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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 health 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 publishes 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:

  • Using iPrevent, an online breast cancer risk assessment and management tool (montage). Source: Peter MacCallum Cancer Centre; Copyright: Peter MacCallum Cancer Centre; URL:; License: Licensed by JMIR.

    The iPrevent Online Breast Cancer Risk Assessment and Risk Management Tool: Usability and Acceptability Testing


    Background: iPrevent estimates breast cancer (BC) risk and provides tailored risk management information. Objective: The objective of this study was to assess the usability and acceptability of the iPrevent prototype. Methods: Clinicians were eligible for participation in the study if they worked in primary care, breast surgery, or genetics clinics. Female patients aged 18-70 years with no personal cancer history were eligible. Clinicians were first familiarized with iPrevent using hypothetical paper-based cases and then actor scenarios; subsequently, they used iPrevent with their patients. Clinicians and patients completed the System Usability Scale (SUS) and an Acceptability questionnaire 2 weeks after using iPrevent; patients also completed measures of BC worry, anxiety, risk perception, and knowledge pre- and 2 weeks post-iPrevent. Data were summarized using descriptive statistics. Results: The SUS and Acceptability questionnaires were completed by 19 of 20 clinicians and 37 of 43 patients. Usability was above average (SUS score >68) for 68% (13/19) clinicians and 76% (28/37) patients. The amount of information provided by iPrevent was reported as “about right” by 89% (17/19) clinicians and 89% (33/37) patients and 95% (18/19) and 97% (36/37), respectively, would recommend iPrevent to others, although 53% (10/19) clinicians and 27% (10/37) patients found it too long. Exploratory analyses suggested that iPrevent could improve risk perception, decrease frequency of BC worry, and enhance BC prevention knowledge without changing state anxiety. Conclusions: The iPrevent prototype demonstrated good usability and acceptability. Because concerns about length could be an implementation barrier, data entry has been abbreviated in the publicly available version of iPrevent.

  • Source: Joint Base Langley-Eustis (Monica Roybal); Copyright: US Air Force; URL:; License: Public Domain (CC0).

    Barriers and Opportunities for Using Wearable Devices to Increase Physical Activity Among Veterans: Pilot Study


    Background: Few studies have examined the use of wearable devices among the veteran population. Objective: The objective of this study was to evaluate veterans’ perceptions of and experiences with wearable devices and identify the potential barriers and opportunities to using such devices to increase physical activity levels in this population. Methods: Veterans able to ambulate with or without assistance completed surveys about their mobile technology use and physical activity levels. They were then given the option of using a wearable device to monitor their activity levels. Follow-up telephone interviews were conducted after 2 months. Results: A total of 16 veterans were enrolled in this study, and all of them agreed to take home and use the wearable device to monitor their activity levels. At follow-up, 91% (10/11) veterans were still using the device daily. Veterans identified both opportunities and barriers for incorporating these devices into interventions to increase physical activity. Conclusions: Veterans engaged in using wearable devices at high rates.

  • Source: Freepik; Copyright: Supreeya Chantalao; URL:; License: Licensed by the authors.

    Time Series Visualizations of Mobile Phone-Based Daily Diary Reports of Stress, Physical Activity, and Diet Quality in Mostly Ethnic Minority Mothers:...


    Background: Health behavior patterns reported through daily diary data are important to understand and intervene upon at the individual level in N-of-1 trials and related study designs. There is often interest in relationships between multiple outcomes, such as stress and health behavior. However, analyses often utilize regressions that evaluate aggregate effects across individuals, and standard analyses target single outcomes. Objective: This paper aims to illustrate how individuals’ daily reports of stress and health behavior (time series) can be explored using visualization tools. Methods: Secondary analysis was conducted on 6 months of daily diary reports of stress and health behavior (physical activity and diet quality) from mostly ethnic minority mothers who pilot-tested a self-monitoring mobile health app. Time series with minimal missing data from 14 of the 44 mothers were analyzed. Correlations between stress and health behavior within each time series were reported as a preliminary step. Stress and health behavior time series patterns were visualized by plotting moving averages and time points where mean shifts in the data occurred (changepoints). Results: Median correlation was small and negative for associations of stress with physical activity (r=−.14) and diet quality (r=−.08). Moving averages and changepoints for stress and health behavior were aligned for some participants but not for others. A third subset of participants exhibited little variation in stress and health behavior reports. Conclusions: Median correlations in this study corroborate prior findings. In addition, time series visualizations highlighted variations in stress and health behavior across individuals and time points, which are difficult to capture through correlations and regression-based summary measures.

