in an Academic Obstetrics and Gynecology Clinic: Patient Survey JO - J Med Internet Res SP - e78 VL - 20 IS - 3 KW - patients KW - social networking sites KW - professionalism KW - surveys and questionnaires KW - perception KW - Twitter N2 - Background: One-third of Americans use social media websites as a source of health care information. Twitter, a microblogging site that allows users to place 280-character posts?or tweets?on the Web, is emerging as an important social media platform for health care. However, most guidelines on medical professionalism on social media are based on expert opinion. Objective: This study sought to examine if provider Twitter profiles with educational tweets were viewed as more professional than profiles with personal tweets or a mixture of the two, and to determine the impact of provider gender on perceptions of professionalism in an academic obstetrics and gynecology clinic. Methods: This study randomized obstetrics and gynecology patients at the University of Michigan Von Voigtlander Clinic to view one of six medical provider Twitter profiles, which differed in provider gender and the nature of tweets. Each participant answered 10 questions about their perception of the provider?s professionalism based on the Twitter profile content. Results: The provider profiles with educational tweets alone received higher mean professionalism scores than profiles with personal tweets. Specifically, the female and male provider profiles with exclusively educational tweets had the highest and second highest overall mean professionalism ratings at 4.24 and 3.85, respectively. In addition, the female provider profiles received higher mean professionalism ratings than male provider profiles with the same content. The female profile with mixed content received a mean professionalism rating of 3.38 compared to 3.24 for the male mixed-content profile, and the female profile with only personal content received a mean professionalism rating of 3.68 compared to 2.68 for the exclusively personal male provider profile. Conclusions: This study showed that in our obstetrics and gynecology clinic, patients perceived providers with educational profiles as more professional than those with a mixture of educational and personal tweets or only personal tweets. It also showed that our patient population perceived the female provider with educational tweets to be the most professional. This study will help inform the development of evidence-based guidelines for social media use in medicine as it adds to the growing body of literature examining professionalism and social media. UR - http://www.jmir.org/2018/3/e78/ UR - http://dx.doi.org/10.2196/jmir.8056 UR - http://www.ncbi.nlm.nih.gov/pubmed/29530838 ID - info:doi/10.2196/jmir.8056 ER - TY - JOUR AU - Harpel, Tammy PY - 2018/03/22 TI - Pregnant Women Sharing Pregnancy-Related Information on Facebook: Web-Based Survey Study JO - J Med Internet Res SP - e115 VL - 20 IS - 3 KW - pregnancy KW - social media KW - Facebook N2 - Background: Research indicates expectant and new mothers use the Internet, specifically social media, to gain information and support during the transition to parenthood. Although parents regularly share information about and photos of their child or children on Facebook, researchers have neither explored the use of Facebook to share pregnancy-related information nor investigated factors that influence such sharing. Objective: The aim of this study was to address a gap in the literature by exploring the use of Facebook by pregnant women. Specifically, the study examined the use of Facebook to share pregnancy-related information, as well as any association between prenatal attachment and the aforementioned aspects of sharing pregnancy-related information on Facebook. Methods: Pregnant women who were at least 18 years of age were recruited for participation in the study through posts and paid advertisements on Facebook and posts to professional organization listservs. Individuals interested in participating were directed to a secure Web-based survey system where they completed the consent form and the survey that focused on their current pregnancy. Participants completed the Maternal Antenatal Attachment Scale and answered questions that assessed how often they shared pregnancy-related information on Facebook, who they shared it with, why they shared it, and what they shared. Results: A total of 117 pregnant women completed the survey. Descriptive statistics indicated that the pregnancy announcement was most commonly shared (75/108, 69.4%), with most women sharing pregnancy-related information on Facebook less than monthly (52/117, 44.4%) with only family and friends (90/116, 77.6% and 91/116, 78.4%, respectively) and for the purpose of involving others or sharing the experience (62/107, 57.9%). Correlation and regression analyses showed that prenatal attachment, in general, was positively and significantly related to all aspects of sharing pregnancy-related information at the P<.05 level, with the exception of sharing because of expectations. Quality of attachment, which involves the positive feelings the woman has about her unborn child, was significantly associated with sharing to involve others or share the pregnancy (t8,93=2.654 , P=.009). In contrast, after controlling for other variables, the strength or preoccupation component of prenatal attachment was significantly associated with frequency of sharing (t8,100=2.554 , P=.01), number to types of information shared (t8,97=2.605 , P=.01), number of groups with whom shared (t8,99=3.467, P=.001), and sharing to get advice (?28=5.339 , P=.02). Conclusions: Pregnant women in this study used Facebook for a variety of reasons, demonstrating the use of the social media platform during pregnancy for supportive and informational purposes. Overall, the results of this study are likely to be useful to professionals who are seeking alternative methods for providing intervention, information, and support to pregnant women via social media in our technology-driven society. UR - http://www.jmir.org/2018/3/e115/ UR - http://dx.doi.org/10.2196/jmir.7753 UR - http://www.ncbi.nlm.nih.gov/pubmed/29567636 ID - info:doi/10.2196/jmir.7753 ER - TY - JOUR AU - Sanz-Lorente, María AU - Wanden-Berghe, Carmina AU - Castejón-Bolea, Ramón AU - Sanz-Valero, Javier PY - 2018/03/22 TI - Web 2.0 Tools in the Prevention of Curable Sexually Transmitted Diseases: Scoping Review JO - J Med Internet Res SP - e113 VL - 20 IS - 3 KW - sexually transmitted diseases, bacterial KW - internet KW - webcasts KW - social media N2 - Background: The internet is now the primary source of information that young people use to get information on issues related to sex, contraception, and sexually transmitted infections. Objective: The goal of the research was to review the scientific literature related to the use of Web 2.0 tools as opposed to other strategies in the prevention of curable sexually transmitted diseases (STDs). Methods: A scoping review was performed on the documentation indexed in the bibliographic databases MEDLINE, Cochrane Library, Scopus, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, PsycINFO, Educational Resources Information Center, the databases of Centro Superior de Investigaciones Científicas in Spain, and the Índice Bibliográfico Español de Ciencias de la Salud from the first available date according to the characteristics of each database until April 2017. The equation search was realized by means of the using of descriptors together with the consultation of the fields of title register and summary with free terms. Bibliographies of the selected papers were searched for additional articles. Results: A total of 627 references were retrieved, of which 6 papers were selected after applying the inclusion and exclusion criteria. The STDs studied were chlamydia, gonorrhea, and syphilis. The Web 2.0 tools used were Facebook, Twitter, Instagram, and YouTube. The 6 papers used Web 2.0 in the promotion of STD detection. Conclusions: Web 2.0 tools have demonstrated a positive effect on the promotion of prevention strategies for STDs and can help attract and link youth to campaigns related to sexual health. These tools can be combined with other interventions. In any case, Web 2.0 and especially Facebook have all the potential to become essential instruments for public health. UR - http://www.jmir.org/2018/3/e113/ UR - http://dx.doi.org/10.2196/jmir.8871 UR - http://www.ncbi.nlm.nih.gov/pubmed/29567633 ID - info:doi/10.2196/jmir.8871 ER - TY - JOUR AU - Chan, SY Windy AU - Leung, YM Angela PY - 2018/03/28 TI - Use of Social Network Sites for Communication Among Health Professionals: Systematic Review JO - J Med Internet Res SP - e117 VL - 20 IS - 3 KW - social networking KW - social media KW - health communication KW - Facebook KW - WhatsApp KW - professional network KW - health professionals N2 - Background: Although much research has been done investigating the roles of social network sites (SNSs) in linking patients and health professionals, there is a lack of information about their uses, benefits, and limitations in connecting health professions only for professional communication. Objective: This review aimed to examine the utilization of SNSs for communication among health professionals in (1) frontline clinical practice, (2) professional networks, and (3) education and training to identify areas for future health communication research. