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JMIR Formative Research


Journal Description

JMIR Formative Research (JFR) (a sister journal of J Med Internet Res (JMIR) and JMIR mHealth & uHealth, the leading eHealth and mHealth journals by impact factor) publishes peer-reviewed, openly accessible papers containing results from process evaluations, feasibility/pilot studies and other kinds of formative research and preliminary results. While the original focus was on the design of medical and health-related research and technology innovations, JFR publishes studies from all areas of medical and health research.

Formative research is research that occurs before a program is designed and implemented, or while a program is being conducted. Formative research can help

  • define and understand populations in need of a intervention or public health program
  • create programs that are specific to the needs of those populations
  • ensure programs are acceptable and feasible to users before launching
  • improve the relationship between users and agencies/research groups
  • demonstrate the feasibility, use, satisfaction with, or problems with a program before large-scale summative evaluation (looking at heatlh outcomes)

Many funding agencies will expect some sort of pilot/feasibility/process evaluation before funding a larger study such as a Randomized Controlled Trial (RCT).

Formative research should be an integral part of developing programs or adapting programs, and should be used while the program is on-going to help refine and improve program activities. Thus, formative evaluation can and should also occur in form of a process evaluation alongside a summative evaluation such as a RCT.

This journal fills an important gap in the academic journals landscape, as it publshes sound and peer-reviewed formative research that is criticial for investigators to apply for further funding, but that is usually not published in outcomes-focussed medical journals aiming for impact and generalizability.


Recent Articles:

  • Source: Unsplash; Copyright: ALP STUDIO; URL:; License: Licensed by JMIR.

    User-Centered Design of a Mobile App for Weight and Health Management in Adolescents With Complex Health Needs: Qualitative Study


    Background: Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted toward the development of these technologies for adolescents with complex health needs receiving specialized tertiary-level health care. Objective: The aim of this study was to conduct a user-centered needs assessment of adolescents interested in weight management with complex health needs requiring specialized health care services, their parents, and health care providers (HCPs) to inform the design and development of a mobile app for weight and health management. Methods: A qualitative study design was employed. Participants were recruited from two tertiary health care centers. Separate audiotaped focus group interviews were conducted with adolescents aged 12 to 18 years, parents, and HCPs. Interviews were transcribed, and field notes were collected by research staff. Iterative simple content analysis was performed independently by 4 research team members using computer software NVivo (QSR International) 10.0. Results: A total of 19 adolescents, 16 parents, and 21 HCPs were interviewed. Qualitative analysis revealed seven major themes related to app functionality: healthy eating, social support, self-monitoring, communicating with HCPs, supporting mental health, gamification and incentives, and user interface (UI) design. Adolescents provided several ideas related to each feature, whereas parents’ views focused on assistance with meal planning and greater access to HCPs. HCPs viewed the app as a novel and more acceptable platform to connect remotely with adolescents than conventional methods. They also strongly endorsed the value of social support capabilities and the ability to connect with an HCP. Conclusions: This is the first study to conduct a qualitative needs assessment in adolescents receiving specialized health care services toward the design of a mobile app for weight and health management. Our results indicate that core components of the app should include tailored meal recommendations and assistance with meal planning, social networking for peer support, customized and convenient tracking, remote access to HCPs, features to support mental health, and an attractive and engaging UI. These findings will be used to develop and evaluate a mobile app targeting adolescents with complex health needs.

  • Source:; Copyright: Kate Mangostar; URL: woman phone&page=3&position=14; License: Creative Commons Attribution (CC-BY).

    A Spiritually-Based Text Messaging Program to Increase Cervical Cancer Awareness Among African American Women: Design and Development of the CervixCheck...