  • Lab sample. Source: Pexels; Copyright: Martin Lopez; URL:; License: Licensed by JMIR.

    Web-Delivered Multimedia Training Materials for the Self-Collection of Dried Blood Spots: A Formative Project


    Background: The use of dried blood spots (DBS) in biomedical research has been increasing as an objective measure for variables that are typically plagued by self-report, such as smoking status and medication adherence. The development of training materials for the self-collection of DBS that can be delivered through the Web would allow for broader use of this methodology. Objective: The objective of this study was to evaluate the acceptability and feasibility of the self-collection of DBS using newly developed multimedia training materials that were delivered through the Web. We also aimed to assess the usability of the collected DBS samples. Methods: We recruited participants through Facebook advertising for two distinct studies. The first study evaluated the acceptability of our newly developed DBS training materials, while the second assessed the implementation of this protocol into a larger Web-based study. Results: In the first study, participants (N=115) were aged, on average, 26.1 (SD 6.4) years. Training materials were acceptable (113/115, 98.2%, of participants were willing to collect DBS again) and produced usable samples (110/115, 95.7%, collected DBS were usable). In the second study, response rate was 25.0% (41/164), with responders being significantly younger than nonresponders (20.3 [SD 0.2] vs 22.0 [SD 0.4]; P<.001), and 92% (31/41) of collected DBS samples were usable by the laboratory. Conclusions: Overall, while the protocol is acceptable, feasible, and produced usable samples, additional work is needed to improve response rates.

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

    Using Cocreation in the Process of Designing a Smartphone App for Adolescents and Young Adults With Cancer: Prototype Development Study


    Background: Adolescent and young adult (AYA) oncology and hematology is a developing field of medicine, focusing on a population that faces many challenges throughout medical treatment and beyond. Mobile health (mHealth) interventions provide exciting new opportunities for improvement of health-related quality of life (HRQoL) in AYAs with cancer. Many smartphone apps are currently available for AYAs with cancer; however, for AYAs with cancer, very few apps have been designed with direct input from AYAs themselves or have demonstrated their effectiveness and benefit. Objective: The objective of this project was to develop the prototype of a smartphone app for AYAs with cancer through the process of cocreation, with the active input of AYAs who have received treatment for cancer directly impacting content and design. Methods: Patients were recruited from a population of Danish AYAs who had received treatment for cancer between the ages of 15 and 29 years. The cocreation process was completed over the course of 3 workshops and intermittent ad hoc meetings, where the recruited AYAs worked in coordination with 1 nurse, 1 doctor, and 2 representatives from a digital agency and app developer. During each workshop, participants prioritized their goals for the app. After new app content was developed, feedback was requested from the participants, and changes were made accordingly. This iterative process continued until consensus on final product features and design were achieved. Health care professionals provided minimal input and primarily performed observational roles in the workshops, with direct interaction limited to introducing the project and explaining measurement features of the app in development. Results: Three key features to be included in the prototype app were identified from the cocreation workshops: (1) a community forum; (2) an information library; and (3) a symptom and side-effect tracking tool. Bright, warm colors were selected for the app by the participating AYAs. The final prototype will be launched for pilot testing and implementation testing in February of 2018. Conclusions: The process of cocreation is a user-involved process that can create an end product that is useful and customized for the target population. This process, as such, is a beneficial process to utilize when addressing the specific needs of AYAs with cancer. The results of the here described app prototype will be evaluated in more detail in the near future. However, this description of the cocreation process in app development can be utilized for the creation of other mHealth interventions.

  • Source: The Authors; Copyright: The Authors; URL:; License: Licensed by JMIR.