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A systematic search of the literature published in the last 10 years (January 1, 2007, to March 1, 2017) was performed in March 2017, using the following electronic databases: MEDLINE via OvidSP, EMBASE, CINAHL Complete, and InfoSci-Journals. The searches were conducted using the following defined search terms: ?social media? OR ?social network? OR ?social network site? OR ?Facebook? OR ?Twitter? OR ?Linkedin? OR ?Instagram? OR ?Weibo? OR ?Whatsapp? OR ?Telegram? OR ?WeChat? AND ?health? OR ?health profession.? Results: Of the 6977 papers retrieved, a total of 33 studies were included in this review. They were exploratory in nature, and the majority used surveys (n=25) and interviews (n=6). All retrieved studies stated that SNSs enhanced effective communication and information sharing. SNSs were used for supporting delivering of clinical services, making referrals, and sharing information. They were beneficial to network building and professional collaboration. SNSs were novel tools to enhance educational interactions among peers, students, instructors, and preceptors. The application of SNSs came with restraints in technical knowledge, concerns on data protection, privacy and liability, issues in professionalism, and data protection. Conclusions: SNSs provide platforms facilitating efficient communication, interactions, and connections among health professionals in frontline clinical practice, professional networks, education, and training with limitations identified as technical knowledge, professionalism, and risks of data protection. The evolving use of SNSs necessitates robust research to explore the full potential and the relative effectiveness of SNSs in professional communication. UR - http://www.jmir.org/2018/3/e117/ UR - http://dx.doi.org/10.2196/jmir.8382 UR - http://www.ncbi.nlm.nih.gov/pubmed/29592845 ID - info:doi/10.2196/jmir.8382 ER - TY - JOUR AU - VanHeerwaarden, Nicole AU - Ferguson, Genevieve AU - Abi-Jaoude, Alexxa AU - Johnson, Andrew AU - Hollenberg, Elisa AU - Chaim, Gloria AU - Cleverley, Kristin AU - Eysenbach, Gunther AU - Henderson, Joanna AU - Levinson, Andrea AU - Robb, Janine AU - Sharpe, Sarah AU - Voineskos, Aristotle AU - Wiljer, David PY - 2018/03/06 TI - The Optimization of an eHealth Solution (Thought Spot) with Transition-Aged Youth in Postsecondary Settings: Participatory Design Research JO - J Med Internet Res SP - e79 VL - 20 IS - 3 KW - students KW - transition-aged youth KW - mental health KW - substance use KW - eHealth KW - mobile apps KW - participatory action research KW - help-seeking N2 - Background: Seventy percent of lifetime cases of mental illness emerge before the age of 24 years, but many youth are unable to access the support and services they require in a timely and appropriate way. With most youth using the internet, electronic health (eHealth) interventions are promising tools for reaching this population. Through participatory design research (PDR) engagement methods, Thought Spot, a Web- and mobile-based platform, was redeveloped to facilitate access to mental health services by transition-aged youth (aged 16-29 years) in postsecondary settings. Objective: The aim of this study was to describe the process of engaging with postsecondary students through the PDR approaches, with the ultimate goal of optimizing the Thought Spot platform. Methods: Consistent with the PDR approaches, five student-led workshops, attended by 41 individuals, were facilitated to obtain feedback regarding the platform?s usability and functionality and its potential value in a postsecondary setting. Various creative engagement activities were delivered to gather experiences and opinions, including semistructured focus groups, questionnaires, personas, journey mapping, and a world café. Innovative technological features and refinements were also brainstormed during the workshops. Results: By using PDR methods of engagement, participants knew that their ideas and recommendations would be applied. There was also an overall sense of respect and care integrated into each group, which facilitated an exchange of ideas and suggestions. Conclusions: The process of engaging with students to redesign the Thought Spot platform through PDR has been effective. Findings from these workshops will significantly inform new technological features within the app to enable positive help-seeking behaviors among students. These behaviors will be further explored in the second phase that involves a randomized controlled trial. UR - http://www.jmir.org/2018/3/e79/ UR - http://dx.doi.org/10.2196/jmir.8102 UR - http://www.ncbi.nlm.nih.gov/pubmed/29510970 ID - info:doi/10.2196/jmir.8102 ER - TY - JOUR AU - Norlund, Fredrika AU - Wallin, Emma AU - Olsson, Gustaf Erik Martin AU - Wallert, John AU - Burell, Gunilla AU - von Essen, Louise AU - Held, Claes PY - 2018/03/08 TI - Internet-Based Cognitive Behavioral Therapy for Symptoms of Depression and Anxiety Among Patients With a Recent Myocardial Infarction: The U-CARE Heart Randomized Controlled Trial JO - J Med Internet Res SP - e88 VL - 20 IS - 3 KW - eHealth KW - treatment adherence and compliance KW - patient acceptance of health care KW - patient selection KW - cardiac rehabilitation N2 - Background: Symptoms of depression and anxiety are common after a myocardial infarction (MI). Internet-based cognitive behavioral therapy (iCBT) has shown good results in other patient groups. Objective: The aim of this study was to evaluate the effectiveness of an iCBT treatment to reduce self-reported symptoms of depression and anxiety among patients with a recent MI. Methods: In total, 3928 patients were screened for eligibility in 25 Swedish hospitals. Of these, 239 patients (33.5%, 80/239 women, mean age 60 years) with a recent MI and symptoms of depression or anxiety were randomly allocated to a therapist-guided, 14-week iCBT treatment (n=117), or treatment as usual (TAU; n=122). The iCBT treatment was designed for post-MI patients. The primary outcome was the total score of the Hospital Anxiety and Depression Scale (HADS) 14 weeks post baseline, assessed over the internet. Treatment effect was evaluated according to the intention-to-treat principle, with multiple imputations. For the main analysis, a pooled treatment effect was estimated, controlling for age, sex, and baseline HADS. Results: There was a reduction in HADS scores over time in the total study sample (mean delta=?5.1, P<.001) but no difference between the study groups at follow-up (beta=?0.47, 95% CI ?1.95 to 1.00, P=.53). Treatment adherence was low. A total of 46.2% (54/117) of the iCBT group did not complete the introductory module. Conclusions: iCBT treatment for an MI population did not result in lower levels of symptoms of depression or anxiety compared with TAU. Low treatment adherence might have influenced the result. Trial Registration: ClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191 (Archived at Webcite at http://www.webcitation.org/6xWWSEQ22) UR - http://www.jmir.org/2018/3/e88/ UR - http://dx.doi.org/10.2196/jmir.9710 UR - http://www.ncbi.nlm.nih.gov/pubmed/29519777 ID - info:doi/10.2196/jmir.9710 ER - TY - JOUR AU - Abdellaoui, Redhouane AU - Foulquié, Pierre AU - Texier, Nathalie AU - Faviez, Carole AU - Burgun, Anita AU - Schück, Stéphane PY - 2018/03/14 TI - Detection of Cases of Noncompliance to Drug Treatment in Patient Forum Posts: Topic Model Approach JO - J Med Internet Res SP - e85 VL - 20 IS - 3 KW - medication adherence KW - compliance KW - infodemiology KW - social media KW - text mining KW - depression KW - psychosis KW - peer-to-peer support KW - virtual community N2 - Background: Medication nonadherence is a major impediment to the management of many health conditions. A better understanding of the factors underlying noncompliance to treatment may help health professionals to address it. Patients use peer-to-peer virtual communities and social media to share their experiences regarding their treatments and diseases. Using topic models makes it possible to model themes present in a collection of posts, thus to identify cases of noncompliance. Objective: The aim of this study was to detect messages describing patients? noncompliant behaviors associated with a drug of interest. Thus, the objective was the clustering of posts featuring a homogeneous vocabulary related to nonadherent attitudes. Methods: We focused on escitalopram and aripiprazole used to treat depression and psychotic conditions, respectively. We implemented a probabilistic topic model to identify the topics that occurred in a corpus of messages mentioning these drugs, posted from 2004 to 2013 on three of the most popular French forums. Data were collected using a Web crawler designed by Kappa Santé as part of the Detec?t project to analyze social media for drug safety. Several topics were related to noncompliance to treatment. Results: Starting from a corpus of 3650 posts related to an antidepressant drug (escitalopram) and 2164 posts related to an antipsychotic drug (aripiprazole), the use of latent Dirichlet allocation allowed us to model several themes, including interruptions of treatment and changes in dosage. The topic model approach detected cases of noncompliance behaviors with a recall of 98.5% (272/276) and a precision of 32.6% (272/844). Conclusions: Topic models enabled us to explore patients? discussions on community websites and to identify posts related with noncompliant behaviors. After a manual review of the messages in the noncompliance topics, we found that noncompliance to treatment was present in 6.17% (276/4469) of the posts. UR - http://www.jmir.org/2018/3/e85/ UR - http://dx.doi.org/10.2196/jmir.9222 UR - http://www.ncbi.nlm.nih.gov/pubmed/29540337 ID - info:doi/10.2196/jmir.9222 ER - TY - JOUR AU - Lanssens, Dorien AU - Vandenberk, Thijs AU - Smeets, JP Christophe AU - De Cannière, Hélène AU - Vonck, Sharona AU - Claessens, Jade AU - Heyrman, Yenthel AU - Vandijck, Dominique AU - Storms, Valerie AU - Thijs, M. Inge AU - Grieten, Lars AU - Gyselaers, Wilfried PY - 2018/03/26 TI - Prenatal Remote Monitoring of Women With Gestational Hypertensive Diseases: Cost Analysis JO - J Med Internet Res SP - e102 VL - 20 IS - 3 KW - remote monitoring KW - gestational hypertensive diseases KW - reimbursement KW - cost-effectiveness N2 - Background: Remote monitoring in obstetrics is relatively new; some studies have shown its effectiveness for both mother and child. However, few studies have evaluated the economic impact compared to conventional care, and no cost analysis of a remote monitoring prenatal follow-up program for women diagnosed with gestational hypertensive diseases (GHD) has been published. Objective: The aim of this study was to assess the costs of remote monitoring versus conventional care relative to reported benefits. Methods: Patient data from the Pregnancy Remote Monitoring (PREMOM) study were used. Health care costs were calculated from patient-specific hospital bills of Ziekenhuis Oost-Limburg (Genk, Belgium) in 2015. Cost comparison was made from three perspectives: the Belgian national health care system (HCS), the National Institution for Insurance of Disease and Disability (RIZIV), and costs for individual patients. The calculations were made for four major domains: prenatal follow-up, prenatal admission to the hospital, maternal and neonatal care at and after delivery, and total amount of costs. A simulation exercise was made in which it was calculated how much could be demanded of RIZIV for funding the remote monitoring service. Results: A total of 140 pregnancies were included, of which 43 received remote monitoring (30.7%) and 97 received conventional care (69.2%). From the three perspectives, there were no differences in costs for prenatal follow-up. Compared to conventional care, remote monitoring patients had 34.51% less HCS and 41.72% less RIZIV costs for laboratory test results (HCS: mean ?0.00 [SD ?55.34] vs mean ?38.28 [SD ? 