    Background: Although Hispanic women have the highest cervical cancer incidence rate, African American women account for a disproportionate burden of cervical cancer incidence and mortality when compared with non-Hispanic white women. Given that religion occupies an essential place in African American lives, delivering health messages through a popular communication delivery channel and framing them with important spiritual themes may allow for a more accessible and culturally appropriate approach to promoting cervical cancer educational content to African American women. Objective: The aim of this paper was to describe the design and development of the CervixCheck project, a spiritually based short message service (SMS) text messaging pilot intervention to increase cervical cancer awareness and Papanicolaou test screening intention among church-attending African American women aged 21 to 65 years. Methods: Through focus group interviews (n=15), formative research was conducted to explore facilitators, motivators, and barriers to cervical cancer screening. The interviews were also used to identify logistical factors that should be considered when developing the CervixCheck intervention. Culturally appropriate and spiritually grounded SMS text messages were developed based on the analysis of focus group data and the review of previous studies that incorporated technology into health behavior change interventions. After the CervixCheck intervention was developed, cognitive response interviews (n=8) were used to review the content of the SMS text messaging library, to ensure that the content was acceptable and understandable, particularly for church-attending African American women aged 21 to 65 years. Results: Design and development of the SMS text messages involved consideration of the content of the messages and technological specifications. Focus group participants overwhelmingly reported cell phone use and an interest in receiving spiritually based SMS text messages on cervical cancer prevention and early detection. Findings from the cognitive response interviews revealed that the content of the SMS text messaging library was acceptable and understandable with the target population. The revised SMS text messaging library currently includes 22 messages for delivery over 16 days, averaging 11 texts per week, with no more than two messages delivered per day. Initial usability testing also showed early feasibility. Conclusions: The design and development of the CervixCheck intervention provides important insight into what may be considered an overlooked minority population and missed opportunity in health information technology research. With increased internet penetration through the use of mobile phones, it is appropriate to investigate the viability of technology as a means to reach minority communities and to reduce health disparities.

  • Source:; Copyright: yanalya; URL:; License: Creative Commons Attribution (CC-BY).

    Factors Affecting Patient Portal Use Among Low-Income Pregnant Women: Mixed-Methods Pilot Study


    Background: Patient portals offer patients personalized and secure Web access to their medical information and enable patients to manage their health care online. However, there is a lack of information about patient acceptance and use of patient portals among low-income pregnant women. Objective: This formative research aims to assess the potential of a patient portal, MyChart, for improving prenatal health care and pregnancy outcomes, and identify the barriers and facilitators of MyChart use among low-income pregnant women. Methods: A mixed-methods study was conducted with a convenience sample of 18 low-income pregnant women comprising low- and high-risk patients enrolled in a prenatal clinic in eastern North Carolina. MyChart use, patient demographics, and pregnancy information were collected by reviewing electronic medical charts. Health literacy was measured. Reported use and attitudes toward MyChart were collected using a semi-structured interview. Results: Although 39% (7/18) of participants interviewed signed up for MyChart, only 22% (4/18) of them became active users. Another 33% (6/18) had never heard of MyChart or was unsure of how to access it. Users primarily accessed test results and appointment schedules. The main facilitating factors for patient portal use were information and motivation from health care providers and concerns about pregnancy due to a history of miscarriage. Reported barriers were lack of educational resources, lack of care provider encouragement, and technical difficulties possibly exacerbated by low health literacy. Participants also suggested improvements for MyChart, especially the provision of discussion-based support for pregnant women. Conclusions: The one-time verbal introduction of MyChart does not meet current patients’ needs. Data reveal the need for more consistent patient education and support programs, tailored to patients’ previous pregnancy histories. The clinic also needs to facilitate better provider-patient communication about the importance of MyChart use.

  • Source: Wikicommons; Copyright: Sigismund von Dobschütz; URL:; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    A Web-Based Platform for People With Memory Problems and Their Caregivers (CAREGIVERSPRO-MMD): Mixed-Methods Evaluation of Usability