    A Web-Based Interactive Tool to Reduce Childhood Obesity Risk in Urban Minority Youth: Usability Testing Study


    Background: Childhood obesity is a serious public health issue among minority youth in the United States. Technology-enhanced approaches can be effective for promoting healthy behavior change. Objective: The purpose of this study was to test the usability of prototypes of a Web-based interactive tool promoting healthy dietary behaviors to reduce childhood obesity risk in urban minority youth. The Web-based tool comprised a manga-style comic with interactive features (eg, sound effects, clickable pop-ups), tailored messaging, and goal setting, and was optimized for use on tablet devices. Methods: Latino and black/African American children ages 9 to 13 years were recruited to participate in two rounds of usability testing. A modified think-aloud method was utilized. Self-reported surveys and field notes were collected. Audio recordings and field notes from usability testing sessions were systematically reviewed by extracting and coding user feedback as either positive comments or usability or negative issues. The quantitative data from self-reported questionnaires were analyzed using descriptive statistics. Results: Twelve children (four female; eight black/African American) with a mean age of 10.92 (SD 1.16) years participated. Testing highlighted overall positive experiences with the Web-based interactive tool, especially related to storyline, sound effects, and color schemes. Specific usability issues were classified into six themes: appearance, content, special effects, storyline, terminology, and navigation. Changes to the Web-based tool after round 1 included adding a navigation guide, making clickable icons more visible, improving graphic designs, and fixing programming errors. In round 2 of testing (after modifications to the Web-based tool were incorporated), many of the usability issues that were identified in round 1 did not emerge. Conclusions: Results of testing will inform further development and finalization of the tool, which will be tested using a two-group pilot randomized study, with the goal of reducing childhood obesity risk in minority, low-income youth.

  • Podcast to promote social media as a strategy for disseminating health and biomedical research tips to the community. Source: Image created by the Authors; Copyright: Dr Joyce Balls-Berry; URL:; License: Creative Commons Attribution + Noncommercial + ShareAlike (CC-BY-NC-SA).

    Linking Podcasts With Social Media to Promote Community Health and Medical Research: Feasibility Study


    Background: Linking podcasts with social media is a strategy to promote and disseminate health and health research information to the community without constraints of time, weather, and geography. Objective: To describe the process of creating a podcast library and promoting it on social media as a strategy for disseminating health and biomedical research topics to the community. Methods: We used a community and patient engagement in research approach for developing a process to use podcasts for dissemination of health and health research information. We have reported the aspects of audience reach, impressions, and engagement on social media through the number of downloads, shares, and reactions posted on SoundCloud, Twitter, and Facebook, among others. Results: In collaboration with our local community partner, we produced 45 podcasts focused on topics selected from a community health needs assessment with input from health researchers. Episodes lasted about 22 minutes and presented health-related projects, community events, and community resources, with most featured guests from Olmsted County (24/45, 53%). Health research was the most frequently discussed topic. Between February 2016 and June 2017, episodes were played 1843 times on SoundCloud and reached 1702 users on our Facebook page. Conclusions: This study demonstrated the process and feasibility of creating a content library of podcasts for disseminating health- and research-related information. Further examination is needed to determine the best methods to develop a sustainable social media plan that will further enhance dissemination (audience reach), knowledge acquisition, and communication of health topics.

  • A person experiencing stress. Source: Pexels; Copyright: Nathan Cowley; URL:; License: Licensed by JMIR.

    Effects of Cold Stimulation on Cardiac-Vagal Activation in Healthy Participants: Randomized Controlled Trial