44.08], P<.001; RIZIV: mean ?21.09 [SD ?27.94] vs mean ?36.19 [SD ?41.36], P<.001) and a reduction of 47.16% in HCS and 48.19% in RIZIV costs for neonatal care (HCS: mean ?989.66 [SD ?3020.22] vs mean ?1872.92 [SD ?5058.31], P<.001; RIZIV: mean ?872.97 [SD ?2761.64] vs mean ?1684.86 [SD ?4702.20], P<.001). HCS costs for medication were 1.92% lower in remote monitoring than conventional care (mean ?209.22 [SD ?213.32] vs mean ?231.32 [SD 67.09], P=.02), but were 0.69% higher for RIZIV (mean ?122.60 [SD ?92.02] vs mean ?121.78 [SD ?20.77], P<.001). Overall HCS costs for remote monitoring were mean ?4233.31 (SD ?3463.31) per person and mean ?4973.69 (SD ?5219.00) per person for conventional care (P=.82), a reduction of ?740.38 (14.89%) per person, with savings mainly for RIZIV of ?848.97 per person (23.18%; mean ?2797.42 [SD ?2905.18] vs mean ?3646.39 [SD ?4878.47], P=.19). When an additional fee of ?525.07 per month per pregnant woman for funding remote monitoring costs is demanded, remote monitoring is acceptable in their costs for HCS, RIZIV, and individual patients. Conclusions: In the current organization of Belgian health care, a remote monitoring prenatal follow-up of women with GHD is cost saving for the global health care system, mainly via savings for the insurance institution RIZIV. UR - http://www.jmir.org/2018/3/e102/ UR - http://dx.doi.org/10.2196/jmir.9552 UR - http://www.ncbi.nlm.nih.gov/pubmed/29581094 ID - info:doi/10.2196/jmir.9552 ER - TY - JOUR AU - Mauz, Elvira AU - Hoffmann, Robert AU - Houben, Robin AU - Krause, Laura AU - Kamtsiuris, Panagiotis AU - Gößwald, Antje PY - 2018/03/05 TI - Mode Equivalence of Health Indicators Between Data Collection Modes and Mixed-Mode Survey Designs in Population-Based Health Interview Surveys for Children and Adolescents: Methodological Study JO - J Med Internet Res SP - e64 VL - 20 IS - 3 KW - public health KW - child and adolescent health KW - health surveys KW - survey methods KW - mixed-mode survey KW - paper-and-pencil questionnaire KW - online questionnaire KW - mode effects N2 - Background: The implementation of an Internet option in an existing public health interview survey using a mixed-mode design is attractive because of lower costs and faster data availability. Additionally, mixed-mode surveys can increase response rates and improve sample composition. However, mixed-mode designs can increase the risk of measurement error (mode effects). Objective: This study aimed to determine whether the prevalence rates or mean values of self- and parent-reported health indicators for children and adolescents aged 0-17 years differ between self-administered paper-based questionnaires (SAQ-paper) and self-administered Web-based questionnaires (SAQ-Web), as well as between a single-mode control group and different mixed-mode groups. Methods: Data were collected for a methodological pilot of the third wave of the "German Health Interview and Examination Survey for Children and Adolescents". Questionnaires were completed by parents or adolescents. A population-based sample of 11,140 children and adolescents aged 0-17 years was randomly allocated to 4 survey designs?a single-mode control group with paper-and-pencil questionnaires only (n=970 parents, n=343 adolescents)?and 3 mixed-mode designs, all of which offered Web-based questionnaire options. In the concurrent mixed-mode design, both questionnaires were offered at the same time (n=946 parents, n=290 adolescents); in the sequential mixed-mode design, the SAQ-Web was sent first, followed by the paper questionnaire along with a reminder (n=854 parents, n=269 adolescents); and in the preselect mixed-mode design, both options were offered and the respondents were asked to request the desired type of questionnaire (n=698 parents, n=292 adolescents). In total, 3468 questionnaires of parents of children aged 0-17 years (SAQ-Web: n=708; SAQ-paper: n=2760) and 1194 questionnaires of adolescents aged 11-17 years (SAQ-Web: n=299; SAQ-paper: n=895) were analyzed. Sociodemographic characteristics and a broad range of health indicators for children and adolescents were compared by survey design and data collection mode by calculating predictive margins from regression models. Results: There were no statistically significant differences in sociodemographic characteristics or health indicators between the single-mode control group and any of the mixed-mode survey designs. Differences in sociodemographic characteristics between SAQ-Web and SAQ-paper were found. Web respondents were more likely to be male, have higher levels of education, and higher household income compared with paper respondents. After adjusting for sociodemographic characteristics, only one of the 38 analyzed health indicators showed different prevalence rates between the data collection modes, with a higher prevalence rate for lifetime alcohol consumption among the online-responding adolescents (P<.001). Conclusions: These results suggest that mode bias is limited in health interview surveys for children and adolescents using a mixed-mode design with Web-based and paper questionnaires. UR - http://www.jmir.org/2018/3/e64/ UR - http://dx.doi.org/10.2196/jmir.7802 UR - http://www.ncbi.nlm.nih.gov/pubmed/29506967 ID - info:doi/10.2196/jmir.7802 ER - TY - JOUR AU - Ashford, D. Robert AU - Lynch, Kevin AU - Curtis, Brenda PY - 2018/03/06 TI - Technology and Social Media Use Among Patients Enrolled in Outpatient Addiction Treatment Programs: Cross-Sectional Survey Study JO - J Med Internet Res SP - e84 VL - 20 IS - 3 KW - digital divide KW - behavioral health KW - social media KW - addiction KW - recovery KW - relapse N2 - Background: Substance use disorder research and practice have not yet taken advantage of emerging changes in communication patterns. While internet and social media use is widespread in the general population, little is known about how these mediums are used in substance use disorder treatment. Objective: The aims of this paper were to provide data on patients' with substance use disorders mobile phone ownership rates, usage patterns on multiple digital platforms (social media, internet, computer, and mobile apps), and their interest in the use of these platforms to monitor personal recovery. Methods: We conducted a cross-sectional survey of patients in 4 intensive outpatient substance use disorder treatment facilities in Philadelphia, PA, USA. Logistic regressions were used to examine associations among variables. Results: Survey participants (N=259) were mostly male (72.9%, 188/259), African American (62.9%, 163/259), with annual incomes less than US $10,000 (62.5%, 161/259), and averaged 39 (SD 12.24) years of age. The vast majority of participants (93.8%, 243/259) owned a mobile phone and about 64.1% (166/259) owned a mobile phone with app capabilities, of which 85.1% (207/243) accessed the internet mainly through their mobile phone. There were no significant differences in age, gender, ethnicity, or socio-economic status by computer usage, internet usage, number of times participants changed their phone, type of mobile phone contract, or whether participants had unlimited calling plans. The sample was grouped into 3 age groups (Millennials, Generation Xers, and Baby Boomers). The rates of having a social media account differed across these 3 age groups with significant differences between Baby Boomers and both Generation Xers and Millennials (P<.001 in each case). Among participants with a social media account (73.6%, 190/259), most (76.1%, 144/190) reported using it daily and nearly all (98.2%, 186/190) used Facebook. Nearly half of participants (47.4%, 90/190) reported viewing content on social media that triggered substance cravings and an equal percentage reported being exposed to recovery information on social media. There was a significant difference in rates of reporting viewing recovery information on social media across the 3 age groups with Baby Boomers reporting higher rates than Millennials (P<.001). The majority of respondents (70.1%, 181/259) said they would prefer to use a relapse prevention app on their phone or receive SMS (short message service) relapse prevention text messages (72.3%, 186/259), and nearly half (49.1%, 127/259) expressed an interest in receiving support by allowing social media accounts to be monitored as a relapse prevention technique. Conclusions: To our knowledge, this is the first and largest study examining the online behavior and preferences regarding technology-based substance use disorder treatment interventions in a population of patients enrolled in community outpatient treatment programs. Patients were