    Background: The increasing number of people with dementia (PwD) drives research exploring Web-based support interventions to provide effective care for larger populations. In this concept, a Web-based platform (CAREGIVERSPRO-MMD, 620911) was designed to (1) improve the quality of life for PwD, (2) reduce caregiver burden, (3) reduce the financial costs for care, and (4) reduce administration time for health and social care professionals. Objective: The objective of this study was to evaluate the usability and usefulness of CAREGIVERSPRO-MMD platform for PwD or mild cognitive impairment (MCI), informal caregivers, and health and social care professionals with respect to a wider strategy followed by the project to enhance the user-centered approach. A secondary aim of the study was to collect recommendations to improve the platform before the future pilot study. Methods: A mixed methods design was employed for recruiting PwD or MCI (N=24), informal caregivers (N=24), and professionals (N=10). Participants were asked to rate their satisfaction, the perceived usefulness, and ease of use of each function of the platform. Qualitative questions about the improvement of the platform were asked when participants provided low scores for a function. Testing occurred at baseline and 1 week after participants used the platform. The dropout rate from baseline to the follow-up was approximately 10% (6/58). Results: After 1 week of platform use, the system was useful for 90% (20.75/23) of the caregivers and for 89% (5.36/6) of the professionals. When users responded to more than 1 question per platform function, the mean of satisfied users per function was calculated. These user groups also provided positive evaluations for the ease of use (caregivers: 82%, 18.75/23; professionals: 97%, 5.82/6) and their satisfaction with the platform (caregivers: 79%, 18.08/23; professionals: 73%, 4.36/6). Ratings from PwD were lower than the other groups for usefulness (57%, 13/23), ease of use (41%, 9.4/23), and overall satisfaction (47%, 11/23) with the platform (P<.05). Qualitative comments related to both improvements for functionality and the platform interface. Conclusions: Although caregivers and professionals were overall satisfied with the platform, further adaptations were recommended by PwD. This reiterates the importance of the involvement of end users in the development of Web-based interventions. Recommendations from users in this paper apply for the interface and functionality of a wider range of Web-based support interventions.

  • A time trade-off question from the authors' online application. Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    A Computer-Assisted Personal Interview App in Research Electronic Data Capture for Administering Time Trade-off Surveys (REDCap): Development and Pretest


    Background: The time trade-off (TTO) task is a method of eliciting health utility scores, which range from 0 (equivalent to death) to 1 (equivalent to perfect health). These scores numerically represent a person’s health-related quality of life. Software apps exist to administer the TTO task; however, most of these apps are poorly documented and unavailable to researchers. Objective: To fill the void, we developed an online app to administer the TTO task for a research study that is examining general public proxy health-related quality of life estimates for persons with Alzheimer’s disease. This manuscript describes the development and pretest of the app. Methods: We used Research Electronic Data Capture (REDCap) to build the TTO app. The app’s modular structure and REDCap’s object-oriented environment facilitated development. After the TTO app was built, we recruited a purposive sample of 11 members of the general public to pretest its functionality and ease of use. Results: Feedback from the pretest group was positive. Minor modifications included clarity enhancements, such as rearranging some paragraph text into bullet points, labeling the app to delineate different question sections, and revising or deleting text. We also added a research question to enable the identification of respondents who know someone with Alzheimer’s disease. Conclusions: We developed an online app to administer the TTO task. Other researchers may access and customize the app for their own research purposes.

  • PrEP-Rx dashboard (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    A Simple Pre-Exposure Prophylaxis (PrEP) Optimization Intervention for Health Care Providers Prescribing PrEP: Pilot Study


    Background: Pre-exposure prophylaxis (PrEP) has been shown to be highly effective for the prevention of HIV in clinical trials and demonstration projects, but PrEP uptake and adherence outside of these settings in the United States has been limited. Lack of knowledge and willingness of health care providers (HCPs) to prescribe PrEP is an important barrier to implementation. Objective: The objective of this study was to describe and examine the feasibility and acceptability of a PrEP Optimization Intervention (PrEP-OI) targeted at HCPs. The ultimate purpose of this intervention was to increase PrEP uptake, adherence, and persistence among those at risk for HIV acquisition. Methods: This intervention included the following: (1) a Web-based panel management tool called PrEP-Rx, which provides comprehensive HIV risk assessment, automates reminders for follow-up, and reports patients’ history of PrEP use; and (2) centralized PrEP coordination by a clinical support staff member (ie, the PrEP coordinator) who can identify individuals at risk for HIV, provide medical insurance navigation, and support multiple HCPs. Feasibility was evaluated based on HCPs’ ability to log in to PrEP-Rx and use it as needed. Acceptability was assessed via individual formative qualitative interviews with HCPs after 1 month of the intervention. Results: The intervention was feasible and acceptable among HCPs (N=6). HCPs identified system-level barriers to PrEP provision, many of which can be addressed by this intervention. HCPs noted that the intervention improved their PrEP knowledge; increased ease of PrEP prescription; and was likely to improve patient engagement and retention in care, enhance communication with patients, and improve patient monitoring and follow-up. Conclusions: Given the critical role HCPs serve in disseminating PrEP, we created an easy-to-use PrEP optimization intervention deemed feasible and acceptable to providers. Further research on this tool and its ability to impact the PrEP continuum of care is needed.