    Background: The experience of psychological stress has not yet been adequately tackled with digital technology by catering to healthy individuals who wish to reduce their acute stress levels. For the design of digitally mediated solutions, physiological mechanisms need to be investigated that have the potential to induce relaxation with the help of technology. Research has shown that physiological mechanisms embodied in the face and neck regions are effective for diminishing stress-related symptoms. Our study expands on these areas with the design for a wearable in mind. As this study charts new territory in research, it also is a first evaluation of the viability for a wearables concept to reduce stress. Objective: The objectives of this study were to assess whether (1) heart rate variability would increase and (2) heart rate would decrease during cold stimulation using a thermode device compared with a (nonstimulated) control condition. We expected effects in particular in the neck and cheek regions and less in the forearm area. Methods: The study was a fully randomized, within-participant design. Volunteer participants were seated in a laboratory chair and tested with cold stimulation on the right side of the body. A thermode was placed on the neck, cheek, and forearm. We recorded and subsequently analyzed participants’ electrocardiogram. The cold stimulation was applied in 16-second intervals over 4 trials per testing location. The control condition proceeded exactly like the cold condition, except we manipulated the temperature variable to remain at the baseline temperature. We measured heart rate as interbeat intervals in milliseconds and analyzed root mean square of successive differences to index heart rate variability. We analyzed data using a repeated-measures ANOVA (analysis of variance) approach with 2 repeated-measures factors: body location (neck, cheek, forearm) and condition (cold, control). Results: Data analysis of 61 participants (after exclusion of outliers) showed a main effect and an interaction effect for body location and for condition, for both heart rate and heart rate variability. The results demonstrate a pattern of cardiovascular reactivity to cold stimulation, suggesting an increase in cardiac-vagal activation. The effect was significant for cold stimulation in the lateral neck area. Conclusions: The results confirmed our main hypothesis that cold stimulation at the lateral neck region would result in higher heart rate variability and lower heart rate than in the control condition. This sets the stage for further investigations of stress reduction potential in the neck region by developing a wearable prototype that can be used for cold application. Future studies should include a stress condition, test for a range of temperatures and durations, and collect self-report data on perceived stress levels to advance findings.

  • Samuel Mugisha, CEO of Innovation Streams, giving a presentation on Stre@mline. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    A Locally Developed Electronic Health Platform in Uganda: Development and Implementation of Stre@mline


    Background: Electronic health records (EHRs) are especially important in low-resource settings due to their potential to address unique challenges such as a high number of patients requiring long-term treatments who are lost to follow-up, the frequent shortages of essential drugs, poor maintenance and storage of records, and inefficient clinical triaging. However, there is a lack of affordable and practical EHR solutions. Stre@mline is an EHR platform that has been locally developed by Ugandan clinicians and engineers in Southwestern Uganda. It is tailored to the specific context and needs of low-resource hospitals. It operates without internet access, incorporates locally relevant standards and key patient safety features, has a medication inventory management component, has local technical support available, and is economically sustainable without funding from international donors. Stre@mline is currently used by over 60,000 patients at 2 hospitals, with plans to expand across Uganda. Objective: The purpose of this article is to describe the key opportunities and challenges in EHR development in sub-Saharan Africa and to summarize the development and implementation of a “Made-for-Africa” EHR, Stre@mline, and how it has led to improved care for over 60,000 vulnerable patients in a rural region of Southwestern Uganda. Methods: A quantitative user survey consisting of a set of 33 questions on usability and performance was conducted at Kisiizi Hospital. Users responded to each question through a Likert scale with the values of strongly disagree, disagree, agree, and strongly agree. Through purposive sampling, 30 users were identified and 28 users completed the survey. Results: We found that users were generally very satisfied with the ease of use of Stre@mline, with 96% (27/28) finding it easy to learn and 100% (28/28) finding it easy to use. Users found that Stre@mline was helpful in improving both clinical efficiency and enhancing patient care. Conclusions: The partnership of local clinicians and developers is crucial to the design and adoption of user-centered technologies tailored to the specific needs of low-resource settings. The EHR described here could serve as a model for the development of future technologies suitable for developing countries.

  • Source: Pixabay; Copyright: terimakasih0; URL:; License: Public Domain (CC0).