generally receptive to using relapse prevention apps and text messaging interventions and a substantial proportion supported social media surveillance tools. However, the design of technology-based interventions remains as many participants have monthly telephone plans which may limit continuity. UR - http://www.jmir.org/2018/3/e84/ UR - http://dx.doi.org/10.2196/jmir.9172 UR - http://www.ncbi.nlm.nih.gov/pubmed/29510968 ID - info:doi/10.2196/jmir.9172 ER - TY - JOUR AU - Tarver, L. Will AU - Menser, Terri AU - Hesse, W. Bradford AU - Johnson, J. Tyler AU - Beckjord, Ellen AU - Ford, W. Eric AU - Huerta, R. Timothy PY - 2018/03/29 TI - Growth Dynamics of Patient-Provider Internet Communication: Trend Analysis Using the Health Information National Trends Survey (2003 to 2013) JO - J Med Internet Res SP - e109 VL - 20 IS - 3 KW - internet KW - health communication N2 - Background: Communication is key in chronic disease management, and the internet has altered the manner in which patients and providers can exchange information. Adoption of secure messaging differs among patients due to the digital divide that keeps some populations from having effective access to online resources. Objective: This study aimed to examine the current state of online patient-provider communication, exploring trends over time in the use of online patient-provider communication tools. Methods: A 3-part analytic process was used to study the following: (1) reanalysis, (2) close replication across years, and (3) trend analysis extension. During the reanalysis stage, the publicly available Health Information National Trends Survey (HINTS) 1 and 2 data were used with the goal of identifying the precise analytic methodology used in a prior study, published in 2007. The original analysis was extended to add 3 additional data years (ie, 2008, 2011, and 2013) using the original analytical approach with the purpose of identifying trends over time. Multivariate logistic regression was used to analyze pooled data across all years, with year as an added predictor, in addition to a model for each individual data year. Results: The odds of internet users to communicate online with health care providers was significantly and increasingly higher year-over-year, starting in 2003 (2005: odds ratio [OR] 1.31, 95% CI 1.03-1.68; 2008: OR 2.14, 95% CI 1.76-2.59; 2011: OR 2.92, 95% CI 2.33-3.66; and 2013: OR 5.77; 95% CI 4.62-7.20). Statistically significant socio-economic factors found to be associated with internet users communicating online with providers included age, having health insurance, having a history of cancer, and living in an urban area of residence. Conclusions: The proportion of internet users communicating online with their health care providers has significantly increased since 2003. Although these trends are encouraging, access challenges still exist for some groups, potentially giving rise to a new set of health disparities related to communication. UR - http://www.jmir.org/2018/3/e109/ UR - http://dx.doi.org/10.2196/jmir.7851 UR - http://www.ncbi.nlm.nih.gov/pubmed/29599107 ID - info:doi/10.2196/jmir.7851 ER - TY - JOUR AU - Arroyo-Gallego, Teresa AU - Ledesma-Carbayo, J. María AU - Butterworth, Ian AU - Matarazzo, Michele AU - Montero-Escribano, Paloma AU - Puertas-Martín, Verónica AU - Gray, L. Martha AU - Giancardo, Luca AU - Sánchez-Ferro, Álvaro PY - 2018/03/26 TI - Detecting Motor Impairment in Early Parkinson?s Disease via Natural Typing Interaction With Keyboards: Validation of the neuroQWERTY Approach in an Uncontrolled At-Home Setting JO - J Med Internet Res SP - e89 VL - 20 IS - 3 KW - eHealth KW - machine learning KW - telemedicine N2 - Background: Parkinson?s disease (PD) is the second most prevalent neurodegenerative disease and one of the most common forms of movement disorder. Although there is no known cure for PD, existing therapies can provide effective symptomatic relief. However, optimal titration is crucial to avoid adverse effects. Today, decision making for PD management is challenging because it relies on subjective clinical evaluations that require a visit to the clinic. This challenge has motivated recent research initiatives to develop tools that can be used by nonspecialists to assess psychomotor impairment. Among these emerging solutions, we recently reported the neuroQWERTY index, a new digital marker able to detect motor impairment in an early PD cohort through the analysis of the key press and release timing data collected during a controlled in-clinic typing task. Objective: The aim of this study was to extend the in-clinic implementation to an at-home implementation by validating the applicability of the neuroQWERTY approach in an uncontrolled at-home setting, using the typing data from subjects? natural interaction with their laptop to enable remote and unobtrusive assessment of PD signs. Methods: We implemented the data-collection platform and software to enable access and storage of the typing data generated by users while using their computer at home. We recruited a total of 60 participants; of these participants 52 (25 people with Parkinson?s and 27 healthy controls) provided enough data to complete the analysis. Finally, to evaluate whether our in-clinic-built algorithm could be used in an uncontrolled at-home setting, we compared its performance on the data collected during the controlled typing task in the clinic and the results of our method using the data passively collected at home. Results: Despite the randomness and sparsity introduced by the uncontrolled setting, our algorithm performed nearly as well in the at-home data (area under the receiver operating characteristic curve [AUC] of 0.76 and sensitivity/specificity of 0.73/0.69) as it did when used to evaluate the in-clinic data (AUC 0.83 and sensitivity/specificity of 0.77/0.72). Moreover, the keystroke metrics presented a strong correlation between the 2 typing settings, which suggests a minimal influence of the in-clinic typing task in users? normal typing. Conclusions: The finding that an algorithm trained on data from an in-clinic setting has comparable performance with that tested on data collected through naturalistic at-home computer use reinforces the hypothesis that subtle differences in motor function can be detected from typing behavior. This work represents another step toward an objective, user-convenient, and quasi-continuous monitoring tool for PD. UR - http://www.jmir.org/2018/3/e89/ UR - http://dx.doi.org/10.2196/jmir.9462 UR - http://www.ncbi.nlm.nih.gov/pubmed/29581092 ID - info:doi/10.2196/jmir.9462 ER - TY - JOUR AU - Zikmund-Fisher, J. Brian AU - Scherer, M. Aaron AU - Witteman, O. Holly AU - Solomon, B. Jacob AU - Exe, L. Nicole AU - Fagerlin, Angela PY - 2018/03/26 TI - Effect of Harm Anchors in Visual Displays of Test Results on Patient Perceptions of Urgency About Near-Normal Values: Experimental Study JO - J Med Internet Res SP - e98 VL - 20 IS - 3 KW - decision making KW - education of patients KW - electronic health record KW - computer graphics KW - clinical laboratory information systems N2 - Background: Patient-facing displays of laboratory test results typically provide patients with one reference point (the ?standard range?). Objective: To test the effect of including an additional harm anchor reference point in visual displays of laboratory test results, which indicates how far outside of the standard range values would need to be in order to suggest substantial patient risk. Methods: Using a demographically diverse, online sample, we compared the reactions of 1618 adults in the United States who viewed visual line displays that included both standard range and harm anchor reference points (?Many doctors are not concerned until here?) to displays that included either (1) only a standard range, (2) standard range plus evaluative categories (eg, ?borderline high?), or (3) a color gradient showing degree of deviation from the standard range. Results: Providing the harm anchor reference point significantly reduced perceived urgency of close-to-normal alanine aminotransferase and creatinine results (P values <.001) but not generally for platelet count results. Notably, display type did not significantly alter perceptions of more extreme results in potentially harmful ranges. Harm anchors also substantially reduced the number of participants who wanted to contact their doctor urgently or go to the hospital about these test results. Conclusions: Presenting patients with evaluative cues regarding when test results become clinically concerning can reduce the perceived urgency of out-of-range results that do not require immediate clinical action. UR - http://www.jmir.org/2018/3/e98/ UR - http://dx.doi.org/10.2196/jmir.8889 UR - http://www.ncbi.nlm.nih.gov/pubmed/29581088 ID - info:doi/10.2196/jmir.8889 ER - TY - JOUR AU - Thompson, A. Lindsay AU - Mercado, Rebeccah AU - Martinko, Thomas AU - Acharya, Ratna PY - 2018/03/21 TI - Novel Interventions and Assessments Using Patient Portals in Adolescent Research: Confidential Survey Study JO - J Med Internet Res SP - e101 VL - 20 IS - 3 KW - adolescent health services KW - preventive health services KW - health information technology N2 - Background: While adolescents can receive confidential health care without parental or guardian notification, they are rarely asked about their experiences and opinions regarding their care because participation in research often requires parental consent. Anonymous research with adolescents via confidential patient portals may ameliorate this research gap. Objective: Because use of a confidential online adolescent patient portal is high at our academic institution, we hypothesized that adolescents would also respond to survey-based research via the portal, especially if asked anonymously and without parental consent. We used a clinical scenario of needing to better understanding adolescent and young adults? views about their health and health care, including information on a long-acting reversible contraceptive (LARC) to