  • Staff at Western Health using the CALD app. Source: Better Care Victoria; Copyright: Better Care Victoria; URL:; License: Licensed by the authors.

    Developing Digital Facilitation of Assessments in the Absence of an Interpreter: Participatory Design and Feasibility Evaluation With Allied Health Groups


    Background: To ensure appropriate and timely care, interpreters are often required to aid communication between clinicians and patients from non-English speaking backgrounds. In a hospital environment, where care is delivered 24 hours a day, interpreters are not always available. Subsequently, culturally and linguistically diverse (CALD) patients are sometimes unable to access timely assessment because of clinicians’ inability to communicate directly with them. Objective: The aim of this study was to design and evaluate CALD Assist, a tablet app to assist communication between patients and allied health clinicians in the absence of an interpreter. CALD Assist uses key phrases translated into common languages and uses pictorial, written, and voice-over prompts to facilitate communication during basic patient assessment. Methods: CALD Assist’s design, functionality, and content were determined through focus groups with clinicians and informed by interpreting and cultural services. An evaluation was conducted in a live trial phase on eight wards across 2 campuses of a hospital in Victoria, Australia. Results: A commercial grade CALD Assist mobile app for five disciplines within allied health was developed and evaluated. The app includes a total of 95 phrases in ten different languages to assist clinicians during their initial assessment. Evaluation results show that clinicians’ confidence in their assessment increased with use of the CALD Assist app: clinicians’ reports of “complete confidence” increased from 10% (3/30) to 42% (5/12), and assessment reports of “no confidence” decreased from 57% (17/30) to 17% (2/12). Average time required to complete an assessment with patients from non-English speaking backgrounds reduced from 42.0 to 15.6 min. Conclusions: Through the use of CALD Assist, clinician confidence in communicating with patients from non-English speaking backgrounds in the absence of an interpreter increased, providing patients from non-English speaking backgrounds with timely initial assessments and subsequent care in line with their English speaking peers. Additionally, the inclusion of images and video demonstrations in CALD Assist increased the ability to communicate with patients and overcome literacy-related barriers. Although a number of hurdles were faced, user uptake and satisfaction were positive, and the app is now available in the Apple App Store.

  • The ACM Check homepage (montage). Source: The Authors /; Copyright: The Authors /; URL:; License: Creative Commons Attribution (CC-BY).

    Identifying Asbestos-Containing Materials in Homes: Design and Development of the ACM Check Mobile Phone App


    Background: Asbestos-containing materials (ACMs) can still be found in many homes in Australia and other countries. ACMs present a health risk when they are damaged or disturbed, such as during do-it-yourself home renovations. However, community members lack knowledge and awareness about asbestos identification and its safe management in residential settings. Objective: The objective of our study was to describe the process of developing a mobile phone app, ACM Check, that incorporates a questionnaire designed to identify and assess ACMs located in residential settings. Methods: A multidisciplinary team was involved in the formative development and creation of the mobile phone app. The formative development process comprised 6 steps: defining the scope of the app; conducting a comprehensive desktop review by searching online literature databases, as well as a wider online search for gray literature; drafting and revising the content, questionnaire, conditional branching rules, and scoring algorithms; obtaining expert input; manually pretesting the questionnaire; and formulating a final content document to be provided to the software development company. We then constructed ACM Check on the iOS platform for use in a validation study, and then updated the app, replicated it on Android, and released it to the public. Results: The ACM Check app identifies potential ACMs, prioritizes the materials based on their condition and likelihood of disturbance, and generates a summary report for each house assessed. Conclusions: ACM Check is an initiative to raise community members’ awareness of asbestos in the residential environment and also serves as a data collection tool for epidemiologic research. It can potentially be modified for implementation in other countries or used as the basis for the assessment of other occupational or environmental hazards.

