@Article{info:doi/10.2196/60294, author="Asomugha, Uloma Adaora and Pakai, Annamaria", title="Trends and Shifts in Swedish Telemedicine Consultations During the Pre--COVID-19, COVID-19, and Post--COVID-19 Periods: Retrospective Observational Study", journal="JMIR Form Res", year="2025", month="May", day="16", volume="9", pages="e60294", keywords="telemedicine", keywords="COVID-19", keywords="health care consultation", keywords="Sweden", keywords="digital health", keywords="patient behavior", keywords="video consultation", keywords="telehealth trends", abstract="Background: In recent times, the telemedicine landscape has changed dramatically; it serves as a bridge, connecting health care providers and patients, especially during challenges such as the recent COVID-19 pandemic. Objective: This study seeks to explore the Swedish telemedicine landscape in terms of primary patient symptoms for teleconsultation and the patterns of telemedicine use in the periods before COVID-19, during COVID-19, and after COVID-19, including the primary care use dynamics with respect to the teleconsultations done. Methods: Secondary data was used in this observational retrospective study. The study population consisted of Swedish residents who had online telemedicine consultations. Telemedicine consultations were divided by text and video delivery; the period of analysis ranged from November 2018 to June 2023. The statistical methods used for the data analysis were descriptive analysis, 2-way cross tabulation, and a generalized linear model. Results: During the pandemic, the number of teleconsultations concerning general, unspecified symptoms increased in comparison to the other analyzed symptoms, signaling a change in care-seeking behavior under epidemiological pressure. General health-related issues were the most pronounced symptom across all periods: 186.9 of 1000 consultations before COVID-19, 1264.6 of 1000 consultations during COVID-19, and 319.2 of 1000 consultations after COVID-19. There was no significant main effect of COVID-19 period on the number of telemedicine consultation meetings (F2=1.653; P=.38). The interaction effect between delivery type and period was statistically significant (F2=14.723; P<.001). Conclusions: The findings are in favor of the COVID-19 pandemic having had a considerable effect on telemedicine use. Telemedicine could subsequently be used more often for general health consultations and acute conditions. Video consultations were more prominent because of the importance of bidirectional communication. The study suggests that there was a transformation of patterns of demand for health care; there is a necessity for health care systems to respond to these changes. ", doi="10.2196/60294", url="https://formative.jmir.org/2025/1/e60294" } @Article{info:doi/10.2196/49520, author="Butz, Leah and Platkin, Charles and Chin, Jonathan and Chavez Salas, Pablo Juan and Serres, Ellie and Leung, May May", title="Food Access in New York City During the COVID-19 Pandemic: Social Media Monitoring Study", journal="JMIR Form Res", year="2025", month="May", day="9", volume="9", pages="e49520", keywords="Twitter", keywords="food access", keywords="food insecurity", keywords="New York City", keywords="topic modeling", keywords="social media", keywords="artificial intelligence", abstract="Background: The COVID-19 pandemic exacerbated issues of poverty and food insecurity in New York City, and many residents experienced difficulty accessing available resources to help them get food on the table. Social media presents an opportunity to observe and understand the barriers people face in accessing affordable, nutritious, and culturally appropriate foods. Objective: This study aims to explore the food access discourse during the COVID-19 pandemic on Twitter (subsequently rebranded as X) in New York City by analyzing publicly available tweets posted from March 1, 2020, to March 31, 2021. Methods: Tweets posted by individuals in New York City during the first 13 months of the COVID-19 pandemic were collected using the observation platform Talkwalker. We categorized a list of multiple keywords into related groups (search strings). Data were cleaned to keep only tweets relevant to food insecurity and food access in New York City and remove duplicate tweets. The software Botometer was used to remove accounts considered to be bots. Topic modeling was used to group these tweets into relevant themes, which were analyzed. The top viral tweets (ie, tweets that received the highest number of retweets in New York City) from this period were further analyzed. Results: We identified 6 major themes (with subthemes) that emerged from the analysis (in order of popularity): community efforts, public assistance programs, grocery shopping and food workers, school foods, millions go hungry, and food justice. Interesting terms that emerged from the data were also identified. Overall, quantities of tweets increased in correlation with current events, such as the closure of New York City public schools; the expansion of the Supplemental Nutrition Assistance