test if and how they will use a portal for research. Methods: Upon receiving Institutional Review Board approval, we sent 2 portal-based surveys about confidential services to 2 groups of females, ages 14 to 25 years, who had attended an adolescent clinic in the past 3 years. This clinic mostly serves Medicaid recipients (80%) and is racially and ethnically diverse with half of patients identifying as African American and roughly 10% Hispanic. The control group was a random sample of female patients who never received a LARC (n=150) and the intervention group included all female adolescents who had received a LARC from the same clinic (n=107). This second sample was manually cross-checked to confirm they had an office visit for this reason. Consenting for themselves, the control group received an email through the patient portal with a link and a request to perform an assessment. The survey for the control group included items assessing health literacy and health communication preferences. The survey for the intervention group included health literacy items as well as items to assess their opinions and perceptions regarding LARCs. We tracked click-through rates and opened messages; each participant received 4 reminders. Results: While only 3 participants fully completed either survey, email read rates (29/107 [27.1%] of LARC recipients and 39/150 [26.0%] of controls) were encouraging. Additionally, of those who opened the messages, almost twice as many of the LARC recipients (10/107 [9.3%]) read through the entire survey, while less than half read the entire survey as compared to those who received the survey asking about health literacy and health care preferences (6/150 [4.0%]). Conclusions: The methodology of using adolescent portals for online surveys provides a new avenue for research even though the study did not yield sufficient participation to understand these adolescents? preferences. Future studies need to test if a different survey topic would engage adolescents or if other methods like text-based reminders would improve participation. UR - http://www.jmir.org/2018/3/e101/ UR - http://dx.doi.org/10.2196/jmir.8340 UR - http://www.ncbi.nlm.nih.gov/pubmed/29563077 ID - info:doi/10.2196/jmir.8340 ER - TY - JOUR AU - Bernhard, Gerda AU - Mahler, Cornelia AU - Seidling, Marita Hanna AU - Stützle, Marion AU - Ose, Dominik AU - Baudendistel, Ines AU - Wensing, Michel AU - Szecsenyi, Joachim PY - 2018/03/27 TI - Developing a Shared Patient-Centered, Web-Based Medication Platform for Type 2 Diabetes Patients and Their Health Care Providers: Qualitative Study on User Requirements JO - J Med Internet Res SP - e105 VL - 20 IS - 3 KW - medication KW - self-management KW - patient portal KW - patient participation KW - type 2 diabetes mellitus KW - focus groups KW - primary care N2 - Background: Information technology tools such as shared patient-centered, Web-based medication platforms hold promise to support safe medication use by strengthening patient participation, enhancing patients? knowledge, helping patients to improve self-management of their medications, and improving communication on medications among patients and health care professionals (HCPs). However, the uptake of such platforms remains a challenge also due to inadequate user involvement in the development process. Employing a user-centered design (UCD) approach is therefore critical to ensure that user? adoption is optimal. Objective: The purpose of this study was to identify what patients with type 2 diabetes mellitus (T2DM) and their HCPs regard necessary requirements in terms of functionalities and usability of a shared patient-centered, Web-based medication platform for patients with T2DM. Methods: This qualitative study included focus groups with purposeful samples of patients with T2DM (n=25), general practitioners (n=13), and health care assistants (n=10) recruited from regional health care settings in southwestern Germany. In total, 8 semistructured focus groups were conducted. Sessions were audio- and video-recorded, transcribed verbatim, and subjected to a computer-aided qualitative content analysis. Results: Appropriate security and access methods, supported data entry, printing, and sending information electronically, and tracking medication history were perceived as the essential functionalities. Although patients wanted automatic interaction checks and safety alerts, HCPs on the contrary were concerned that unspecific alerts confuse patients and lead to nonadherence. Furthermore, HCPs were opposed to patients? ability to withhold or restrict access to information in the platform. To optimize usability, there was consensus among participants to display information in a structured, chronological format, to provide information in lay language, to use visual aids and customize information content, and align the platform to users? workflow. Conclusions: By employing a UCD, this study provides insight into the desired functionalities and usability of patients and HCPs regarding a shared patient-centered, Web-based medication platform, thus increasing the likelihood to achieve a functional and useful system. Substantial and ongoing engagement by all intended user groups is necessary to reconcile differences in requirements of patients and HCPs, especially regarding medication safety alerts and access control. Moreover, effective training of patients and HCPs on medication self-management (support) and optimal use of the tool will be a prerequisite to unfold the platform?s full potential. UR - http://www.jmir.org/2018/3/e105/ UR - http://dx.doi.org/10.2196/jmir.8666 UR - http://www.ncbi.nlm.nih.gov/pubmed/29588269 ID - info:doi/10.2196/jmir.8666 ER - TY - JOUR AU - Brodey, Benjamin AU - Purcell, E. Susan AU - Rhea, Karen AU - Maier, Philip AU - First, Michael AU - Zweede, Lisa AU - Sinisterra, Manuela AU - Nunn, Brad M. AU - Austin, Marie-Paule AU - Brodey, S. Inger PY - 2018/03/23 TI - Rapid and Accurate Behavioral Health Diagnostic Screening: Initial Validation Study of a Web-Based, Self-Report Tool (the SAGE-SR) JO - J Med Internet Res SP - e108 VL - 20 IS - 3 KW - mental health KW - differential diagnosis KW - surveys and questionnaires KW - self-report KW - primary health care KW - computer-assisted diagnosis N2 - Background: The Structured Clinical Interview for DSM (SCID) is considered the gold standard assessment for accurate, reliable psychiatric diagnoses; however, because of its length, complexity, and training required, the SCID is rarely used outside of research. Objective: This paper aims to describe the development and initial validation of a Web-based, self-report screening instrument (the Screening Assessment for Guiding Evaluation-Self-Report, SAGE-SR) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the SCID-5-Clinician Version (CV) intended to make accurate, broad-based behavioral health diagnostic screening more accessible within clinical care. Methods: First, study staff drafted approximately 1200 self-report items representing individual granular symptoms in the diagnostic criteria for the 8 primary SCID-CV modules. An expert panel iteratively reviewed, critiqued, and revised items. The resulting items were iteratively administered and revised through 3 rounds of cognitive interviewing with community mental health center participants. In the first 2 rounds, the SCID was also administered to participants to directly compare their Likert self-report and SCID responses. A second expert panel evaluated the final pool of items from cognitive interviewing and criteria in the DSM-5 to construct the SAGE-SR, a computerized adaptive instrument that uses branching logic from a screener section to administer appropriate follow-up questions to refine the differential diagnoses. The SAGE-SR was administered to healthy controls and outpatient mental health clinic clients to assess test duration and test-retest reliability. Cutoff scores for screening into follow-up diagnostic sections and criteria for inclusion of diagnoses in the differential diagnosis were evaluated. Results: The expert panel reduced the initial 1200 test items to 664 items that panel members agreed collectively represented the SCID items from the 8 targeted modules and DSM criteria for the covered diagnoses. These 664 items were iteratively submitted to 3 rounds of cognitive interviewing with 50 community mental health center participants; the expert panel reviewed session summaries and agreed on a final set of 661 clear and concise self-report items representing the desired criteria in the DSM-5. The SAGE-SR constructed from this item pool took an average of 14 min to complete in a nonclinical sample versus 24 min in a clinical sample. Responses to individual items can be combined to generate DSM criteria endorsements and differential diagnoses, as well as provide indices of individual symptom severity. Preliminary measures of test-retest reliability in a small, nonclinical sample were promising, with good to excellent reliability for screener items in 11 of 13 diagnostic screening modules (intraclass correlation coefficient [ICC] or kappa coefficients ranging from .60 to .90), with mania achieving fair test-retest reliability (ICC=.50) and other substance use endorsed too infrequently for analysis. Conclusions: The SAGE-SR is a computerized adaptive self-report instrument designed to provide rigorous differential diagnostic information to clinicians. UR - http://www.jmir.org/2018/3/e108/ UR - http://dx.doi.org/10.2196/jmir.9428 UR - http://www.ncbi.nlm.nih.gov/pubmed/29572204 ID - info:doi/10.2196/jmir.9428 ER - TY - JOUR AU - Välimäki, Maritta AU - Mishina, Kaisa AU - Kaakinen, K. Johanna AU - Holm, K. Suvi AU - Vahlo, Jukka AU - Kirjonen, Markus AU - Pekurinen, Virve AU - Tenovuo, Olli AU - Korkeila, Jyrki AU - Hämäläinen, Heikki AU - Sarajuuri, Jaana AU - Rantanen, Pekka AU - Orenius, Tage AU - Koponen, Aki PY - 2018/03/19 TI - Digital Gaming for Improving the Functioning of People With Traumatic Brain Injury: Randomized Clinical Feasibility