  • The Arthritis New Zealand Facebook page. Source: The Authors; Copyright: Karen Day; URL:; License: Creative Commons Attribution (CC-BY).

    A Health Professional–Led Synchronous Discussion on Facebook: Descriptive Analysis of Users and Activities


    Background: Arthritis is a major cause of pain and disability. Arthritis New Zealand (Arthritis NZ) is a nongovernmental organization that provides advocacy, information, and advice and support services for people with arthritis in New Zealand. Since many people seek health information on the Web, Arthritis NZ has a webpage and a Facebook page. In addition to static content, Arthritis NZ provides synchronous discussions with an arthritis educator each week via Facebook. Objective: The aim of this study was to describe participation and structure of synchronous discussion with a health educator on a social media platform and the type of information and support provided to people with arthritis during discussions on this social media platform. Methods: Interpretive multimethods were used. Facebook Analytics were used to describe the users of the Arthritis NZ Facebook page and to provide descriptive summary statistics. Graphic analysis was used to summarize activity during a convenience sample of 10 arthritis educator–led synchronous discussions. Principles of thematic analysis were used to interpret transcripts of all comments from these 10 weekly arthritis educator–led discussions. Results: Users of the Arthritis NZ Facebook page were predominantly female (1437/1778, 80.82%), aged 18 to 54 years. Three major activities occurred during arthritis educator–led synchronous discussions: (1) seeking or giving support; (2) information enquiry; and (3) information sharing across a broad range of topic areas, largely related to symptoms and maintaining physical functioning. There was limited peer-to-peer interaction, with most threads consisting of two-comment exchanges between the users and arthritis educators. Conclusions: Arthritis educator–led discussions provided a forum for informational and emotional support for users. The facilitated discussion forum for people with arthritis on Facebook could be enhanced by encouraging increased user participation and increasing peer-to-peer interactions and further training of arthritis educators in facilitation of Web-based discussion. Future research should focus on addressing barriers to user participation and assessing the impact of arthritis educator facilitation training, with the latter leveraging the Action Research paradigm.

  • Virtual pill box of the Medisafe app (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Implications for Training on Smartphone Medication Reminder App Use by Adults With Chronic Conditions: Pilot Study Applying the Technology Acceptance Model


    Background: The majority of middle-aged to older patients with chronic conditions report forgetting to take medications as prescribed. The promotion of patients’ smartphone medication reminder app (SMRA) use shows promise as a feasible and cost-effective way to support their medication adherence. Providing training on SMRA use, guided by the technology acceptance model (TAM), could be a promising intervention to promote patients’ app use. Objective: The aim of this pilot study was to (1) assess the feasibility of an SMRA training session designed to increase patients’ intention to use the app through targeting perceived usefulness of app, perceived ease of app use, and positive subjective norm regarding app use and (2) understand the ways to improve the design and implementation of the training session in a hospital setting. Methods: A two-group design was employed. A total of 11 patients older than 40 years (median=58, SD=9.55) and taking 3 or more prescribed medications took part in the study on one of two different dates as participants in either the training group (n=5) or nontraining group (n=6). The training group received an approximately 2-hour intervention training session designed to target TAM variables regarding one popular SMRA, the Medisafe app. The nontraining group received an approximately 2-hour control training session where the participants individually explored Medisafe app features. Each training session was concluded with a one-time survey and a one-time focus group. Results: Mann-Whitney U tests revealed that the level of perceived ease of use (P=.13) and the level of intention to use an SMRA (P=.33) were higher in the training group (median=7.00, median=6.67, respectively) than in the nontraining group (median=6.25, median=5.83). However, the level of perceived usefulness (U=4.50, Z=−1.99, P=.05) and the level of positive subjective norm (P=.25) were lower in the training group (median=6.50, median=4.29) than in the nontraining group (median=6.92, median=4.50). Focus groups revealed the following participants’ perceptions of SMRA use in the real-world setting that the intervention training session would need to emphasize in targeting perceived usefulness and positive subjective norm: (1) the participants would find an SMRA to be useful if they thought the app could help address specific struggles in medication adherence in their lives and (2) the participants think that their family members (or health care providers) might view positively the participants’ SMRA use in primary care settings (or during routine medical checkups). Conclusions: Intervention training session, guided by TAM, appeared feasible in targeting patients’ perceived ease of use and, thereby, increasing intention to use an SMRA. Emphasizing the real-world utility of SMRA, the training session could better target patients’ perceived usefulness and positive subjective norm that are also important in increasing their intention to use the app.