    Adolescent Preferences and Design Recommendations for an Asthma Self-Management App: Mixed-Methods Study


    Background: Approximately 10% of adolescents in the United States have asthma. Adolescents widely use apps on mobile phones and tablet technology for social networking and gaming purposes. Given the increase in recreational app use among adolescents, leveraging apps to support adolescent asthma disease management seems warranted. However, little empirical research has influenced asthma app development; adolescent users are seldom involved in the app design process. Objective: The aim of this mixed-methods study was to assess adolescent preferences and design recommendations for an asthma self-management app. Methods: A total of 20 adolescents with persistent asthma (aged 12-16 years) provided feedback on two asthma self-management apps during in-person semistructured interviews following their regularly scheduled asthma clinic visit and via telephone 1 week later. Interviews were audiorecorded, transcribed verbatim, analyzed using SPSS v24, and coded thematically using MAXQDA 11. Results: Regarding esthetics, app layout and perceived visual simplicity were important to facilitate initial app use. Adolescents were more likely to continually engage with apps that were deemed useful and met their informational needs. Adolescents also desired app features that fit within their existing paradigm or schema and included familiar components (eg, medication alerts that appear and sound like FaceTime notifications and games modeled after Quiz Up and Minecraft), as well as the ability to customize app components. They also suggested that apps include other features, such as an air quality tracker and voice command. Conclusions: Adolescents desire specific app characteristics including customization and tailoring to meet their asthma informational needs. Involving adolescents in early stages of app development is likely to result in an asthma app that meets their self-management needs and design preferences and ultimately the adoption and maintenance of positive asthma self-management behaviors.

  • Congenital heart disease transition checklist for mobile app (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Improving Transitions of Care for Young Adults With Congenital Heart Disease: Mobile App Development Using Formative Research


    Background: Congenital heart diseases (CHDs) are the most common type of birth defects. Improvements in CHD care have led to approximately 1.4 million survivors reaching adulthood. Successful transition and transfer from pediatric to adult care is crucial. Unfortunately, less than 30% of adolescents with CHD successfully transition to adult care; this number is lower for minority and lower socioeconomic status populations. Few CHD programs exist to facilitate successful transition. Objective: The goal of our study was to describe the formative research used to develop a prototype mobile app to facilitate transition to adult care for adolescents with CHD. Methods: A literature search about best practices in transition medicine for CHD was conducted to inform app development. Formative research with a diverse group of CHD adolescents and their parents was conducted to determine gaps and needs for CHD transition to adult care. As part of the interview, surveys assessing transition readiness and CHD knowledge were completed. Two adolescent CHD expert panels were convened to inform educational content and app design. Results: The literature review revealed 113 articles, of which 38 were studies on transition programs and attitudes and 3 identified best practices in transition specific to CHD. A total of 402 adolescents aged 15 to 22 years (median 16 years) participated in semistructured interviews. The group was racially and ethnically diverse (12.6% [51/402] African American and 37.8% [152/402] Latino) and 42.0% (169/402) female; 36.3% (146/402) received public insurance. Most adolescents (313/402, 76.7%) had moderate or severe CHD complexity and reported minimal CHD understanding (79.0% [275/348] of those aged 15 to 17 years and 61.1% [33/54] of those aged 18 to 22 years). Average initial transition readiness score was 50.9/100, meaning that transition readiness training was recommended. When participants with moderate to severe CHD (313/402, 77.9%) were asked about technology use, 94.2% (295/313) reported having access to a mobile phone. Interviews with parents revealed limited interactions with the pediatric cardiologist about transition-related topics: 79.4% (331/417) reported no discussions regarding future family planning, and 55.2% (230/417) reported the adolescent had not been screened for mental health concerns (depression, anxiety). Further, 66.4% (277/417) reported not understanding how health care changes as adolescents become adults. Adolescents in the expert panels (2 groups of 3 adolescents each) expressed interest in a CHD-specific tailored app consisting of quick access to specific educational questions (eg, “Can I exercise?”), a CHD story-blog forum, a mentorship platform, a question and answer space, and a checklist to facilitate transition. They expressed interest in using the app to schedule CHD clinic appointments and receive medication reminders. Based on this data, a prototype mobile app was created to assist in adolescent CHD transition. Conclusions: Formative research revealed that most adolescents with CHD had access to mobile phones, were not prepared for transition to adult care, and were interested in an app to facilitate transition to adult CHD care. Understanding adolescent and parent needs, interests, and concerns helped in the development of a mobile app with a broader, tailored approach for adolescents with CHD.