Program and unemployment benefits; the proliferation of mutual aid groups in the spring of 2020; and the May Day Instacart, Amazon, and Target strike in 2020. Conclusions: Findings revealed that in the earliest months of the COVID-19 pandemic, Twitter users in New York City quickly responded to the wave of need by sharing information and resources about food access in their communities. Some users turned to Twitter to either solicit or offer help finding food. Furthermore, the platform lent itself to many conversations about the policies enacted on a federal, state, and city level to help feed New Yorkers in need. Future research on this topic should include an analysis of social media posting on platforms such as Facebook, as well as languages other than English. Results from this type of research can provide information to community leaders and elected officials to better address future crises. ", doi="10.2196/49520", url="https://formative.jmir.org/2025/1/e49520" } @Article{info:doi/10.2196/59467, author="Slotkin, Rebecca and Kyriakides, C. Tassos and Yu, Vinni and Chen, Xien and Kundu, Anupam and Gupta, Shaili", title="CoVimmune COVID-19 Immunity Calculator: Web Application Development and Validation Study", journal="JMIR Form Res", year="2025", month="Apr", day="22", volume="9", pages="e59467", keywords="COVID-19", keywords="immunity", keywords="neutralizing antibody", keywords="immunoglobulin G", keywords="vaccine hesitancy", keywords="vaccine timing", keywords="patient-centered care", keywords="web application", keywords="vaccination", keywords="SARS-CoV-2", abstract="Background: This study illustrates the development of a simple web-based application, which demonstrates the relationship between serum anti-SARS-CoV-2 S1/receptor-binding domain immunoglobulin G (IgG) and anti-SARS-CoV-2 neutralizing antibody (nAb) half-maximal inhibitory concentration (IC50) titers in a vaccinated US adult population and compares them to prior data on nAb titers at different time points after vaccination. Objective: The objective of this study is to create an easily accessible calculator that uses the results of commercially available anti-SARS-CoV-2 serum IgG to approximate the underlying ability to neutralize SARS-CoV-2. Methods: Our web-based application leveraged two previously published datasets. One dataset demonstrated a robust correlation between nAb and serum IgG. The other dataset measured nAb titers at specific time periods over a year-long interval following a messenger RNA vaccination primary series and booster vaccine dose. Clinical factors that were statistically significant on a forward linear regression model examining the prediction of nAb from serum IgG were incorporated in the application tool. Results: By combining the datasets described above, we developed a publicly available web-based application that allows users to enter a serum IgG value and determine their estimated nAb titer. The application contextualizes the estimated nAb titer with the theoretical distance from the corresponding vaccine-mediated antibody protection. Using the clinical variables that had a significant impact on how well IgG values predict nAb titers, this application allows for a patient-centered, nAb titer prediction. Conclusions: This application offers an example of how we might bring the advances made in scientific research on protective antibodies post-SARS-CoV-2 vaccination into the clinical sphere with practical tools. ", doi="10.2196/59467", url="https://formative.jmir.org/2025/1/e59467" } @Article{info:doi/10.2196/57032, author="Decambron, M{\'e}lanie and Tchikladze Merand, Christine", title="Telemedicine Booths for Screening Cardiovascular Risk Factors: Prospective Multicenter Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="22", volume="12", pages="e57032", keywords="cardiovascular disease risk factors", keywords="cardiovascular disease", keywords="CVD", keywords="cardiology", keywords="cardiac", keywords="cardiologists", keywords="health check", keywords="hypertension", keywords="HTN", keywords="hypertensive", keywords="high blood pressure", keywords="blood pressure", keywords="obesity", keywords="screening", keywords="health screening", keywords="telemedicine", keywords="telehealth", keywords="virtual care", keywords="virtual health", keywords="virtual medicine", keywords="COVID-19", keywords="SARS-CoV-2", keywords="Coronavirus", keywords="respiratory", keywords="infectious", keywords="pulmonary", keywords="pandemic", abstract="Background: Cardiovascular risk factors such as hypertension often remain undetected and untreated. This was particularly problematic during the COVID-19 pandemic when there were fewer in-person medical consultations. Objective: This study aimed to determine whether health screening using a telemedicine booth would have an impact on people's medical care during the COVID-19 pandemic. Methods: Health screening was run using a telemedicine booth (the consult station) that was placed in three different vaccination centers in northern France between July 2021 and September 2021. Participants followed