  • Source: Flickr; Copyright: Bread for the World; URL:; License: Creative Commons Attribution + Noncommercial + NoDerivatives (CC-BY-NC-ND).

    Using mHealth to Support Postabortion Contraceptive Use: Results From a Feasibility Study in Urban Bangladesh


    Background: As access to mobile technology improves in low- and middle-income countries, it becomes easier to provide information about sensitive issues, such as contraception and abortion. In Bangladesh, 97% of the population has access to a mobile signal, and the equity gap is closing in mobile phone ownership. Bangladesh has a high pregnancy termination rate and improving effective use of contraception after abortion is essential to reducing subsequent unwanted pregnancies. Objective: This study examines the feasibility and acceptability of implementing a short message service (SMS) text message-based mHealth intervention to support postabortion contraceptive use among abortion clients in Bangladesh, including women’s interest in the intervention, intervention preferences, and privacy concerns. Methods: This feasibility study was conducted in four urban, high abortion caseload facilities. Women enrolled in the study were randomized into an intervention (n=60) or control group (n=60) using block randomization. Women completed a baseline interview on the day of their abortion procedure and a follow-up interview 4 months later (retention rate: 89.1%, 107/120). Women in the intervention group received text message reminders to use their selected postabortion contraceptive methods and reminders to contact the facility if they had problems or concerns with their method. Women who did not select a method received weekly messages that they could visit the clinic if they would like to start a method. Women in the control group did not receive any messages. Results: Almost all women in the feasibility study reported using their mobile phones at least once per day (98.3%, 118/120) and 77.5% (93/120) used their phones for text messaging. In the intervention group, 87% (48/55) of women were using modern contraception at the 4-month follow-up, whereas 90% (47/52) were using contraception in the control group (P=.61). The intervention was not effective in increasing modern contraceptive use at follow-up, but 93% (51/55) of women reported at follow-up that the text reminders helped them use their method correctly and 76% (42/55) said they would sign up for this service again. Approximately half of the participants (53%, 29/55) said that someone they did not want to know about the text message reminders found out, mostly their husbands or children. Conclusions: In this small-scale feasibility study, text reminders did not increase postabortion contraceptive use. Despite the ineffectiveness of the text reminder intervention, implementation of a mHealth intervention among abortion clients in urban Bangladesh was feasible in that women were interested in receiving follow-up messages after their abortion and mobile phone use was common. Text messages may not be the best modality for a mHealth intervention due to relatively low baseline SMS text message use and privacy concerns.

  • Nonparticipation in videoconferencing-based alcohol treatment. Source: Image created by the Authors and Colleagues; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Videoconferencing-Based Treatment of Alcohol Use Disorders: Analyses of Nonparticipation