  • Source: Pexels; Copyright: Kaboompics; URL:; License: Public Domain (CC0).

    Adapting a Behavioral Weight Loss Intervention for Delivery via Facebook: A Pilot Series Among Low-Income Postpartum Women


    Background: Efforts to translate evidence-based weight loss interventions, such as the Diabetes Prevention Program (DPP), to low-income postpartum women have resulted in poor intervention attendance and high attrition. Strategies that improve engagement and retention in this population are needed to maximize the reach of evidence-based weight loss interventions. Objective: The objective of this study was to adapt a DPP-based weight loss intervention (Fresh Start) for Facebook delivery and to evaluate its feasibility among low-income postpartum women. Methods: This study comprised 3 single-group pilot studies where feasibility outcomes iteratively informed changes from one pilot to the next. We paralleled the in-person program for Facebook delivery by translating the protocol to a content library of Facebook posts with additional posts from lifestyle coaches. Low-income postpartum women were recruited from Women, Infants, and Children (WIC) clinics in Worcester, Massachusetts. Participants were enrolled into a 16-week weight loss intervention delivered via Facebook. During the first 8 weeks, Facebook intervention posts were delivered 2 times per day, with additional posts from coaches aiming to stimulate interaction among participants or respond to participants’ questions and challenges. For the following 8 weeks, posts were delivered once per day without additional coaching. Feasibility outcomes were engagement (defined by number of likes, comments, and posts measured throughout intervention delivery), acceptability, and retention (survey at follow-up and assessment completion rate, respectively). Changes in weight were also assessed at baseline and follow-up. Results: Pilot 1 had a retention rate of 89% (24/27), and on average, 62% (17/27) of women actively engaged with the group each week during the 8-week coached phase. Mean weight loss was 2.6 (SD 8.64) pounds, and 79% (19/27) would recommend the program to a friend. Pilot 2 had a retention rate of 83% (20/24), and on average, 55% (13/24) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 2.5 (SD 9.23) pounds, and 80% (16/24) would recommend the program to a friend. Pilot 3 had a retention rate of 88% (14/16), and on average, 67% (11/16) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 7.0 (SD 11.6) pounds, and 100% (16/16) would recommend the program to a friend. Conclusions: Our findings demonstrated that a Facebook-delivered intervention was acceptable and could be feasibly delivered to low-income postpartum women. Future research is needed to evaluate the efficacy of a Facebook-delivered weight loss intervention.

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  • Assessing the usability of “SCOPE”: an online resource about online pornography and sharing of sexually explicit imagery for young people.

    Date Submitted: Nov 14, 2018

    Open Peer Review Period: Nov 17, 2018 - Jan 12, 2019

    Background: While we know that many young people watch online pornography and engage in ‘sexting’, there is limited literature examining their needs in relation to information on these highly sens...

    Background: While we know that many young people watch online pornography and engage in ‘sexting’, there is limited literature examining their needs in relation to information on these highly sensitive and complex issues. Online resources exist, however, we can find no evidence of any having been formally tested for usability within the target population. Objective: The objective of this study was to test the usability of a resource about online pornography and sexting among young people. Methods: Semi-structured interviews were conducted with 17 participants aged 15-29 years old. Results: We found that the “SCOPE” resource was perceived as trustworthy and credible due to its evidence based content, non-judgmental tone, and balanced perspectives. Multi-media and video content enhanced the layout and usability of the resource, however content relevance could be improved by targeting age and developmental stages. Participants identified resource sections like “Real Stories” from young people as relevant and engaging. However, they raised issues with the translation of formative research findings relating to these stories into their final presentation. Conclusions: Our findings suggest that young people prefer online resources about complex issues like online pornography and sexting if they are balanced in content and tone. Most importantly, in the context of responding to complex and sensitive issues such as these, co-design methods can ensure that young people are central to the development of resources and avoid gaps in translating research into practice. In the context of limited literature focusing on the usability of online resources about these topics, this paper provides important insights for public health practitioners working in this emerging space. Clinical Trial: NA

  • Implementation of blockchains in healthcare: Analysis of trade-offs in systems design

    Date Submitted: Oct 5, 2018

    Open Peer Review Period: Oct 9, 2018 - Dec 4, 2018

    Background: A blockchain is a digitised, decentralised, distributed public ledger; a shared and synchronised database that records cryptocurrency transactions. Despite the shift towards digital platfo...