Study JO - J Med Internet Res SP - e77 VL - 20 IS - 3 KW - rehabilitation KW - traumatic brain injury KW - video games N2 - Background: Traumatic brain injury (TBI) is a major health problem that often requires intensive and long-term rehabilitation. Objective: The aim of this study was to determine whether rehabilitative digital gaming facilitates cognitive functioning and general well-being in people with TBI. Methods: A total of 90 Finnish-speaking adults with TBI (18-65 years) were recruited from an outpatient neuroscience clinic. The participants were randomly allocated to one of the three groups: a rehabilitation gaming group (n=29, intervention), an entertainment gaming group (n=29, active control), or a passive control group (n=32). The gaming groups were instructed to engage in gaming for a minimum of 30 min per day for 8 weeks. Primary and secondary outcomes were measured at three time points: before the intervention, after the intervention, and 3 months following the intervention. The primary outcome was cognitive status measured by processing speed and visuomotor tasks (The Trail Making Test; Wechsler Adult Intelligence Scale-Fourth Edition, WAIS-IV, symbol search, coding, and cancellation tasks). Secondary outcomes were attention and executive functions (Simon task), working memory (WAIS-IV digit span and Paced Auditory Serial Addition Test, PASAT), depression (Patient Health Questionnaire-9), self-efficacy (General Self-efficacy Scale), and executive functions (Behavior Rating Inventory of Executive Function-Adult Version). Feasibility information was assessed (acceptability, measurement instruments filled, dropouts, adherence, usability, satisfaction, and possible future use). Cognitive measurements were conducted in face-to-face interviews by trained psychologists, and questionnaires were self-administered. Results: The effects of rehabilitation gaming did not significantly differ from the effects of entertainment gaming or being in a passive control group. For primary outcomes and PASAT tests, the participants in all three groups showed overall improvement in test scores across the three measurement points. However, depression scores increased significantly between baseline and after 8 weeks and between baseline and after 3 months in the rehabilitative gaming group. No differences were found in patients? self-efficacy between the three measuring points in any of the groups. Participants did use the games (rehabilitation group: 93%, 27/29; entertainment group 100%, 29/29). Games were seen as a usable intervention (rehabilitation group: 70%, 14/29; entertainment group: 83%, 20/29). The rehabilitation group was less satisfied with the gaming intervention (68%, 13/29 vs 83%, 20/29), but they were more willing to use the game after the intervention period (76%, 16/29 vs 63%, 15/29). Total time spent on gaming during the intervention period was low (15.22 hour rehabilitation gaming group, 19.22 hour entertainment gaming group). Conclusions: We did not find differences between the groups in improvement in the outcome measures. The improvements in test performance by all three groups may reflect rehearsal effects. Entertainment gaming had elements that could be considered when rehabilitative games are designed for, implemented in, and assessed in larger clinical trials for persons with TBI. Trial Registration: ClinicalTrials.gov NCT02425527; https://clinicaltrials.gov/ct2/show/NCT02425527 (Archived by WebCite at http://www.webcitation.org/6esKI1uDH) UR - http://www.jmir.org/2018/3/e77/ UR - http://dx.doi.org/10.2196/jmir.7618 UR - http://www.ncbi.nlm.nih.gov/pubmed/29555622 ID - info:doi/10.2196/jmir.7618 ER - TY - JOUR AU - van Kasteren, Yasmin AU - Freyne, Jill AU - Hussain, Sazzad M. PY - 2018/03/20 TI - Total Knee Replacement and the Effect of Technology on Cocreation for Improved Outcomes and Delivery: Qualitative Multi-Stakeholder Study JO - J Med Internet Res SP - e95 VL - 20 IS - 3 KW - arthroplasty KW - replacement KW - osteoarthritis KW - patient participation KW - consumer health informatics KW - technology KW - telemedicine KW - rehabilitation KW - self-care KW - exercise therapy KW - human computer interaction KW - wearables N2 - Background: The growth in patient-centered care delivery combined with the rising costs of health care have perhaps not unsurprisingly been matched by a proliferation of patient-centered technology. This paper takes a multistakeholder approach to explore how digital technology can support the cocreation of value between patients and their care teams in the delivery of total knee replacement (TKR) surgery, an increasingly common procedure to return mobility and relieve pain for people suffering from osteoarthritis. Objective: The aim of this study was to investigate communications and interactions between patients and care teams in the delivery of TKR to identify opportunities for digital technology to add value to TKR health care service by enhancing the cocreation of value. Methods: A multistakeholder qualitative study of user needs was conducted with Australian stakeholders (N=34): surgeons (n=12), physiotherapists (n=3), patients (n=11), and general practitioners (n=8). Data from focus groups and interviews were recorded, transcribed, and analyzed using thematic analysis. Results: Encounters between patients and their care teams are information-rich but time-poor. Results showed seven different stages of the TKR journey that starts with referral to a surgeon and ends with a postoperative review at 12 months. Each stage of the journey has different information and communication challenges that can be enhanced by digital technology. Opportunities for digital technology include improved waiting list management, supporting and reinforcing patient retention and recall of information, motivating and supporting rehabilitation, improving patient preparation for hospital stay, and reducing risks and anxiety associated with postoperative wound care. Conclusions: Digital technology can add value to patients? care team communications by enhancing information flow, assisting patient recall and retention of information, improving accessibility and portability of information, tailoring information to individual needs, and by providing patients with tools to engage in their own health care management. For care teams, digital technology can add value through early detection of postoperative complications, proactive surveillance of health data for postoperative patients and patients on waiting lists, higher compliance with rehabilitation programs, and reduced length of stay. Digital technology has the potential to improve patient satisfaction and outcomes, as well as potentially reduce hospital length of stay and the burden of disease associated with postoperative morbidity. UR - http://www.jmir.org/2018/3/e95/ UR - http://dx.doi.org/10.2196/jmir.7541 UR - http://www.ncbi.nlm.nih.gov/pubmed/29559424 ID - info:doi/10.2196/jmir.7541 ER - TY - JOUR AU - Tucker, D. Joseph AU - Pan, W. Stephen AU - Mathews, Allison AU - Stein, Gabriella AU - Bayus, Barry AU - Rennie, Stuart PY - 2018/03/09 TI - Ethical Concerns of and Risk Mitigation Strategies for Crowdsourcing Contests and Innovation Challenges: Scoping Review JO - J Med Internet Res SP - e75 VL - 20 IS - 3 KW - crowdsourcing KW - health communication KW - ethical analysis N2 - Background: Crowdsourcing contests (also called innovation challenges, innovation contests, and inducement prize contests) can be used to solicit multisectoral feedback on health programs and design public health campaigns. They consist of organizing a steering committee, soliciting contributions, engaging the community, judging contributions, recognizing a subset of contributors, and sharing with the community. Objective: This scoping review describes crowdsourcing contests by stage, examines ethical problems at each stage, and proposes potential ways of mitigating risk. Methods: Our analysis was anchored in the specific example of a crowdsourcing contest that our team organized to solicit videos promoting condom use in China. The purpose of this contest was to create compelling 1-min videos to promote condom use. We used a scoping review to examine the existing ethical literature on crowdsourcing to help identify and frame ethical concerns at each stage. Results: Crowdsourcing has a group of individuals solve a problem and then share the solution with the public. Crowdsourcing contests provide an opportunity for community engagement at each stage: organizing, soliciting, promoting, judging, recognizing, and sharing. Crowdsourcing poses several ethical concerns: organizing?potential for excluding community voices; soliciting?potential for overly narrow participation; promoting?potential for divulging confidential information; judging?potential for biased evaluation; recognizing?potential for insufficient recognition of the finalist; and sharing?potential for the solution to not be implemented or widely disseminated. Conclusions: Crowdsourcing contests can be effective and engaging public health tools but also introduce potential ethical problems. We present methods for the responsible conduct of crowdsourcing contests. UR - http://www.jmir.org/2018/3/e75/ UR - http://dx.doi.org/10.2196/jmir.8226 UR - http://www.ncbi.nlm.nih.gov/pubmed/29523500 ID - info:doi/10.2196/jmir.8226 ER - TY - JOUR AU - Tully, P. Mary AU - Bozentko, Kyle AU - Clement, Sarah AU - Hunn, Amanda AU - Hassan, Lamiece AU - Norris, Ruth AU - Oswald, Malcolm AU - Peek, Niels PY - 2018/03/28 TI - Investigating the Extent to Which Patients Should Control Access to Patient Records for Research: A Deliberative Process Using Citizens? Juries JO - J Med Internet Res SP - e112 VL - 20 IS - 3 KW - public participation KW - patient engagement KW - public opinion KW - medical research KW - confidentiality KW - privacy KW - national health services KW - data linkage KW - public policy, decision making, organizational N2 - Background: The secondary use of health data for research raises complex