    Background: We recently conducted a small randomized controlled trial (RCT) aiming to examine the effectiveness of videoconferencing-based treatment of alcohol use disorders in a real-life setting. The patient and participation rates were lower than anticipated. Objective: The objectives of our study were (1) to examine differences between participants and nonparticipants, and (2) to examine the characteristics of nonparticipants and their reported reasons for not participating. Methods: First, we analyzed nonparticipation through a comparative analysis of participants and nonparticipants using data from a clinical database, covering all patients starting treatment at the clinic. Second, on the basis of data from an anonymous questionnaire filled out by nonparticipants, we analyzed barriers to participating and the descriptive sociodemographics of nonparticipants who reported technical barriers versus those who did not. Results: Of 128 consecutive patients starting treatment during the study period, we found no significant differences between participants (n=71) and nonparticipants (n=51) according to sociodemographics, alcohol measures, and composite scores. Of 51 nonparticipants, 43 filled out the questionnaire with reasons for not participating. We derived 2 categories of barriers from the questionnaire: scientific barriers, which were barriers to the scientific study in general (n=6), and technical barriers, which were barriers to using a laptop or videoconferencing specifically (n=27). We found no significant differences in sociodemographics between nonparticipants who reported technical barriers to participating in the study and those who did not note technical barriers. A total of 13 patients elaborated on technical barriers, and 9 patients found videoconferencing impersonal, preferred personal contact, and would rather attend face-to-face treatment at the clinic. Conclusions: Patient barriers to participating in the RCT were mainly concerned with the technology. There were no significant differences between participants and nonparticipants, nor between nonparticipants who noted technical barriers to participating and those who did not. If a similar study is to be conducted or the solution is to be upscaled and implemented, attention should be given to the user friendliness of the technical equipment and the recruitment process, preparing the patients by emphasizing the information given to them about the technical equipment and its advantages.

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  • Mobile Device Use among Rural, Low-Income Families and the Feasibility of an App to Encourage Preschooler’s Physical Activity: A Qualitative Study

    Date Submitted: Apr 24, 2018

    Open Peer Review Period: Apr 24, 2018 - Jun 19, 2018

    Background: As mobile devices are becoming ubiquitous, technology-based interventions provide a promising strategy to positively influence health behaviors of families with young children. However, qu...

    Background: As mobile devices are becoming ubiquitous, technology-based interventions provide a promising strategy to positively influence health behaviors of families with young children. However, questions remain about the feasibility and acceptability of intervention delivery via mobile apps in low-income, rural settings and among families with preschoolers. Objective: The aims of this study were to understand the content and context of preschooler’s mobile device; explore parent beliefs on this topic, including the acceptability of intervention delivery via mobile devices; and to test a prototype of an app to encourage preschoolers’ physical activity with both parents and children. Methods: Parents (n=29) were recruited from five preschool centers in eastern, rural Colorado to complete a semi-structured telephone interview regarding preschooler’s mobile device use. A second sample of parents (n=31) were recruited from the same preschool centers to view the app prototype independently and provide feedback. A third sample of preschool children (n=24) were videotaped using the app in small groups to measure engagement and record their responses to the app. Results: Five key content areas emerged from the telephone interviews: 1) mobile devices are an important part of families’ everyday routines and parents have parameters governing their use; 2) parents often use mobile devices as a tool for behavior management; 3) parents clearly distinguish between mobile device use for learning vs entertainment; 4) parents have an overarching desire for balance in regards to their child’s mobile device use; and 5) parents were generally supportive of the idea of using mobile apps for intervention delivery. From the app prototype testing with parents, participants reacted positively to the app and felt that it would be useful in a variety of situations. Testing with preschoolers showed the children were highly engaged with the app and on average, moved actively for 74% of the movement time, or just over 2 minutes, each time they used the app. Conclusions: Mobile devices are already integrated into most families’ daily routines and appear to be an acceptable method of intervention delivery in low-income, rural, Colorado families. The physical activity app represents an innovative way to reach these families and, with further improvements based on participant feedback, will provide children a unique opportunity to practice key movement skills.

  • Developing, Implementing, and Evaluating a Multimedia Decision Aid Program to Reform the Informed Consent Process of a Peripherally Inserted Central Venous Catheter Procedure

    Date Submitted: Apr 5, 2018

    Open Peer Review Period: Apr 9, 2018 - Jun 4, 2018

    Background: Informed consent has considerable clinical, ethical, and legal implications for patient safety and liability. Advances in multimedia technology increased the utilization of multimedia pati...