    Background: A blockchain is a digitised, decentralised, distributed public ledger; a shared and synchronised database that records cryptocurrency transactions. Despite the shift towards digital platforms enabled by Electronic Medical Records (EMRs), demonstrating a will to reform the healthcare sector, health systems face issues including security, interoperability, data fragmentation, timely access to patient data and silos. Application of healthcare blockchains could enable data interoperability, enhancement of precision medicine and reduction in prescription frauds through implementing novel methods in access and patient consent. Objective: To summarise the evidence on the strategies and frameworks utilised to implement blockchains for patient data in healthcare to ensure privacy and improve interoperability and scalability. Methods: A systematic search of MEDLINE/PubMed, Embase, Scopus, ProQuest Technology Collection and Engineering Index (Compendex) has been conducted. Results: This early report summarises key findings from that review for dissemination and discussion. 16 design trade-offs in blockchain implementation have been identified from the existing literature. Conclusions: There is more work that is necessary to thoroughly analyse blockchain trade-off research: While this study was able to identify trade-offs, being able to quantify the mathematical relationships between trade-offs would be of enormous benefit to the field. Clinical Trial: International Prospective Register for Systematic Reviews (PROSPERO) number CRD42018096947.

  • Web-based prescription opioid abuse prevention for adolescents: Program development and formative evaluation

    Date Submitted: Oct 2, 2018

    Open Peer Review Period: Oct 6, 2018 - Dec 1, 2018

    Background: Background: The unprecedented number of youth engaged in nonmedical use of prescription opioids (PO), as well as the myriad negative consequences of such misuse emphasize the importance of...

    Background: Background: The unprecedented number of youth engaged in nonmedical use of prescription opioids (PO), as well as the myriad negative consequences of such misuse emphasize the importance of prevention efforts targeting this public health crisis. Although there are several science-based, interactive, drug-abuse prevention programs focused on preventing use of non-prescription drugs in youth, to our knowledge, there are no science-based, interactive programs focused on the prevention of prescription opioid abuse among adolescents. Objective: Objectives: The aim of this study was to develop and conduct a formative evaluation of a science-based, interactive web-based program focused on the prevention of prescription opioid abuse among adolescents aged 12-17 ( This work was conducted to prepare for a randomized, controlled trial designed to evaluate the effectiveness of Pop4Teens compared to an active control website, (Drug Enforcement Administration) in impacting knowledge and attitudes about prescription opioids, perceptions of risk associated with abuse of prescription opioids, as well as intentions to use and actual use of prescription opioids. Methods: Methods: We conducted six focus groups with 30 youth (M = 5/group: 12-19 years of age eligible) along a continuum of exposure to POs (in treatment for opioid use disorder, in general treatment for other substance use disorder, prescribed an opioid, and opioid naïve), and writing sessions with 30 youth in treatment for opioid use disorder (12-19) to inform the development of the web-based prevention tool. Feasibility and acceptability of a prototype of the web-based intervention were then assessed through individual feedback sessions with 57 youth (drawn from same populations as focus groups). Results: Results: We successfully completed the development of a web-based prescription opioid abuse prevention program (Pop4Teens). Analyses of focus group transcripts informed the development of the program (e.g., quiz content/format, script writing, story editing). Selected writing session narratives anchored the planned scientific content by lending credibility, as well as informing the development of compelling storylines intended to motivate youth to engage with the program. Feedback session data indicate that the web-based tool could be potentially useful and acceptable. Also, feedback session participants demonstrated significant increases in their knowledge of key topics related to the prevention of prescription opioid abuse after exposure to sections of the web-based program. Conclusions: Conclusions: The opioid crisis is predicted to get worse before it gets better. An effective response will likely require a multi-pronged strategy inclusive of effective evidence-based prevention programs acceptable to, and accessible by, a majority of youth. Clinical Trial: NA