questions of privacy and governance. Such questions are ill-suited to opinion polling where citizens must choose quickly between multiple-choice answers based on little information. Objective: The aim of this project was to extend knowledge about what control informed citizens would seek over the use of health records for research after participating in a deliberative process using citizens? juries. Methods: Two 3-day citizens? juries, of 17 citizens each, were convened to reflect UK national demographics from 355 eligible applicants. Each jury addressed the mission ?To what extent should patients control access to patient records for secondary use?? Jurors heard from and questioned 5 expert witnesses (chosen either to inform the jury, or to argue for and against the secondary use of data), interspersed with structured opportunities to deliberate among themselves, including discussion and role-play. Jurors voted on a series of questions associated with the jury mission, giving their rationale. Individual views were polled using questionnaires at the beginning and at end of the process. Results: At the end of the process, 33 out of 34 jurors voted in support of the secondary use of data for research, with 24 wanting individuals to be able to opt out, 6 favoring opt in, and 3 voting that all records should be available without any consent process. When considering who should get access to data, both juries had very similar rationales. Both thought that public benefit was a key justification for access. Jury 1 was more strongly supportive of sharing patient records for public benefit, whereas jury 2 was more cautious and sought to give patients more control. Many jurors changed their opinion about who should get access to health records: 17 people became more willing to support wider information sharing of health data for public benefit, whereas 2 moved toward more patient control over patient records. Conclusions: The findings highlight that, when informed of both risks and opportunities associated with data sharing, citizens believe an individual?s right to privacy should not prevent research that can benefit the general public. The juries also concluded that patients should be notified of any such scheme and have the right to opt out if they so choose. Many jurors changed their minds about this complex policy question when they became more informed. Many, but not all, jurors became less skeptical about health data sharing, as they became better informed of its benefits and risks. UR - http://www.jmir.org/2018/3/e112/ UR - http://dx.doi.org/10.2196/jmir.7763 UR - http://www.ncbi.nlm.nih.gov/pubmed/29592847 ID - info:doi/10.2196/jmir.7763 ER - TY - JOUR AU - Wenham, Clare AU - Gray, R. Eleanor AU - Keane, E. Candice AU - Donati, Matthew AU - Paolotti, Daniela AU - Pebody, Richard AU - Fragaszy, Ellen AU - McKendry, A. Rachel AU - Edmunds, John W. PY - 2018/03/01 TI - Self-Swabbing for Virological Confirmation of Influenza-Like Illness Among an Internet-Based Cohort in the UK During the 2014-2015 Flu Season: Pilot Study JO - J Med Internet Res SP - e71 VL - 20 IS - 3 KW - influenza KW - influenza-like illness KW - surveillance KW - online KW - cohort study KW - virological confirmation N2 - Background: Routine influenza surveillance, based on laboratory confirmation of viral infection, often fails to estimate the true burden of influenza-like illness (ILI) in the community because those with ILI often manage their own symptoms without visiting a health professional. Internet-based surveillance can complement this traditional surveillance by measuring symptoms and health behavior of a population with minimal time delay. Flusurvey, the UK?s largest crowd-sourced platform for surveillance of influenza, collects routine data on more than 6000 voluntary participants and offers real-time estimates of ILI circulation. However, one criticism of this method of surveillance is that it is only able to assess ILI, rather than virologically confirmed influenza. Objective: We designed a pilot study to see if it was feasible to ask individuals from the Flusurvey platform to perform a self-swabbing task and to assess whether they were able to collect samples with a suitable viral content to detect an influenza virus in the laboratory. Methods: Virological swabbing kits were sent to pilot study participants, who then monitored their ILI symptoms over the influenza season (2014-2015) through the Flusurvey platform. If they reported ILI, they were asked to undertake self-swabbing and return the swabs to a Public Health England laboratory for multiplex respiratory virus polymerase chain reaction testing. Results: A total of 700 swab kits were distributed at the start of the study; from these, 66 participants met the definition for ILI and were asked to return samples. In all, 51 samples were received in the laboratory, 18 of which tested positive for a viral cause of ILI (35%). Conclusions: This demonstrated proof of concept that it is possible to apply self-swabbing for virological laboratory testing to an online cohort study. This pilot does not have significant numbers to validate whether Flusurvey surveillance accurately reflects influenza infection in the community, but highlights that the methodology is feasible. Self-swabbing could be expanded to larger online surveillance activities, such as during the initial stages of a pandemic, to understand community transmission or to better assess interseasonal activity. UR - http://www.jmir.org/2018/3/e71/ UR - http://dx.doi.org/10.2196/jmir.9084 UR - http://www.ncbi.nlm.nih.gov/pubmed/29496658 ID - info:doi/10.2196/jmir.9084 ER - TY - JOUR AU - Hsu, Greta AU - Sun, Y. Jessica AU - Zhu, Shu-Hong PY - 2018/03/12 TI - Evolution of Electronic Cigarette Brands From 2013-2014 to 2016-2017: Analysis of Brand Websites JO - J Med Internet Res SP - e80 VL - 20 IS - 3 KW - electronic cigarettes KW - vaping KW - nicotine KW - longitudinal studies KW - internet KW - market research N2 - Background: The electronic cigarette (e-cigarette) industry has grown in size and organizational complexity in recent years, most notably with the entry of major tobacco companies in 2012 and the proliferation of vape shops. Many brands maintain retail websites that present e-cigarette marketing claims and sell directly to consumers. Understanding of the evolving composition of different types of e-cigarette brand websites is currently underdeveloped. Objective: This paper presents how e-cigarette brand websites surveyed in 2013-2014 evolved by 2016-2017, and how the websites run by different types of e-cigarette producers currently differ. Methods: In 2016-2017, we revisited 466 e-cigarette brand websites surveyed in 2013-2014, 288 of which were extant, and identified 145 new English-language websites. We compared product designs, marketing claims, and age-based warnings presented by types of e-cigarette producers: major tobacco companies, independent vape shops, and independent internet-only companies. Results: Among the 433 websites examined in 2016-2017, 12 were owned by major tobacco companies, 162 operated a physical vape shop, and 259 were internet-only operations. Closed-system product designs were sold by 83% (10/12) of tobacco-owned brands. In comparison, 29.0% (47/162, P<.001) of vape shop and 55.2% (143/259, P=.06) of internet-only brands sold closed-system designs. Compared with vape shop and internet-only brands, tobacco-owned brands offered a smaller set of product models (P values <.001) and a narrower range of flavors (P values <.01), with greater emphasis on the traditional combustible cigarette flavors of tobacco and menthol (P values <.001). Tobacco-owned brands also offered a narrower range of nicotine options than the vape shops (P=.002) and were less likely to offer nicotine-free e-liquid compared with internet-only and vape shop brands (P values <.001). Finally, 83% (10/12) of tobacco-owned brand websites featured age verification pop-up windows. In comparison, only 50.2% (130/259) of internet-only brands (P=.01) and 60.5% (98/162) of vape shop brands (P=.06) featured age verification windows. Websites surveyed in both 2013-2014 and 2016-2017 became more likely to sell open-system mods (P<.001) and sold an increased number of product models (P<.001), flavors (P<.001), and nicotine options (P<.001). Prevalence of several types of claims decreased significantly, including indirect claims regarding smoking cessation (P<.001), claims regarding e-cigarettes as healthier (P<.001), less expensive (P<.001), and usable in more places (P<.001) compared with combustible cigarettes. Conclusions: The number of e-cigarette brands has not appeared to increase since 2014, even as website messaging evolved, with brands owned by tobacco companies and vape shops pulling in opposite directions. Brands owned by tobacco companies offered a limited range of e-cigarette products, whereas brands owned by vape shops emphasized a panoply of flavor and nicotine options. Furthermore, the Food and Drug Administration?s regulatory action may influence the types of e-cigarette products offered and the market shares of various companies. UR - http://www.jmir.org/2018/3/e80/ UR - http://dx.doi.org/10.2196/jmir.8550 UR - http://www.ncbi.nlm.nih.gov/pubmed/29530840 ID - info:doi/10.2196/jmir.8550 ER - TY - JOUR AU - Liu, Janine Jessica AU - Matelski, Justin John AU - Bell, M. Chaim PY - 2018/03/07 TI - Scope, Breadth, and Differences in Online Physician Ratings Related to Geography, Specialty, and Year: Observational Retrospective Study JO - J Med Internet Res SP - e76 VL - 20 IS - 3 KW - quality improvement KW - patient satisfaction KW - patient-centered care KW - online ratings N2 - Background: Physician ratings websites have emerged as a novel forum for consumers to comment on their health care experiences. Little is known about such ratings in Canada. Objective: We investigated the scope and trends for specialty, geographic region, and time for online physician ratings in Canada using a national data source