    Background: Informed consent has considerable clinical, ethical, and legal implications for patient safety and liability. Advances in multimedia technology increased the utilization of multimedia patient decision aids (PtDA) to supplement the conventional informed consent process. Little information is available about the use of multimedia PtDAs in the consent process for therapeutic invasive procedures such as the peripherally inserted central venous catheter (PICC). Additionally, none of the available studies have designed their multimedia PtDAs based on the patients’ information needs and the Agency for Healthcare Research and Quality (AHRQ’s) comprehensive guide for informed consent. Objective: This paper describes a patient-centered, systematic, multidisciplinary approach to develop, implement, and evaluate an effective multimedia PtDA to reform the informed consent process of a PICC procedure for patients in 10 acute and intensive care units. Methods: The development, implementation, and evaluation processes of the PtDA followed the phases described in the Multimedia Production Framework: preproduction (planning), production (filming), and postproduction (testing and editing). Within this Framework, the Criteria for Judging the Quality of PtDAs developed by the International Collaboration for PtDA Standards were applied. The methodology for improving the informed consent process was guided by the AHRQ’s Making Informed Consent an Informed Choice comprehensive guide, the AHRQ’s Health Literacy Universal Precautions Toolkit Guide, and the AHRQ’s Patient Education Materials Assessment Tool Guide for Audio/Video Materials. Conclusions: PtDAs are recommended tools to supplement the informed consent process of treatment procedures. Well-designed PtDAs can eliminate many limitations of the conventional consent process by ensuring comprehensive, standardized, and easy to comprehend information about therapeutic procedures and treatment options and providing sufficient time for the patients to reflect on the information. To be effective, PtDAs should follow a systematic, patient-centered, evidence-based, and rigorous approach in the development, implementation, and evaluation processes. Including key stakeholders such as leaders, clinicians, and patients is fundamental for the success of PtDAs.

  • ‘Train your Mind’ program: Enhancing Executive Functions among Dutch Elementary School Children: systematic development

    Date Submitted: Apr 4, 2018

    Open Peer Review Period: Apr 6, 2018 - Jun 1, 2018

    Background: Executive functions are higher cognitive control functions, consisting of inhibitory control, working memory, and cognitive flexibility, and are central to academic performance, and a heal...

    Background: Executive functions are higher cognitive control functions, consisting of inhibitory control, working memory, and cognitive flexibility, and are central to academic performance, and a healthy and successful life. While it has been shown that executive functions are trainable, how such improvements translate into everyday behaviors is not yet fully understood. The current project aimed to develop an intervention capable of enhancing executive functions among children aged 9 to 11. Subsequently, we hypothesized these improvements in EFs would lead to improved self-control, emotion-regulation, and attention (timely given the current potential rise in attentional problems); which in turn translate to more healthy behaviors in daily life, specifically physical activity and healthy eating – which is especially interesting given the recent rise in (childhood) obesity. To further stimulate the development of the latter behaviors, personalized tailored feedback was provided in the fourth and final module, eHealth. Objective: The present paper describes (1) what EFs are, why they matter in life, and how they can be trained and (2) the development of the Train your Mind intervention. Methods: The design of this intervention, and the development of the program materials, was guided by the Intervention Mapping framework. Results: A multi-component intervention was composed, including: (1) focused physical exercise (kung fu), (2) cognitive games, (3) socio-emotional development, and (4) eHealth. All four components received positive feedback during pilot-testing in terms of user friendliness (readability, graphics), gameplay (clear instructions, fun), and feasibility (for teachers). Conclusions: The current literature base seems to suggest a multi-modal approach (cognitive, socio-emotional, and physical) may hold promising potential for the purpose of training executive functions, and perhaps even attain the much-desired broad transfer (practical translation into daily life), which, to date, has not been demonstrated before. In sum, encouraging the development of executive functions could yield great benefits in terms of academic performance, (physical and socio-emotional) health, and decreased risks during adolescence. Even though IM could not be applied completely, the overarching framework and various steps, provided guidance in developing and planning the intervention. Clinical Trial: NTR 5804 (Nederlands Trial Register)