from the country?s leading physician-rating website. Methods: This observational retrospective study used online ratings data from Canadian physicians (January 2005-September 2013; N=640,603). For specialty, province, and year of rating, we assessed whether physicians were likely to be rated favorably by using the proportion of ratings greater than the overall median rating. Results: In total, 57,412 unique physicians had 640,603 individual ratings. Overall, ratings were positive (mean 3.9, SD 1.3). On average, each physician had 11.2 (SD 10.1) ratings. By comparing specialties with Canadian Institute of Health Information physician population numbers over our study period, we inferred that certain specialties (obstetrics and gynecology, family practice, surgery, and dermatology) were more commonly rated, whereas others (pathology, radiology, genetics, and anesthesia) were less represented. Ratings varied by specialty; cardiac surgery, nephrology, genetics, and radiology were more likely to be rated in the top 50th percentile, whereas addiction medicine, dermatology, neurology, and psychiatry were more often rated in the lower 50th percentile of ratings. Regarding geographic practice location, ratings were more likely to be favorable for physicians practicing in eastern provinces compared with western and central Canada. Regarding year, the absolute number of ratings peaked in 2007 before stabilizing and decreasing by 2013. Moreover, ratings were most likely to be positive in 2007 and again in 2013. Conclusions: Physician-rating websites are a relatively novel source of provider-level patient satisfaction and are a valuable source of the patient experience. It is important to understand the breadth and scope of such ratings, particularly regarding specialty, geographic practice location, and changes over time. UR - http://www.jmir.org/2018/3/e76/ UR - http://dx.doi.org/10.2196/jmir.7475 UR - http://www.ncbi.nlm.nih.gov/pubmed/29514775 ID - info:doi/10.2196/jmir.7475 ER - TY - JOUR AU - Yaraghi, Niam AU - Wang, Weiguang AU - Gao, (Gordon) Guodong AU - Agarwal, Ritu PY - 2018/03/26 TI - How Online Quality Ratings Influence Patients? Choice of Medical Providers: Controlled Experimental Survey Study JO - J Med Internet Res SP - e99 VL - 20 IS - 3 KW - quality of health care KW - health care evaluation mechanisms N2 - Background: In recent years, the information environment for patients to learn about physician quality is being rapidly changed by Web-based ratings from both commercial and government efforts. However, little is known about how various types of Web-based ratings affect individuals? choice of physicians. Objective: The objective of this research was to measure the relative importance of Web-based quality ratings from governmental and commercial agencies on individuals? choice of primary care physicians. Methods: In a choice-based conjoint experiment conducted on a sample of 1000 Amazon Mechanical Turk users in October 2016, individuals were asked to choose their preferred primary care physician from pairs of physicians with different ratings in clinical and nonclinical aspects of care provided by governmental and commercial agencies. Results: The relative log odds of choosing a physician increases by 1.31 (95% CI 1.26-1.37; P<.001) and 1.32 (95% CI 1.27-1.39; P<.001) units when the government clinical ratings and commercial nonclinical ratings move from 2 to 4 stars, respectively. The relative log odds of choosing a physician increases by 1.12 (95% CI 1.07-1.18; P<.001) units when the commercial clinical ratings move from 2 to 4 stars. The relative log odds of selecting a physician with 4 stars in nonclinical ratings provided by the government is 1.03 (95% CI 0.98-1.09; P<.001) units higher than a physician with 2 stars in this rating. The log odds of selecting a physician with 4 stars in nonclinical government ratings relative to a physician with 2 stars is 0.23 (95% CI 0.13-0.33; P<.001) units higher for females compared with males. Similar star increase in nonclinical commercial ratings increases the relative log odds of selecting the physician by female respondents by 0.15 (95% CI 0.04-0.26; P=.006) units. Conclusions: Individuals perceive nonclinical ratings provided by commercial websites as important as clinical ratings provided by government websites when choosing a primary care physician. There are significant gender differences in how the ratings are used. More research is needed on whether patients are making the best use of different types of ratings, as well as the optimal allocation of resources in improving physician ratings from the government?s perspective. UR - http://www.jmir.org/2018/3/e99/ UR - http://dx.doi.org/10.2196/jmir.8986 UR - http://www.ncbi.nlm.nih.gov/pubmed/29581091 ID - info:doi/10.2196/jmir.8986 ER - TY - JOUR AU - Hogan, P. Timothy AU - Luger, M. Tana AU - Volkman, E. Julie AU - Rocheleau, Mary AU - Mueller, Nora AU - Barker, M. Anna AU - Nazi, M. Kim AU - Houston, K. Thomas AU - Bokhour, G. Barbara PY - 2018/03/08 TI - Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging JO - J Med Internet Res SP - e82 VL - 20 IS - 3 KW - health communication KW - electronic mail KW - patient portals KW - patient-centered care KW - veterans N2 - Background: As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. Objective: Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. Methods: We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. Results: Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and respectful in nature (25.7%, 96/373 vs 33.4%, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4%, 86/338) but also displayed friendliness or warmth (18.9%, 64/338) and reassurance or encouragement (18.6%, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions. Conclusions: This evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members. UR - http://www.jmir.org/2018/3/e82/ UR - http://dx.doi.org/10.2196/jmir.8801 UR - http://www.ncbi.nlm.nih.gov/pubmed/29519774 ID - info:doi/10.2196/jmir.8801 ER - TY - JOUR AU - Herrmann, Maximilian AU - Boehme, Philip AU - Mondritzki, Thomas AU - Ehlers, P. Jan AU - Kavadias, Stylianos AU - Truebel, Hubert PY - 2018/03/27 TI - Digital Transformation and Disruption of the Health Care Sector: Internet-Based Observational Study JO - J Med Internet Res SP - e104 VL - 20 IS - 3 KW - digital transformation KW - health care sector KW - health care reform KW - incremental innovation KW - disruptive innovation KW - organizational innovation KW - entrepreneurship KW - efficiency KW - models KW - organizational KW - diffusion of innovation KW - delivery of health care N2 - Background: Digital innovation, introduced across many industries, is a strong force of transformation. Some industries have seen faster transformation, whereas the health care sector only recently came into focus. A context where digital corporations move into health care, payers strive to keep rising costs at bay, and longer-living patients desire continuously improved quality of care points to a digital and value-based transformation with drastic implications for the health care sector. Objective: We tried to operationalize the discussion within the health care sector around digital and disruptive innovation to identify what type of technological enablers, business models, and value networks seem to be emerging from different groups of innovators with respect to their digital transformational efforts. Methods: From the Forbes 2000 and CBinsights databases, we identified 100 leading technology, life science, and start-up companies active in the health care sector. Further analysis identified projects from these companies within a digital context that were subsequently evaluated using the following criteria: delivery of patient value, presence of a comprehensive and distinctive underlying business model, solutions provided, and customer needs addressed. Results: Our methodological approach recorded more than 400 projects and collaborations. We identified patterns that show established corporations rely more on incremental innovation that supports their current business models, while start-ups engage their flexibility to explore new market segments with notable transformations of established business models. Thereby, start-ups offer higher promises of disruptive innovation. Additionally, start-ups offer more diversified value propositions addressing broader areas of the health care sector. Conclusions: Digital transformation is an opportunity to accelerate health care performance by lowering cost and improving quality of care. At an economic scale, business models can be strengthened and disruptive innovation models enabled. Corporations should look for collaborations with start-up companies to keep investment costs at bay and off the balance sheet. At the same time, the regulatory knowledge of established corporations might help start-ups to kick off digital disruption in the health care sector. UR - http://www.jmir.org/2018/3/e104/ UR - http://dx.doi.org/10.2196/jmir.9498 UR - http://www.ncbi.nlm.nih.gov/pubmed/29588274 ID - info:doi/10.2196/jmir.9498 ER - TY - JOUR AU - Sisa, Ivan PY - 2018/03/05 TI - Comment on: Clinical Validity, Understandability, and Actionability of Online Cardiovascular Disease Risk Calculators: Systematic Review JO - J Med Internet Res SP - e10093 VL - 20 IS - 3 KW - cardiovascular disease KW - risk assessment KW - risk model UR - http://www.jmir.org/2018/3/e10093/ UR - http://dx.doi.org/10.2196/10093 UR - http://www.ncbi.nlm.nih.gov/pubmed/29506971 ID - info:doi/10.2196/10093 ER - TY - JOUR AU - Ueda, Nao AU - Yokouchi, Ryoki AU - Onoda, Taro AU - Ogihara, Atsushi PY - 2018/03/16 TI - Figure Caption Correction: Characteristics of Articles About Human Papillomavirus Vaccination in Japanese Newspapers: Time-Series Analysis Study JO - J Med Internet Res SP - e27 VL - 20 IS - 3 UR - http://www.jmir.org/2018/3/e27/ UR - http://dx.doi.org/10.2196/jmir.9728 UR - http://www.ncbi.nlm.nih.gov/pubmed/29547387 ID - info:doi/10.2196/jmir.9728 ER -