a series of instructions to obtain various measures, including their blood pressure, BMI, and heart rate. If any measures were found to be outside of the normal range, participants were advised to consult a doctor. After 3 months, the participants with abnormal readings were contacted by telephone and were asked a series of standardized questions. The primary outcome was the percentage of respondents who reported that they had consulted a doctor since the health check. Results: Approximately 6000 people attended the 3 vaccination centers over the study period. Of these, around 2500 used the consult station. A total of 1333 participants (53.3\%) were found to have abnormal readings, which mostly concerned their blood pressure, heart rate, or BMI. There were 638 participants who responded to the follow-up call, and 234 of these (37\%) reported that they had consulted a doctor since the health check. However, 158 of the 638 respondents (24.8\%) reported that they would have consulted a doctor even without the screening. Conclusions: We succeeded in screening large numbers of people for cardiovascular risk factors during the COVID-19 pandemic by using a telemedicine booth. Although relatively few follow-up call respondents reported that they went on to consult a physician, the screening would nevertheless have raised people's awareness of their cardiovascular risk factors. ", doi="10.2196/57032", url="https://humanfactors.jmir.org/2025/1/e57032" } @Article{info:doi/10.2196/66509, author="Raspado, Olivier and Brack, Michel and Brack, Olivier and Vivancos, M{\'e}lanie and Esparcieux, Aur{\'e}lie and Cart-Tanneur, Emmanuelle and Aouifi, Abdellah", title="Oxidative Stress Markers and Prediction of Severity With a Machine Learning Approach in Hospitalized Patients With COVID-19 and Severe Lung Disease: Observational, Retrospective, Single-Center Feasibility Study", journal="JMIR Form Res", year="2025", month="Apr", day="11", volume="9", pages="e66509", keywords="oxidative stress", keywords="COVID-19", keywords="SARS-CoV-2", keywords="coronavirus", keywords="respiratory", keywords="infectious", keywords="pulmonary", keywords="respiration disorders", keywords="hospitalization", keywords="machine learning", keywords="ML", keywords="biomarker", keywords="lung", keywords="severity", keywords="prediction", abstract="Background: Serious pulmonary pathologies of infectious, viral, or bacterial origin are accompanied by inflammation and an increase in oxidative stress (OS). In these situations, biological measurements of OS are technically difficult to obtain, and their results are difficult to interpret. OS assays that do not require complex preanalytical methods, as well as machine learning methods for improving interpretation of the results, would be very useful tools for medical and care teams. Objective: We aimed to identify relevant OS biomarkers associated with the severity of hospitalized patients' condition and identify possible correlations between OS biomarkers and the clinical status of hospitalized patients with COVID-19 and severe lung disease at the time of hospital admission. Methods: All adult patients hospitalized with COVID-19 at the Infirmerie Protestante (Lyon, France) from February 9, 2022, to May 18, 2022, were included, regardless of the care service they used, during the respiratory infectious COVID-19 epidemic. We collected serous biomarkers from the patients (zinc [Zn], copper [Cu], Cu/Zn ratio, selenium, uric acid, high-sensitivity C-reactive protein [hs-CRP], oxidized low-density lipoprotein, glutathione peroxidase, glutathione reductase, and thiols), as well as demographic variables and comorbidities. A support vector machine (SVM) model was used to predict the severity of the patients' condition based on the collected data as a training set. Results: A total of 28 patients were included: 8 were asymptomatic at admission (grade 0), 14 had mild to moderate symptoms (grade 1) and 6 had severe to critical symptoms (grade 3). As the first outcome, we found that 3 biomarkers of OS were associated with severity (Zn, Cu/Zn ratio, and thiols), especially between grades 0 and 1 and between grades 0 and 2. As a second outcome, we found that the SVM model could predict the level of severity based on a biological analysis of the level of OS, with only 7\% misclassification on the training dataset. As an illustrative example, we simulated 3 different biological profiles (named A, B, and C) and submitted them to the SVM model. Profile B had significantly high Zn, low hs-CRP, a low Cu/Zn ratio, and high thiols, corresponding to grade 0. Profile C had low Zn, low selenium, high oxidized low-density lipoprotein, high glutathione peroxidase, a low Cu/Zn ratio, and low glutathione reductase, corresponding to grade 2. Conclusions: The level of severity of pulmonary damage in patients hospitalized with COVID-19 was predicted using an SVM model; moderate to severe symptoms in patients were associated with low Zn, low plasma thiol, increased hs-CRP, and an increased Cu/Zn ratio among a panel of 10 biomarkers of OS. Since this panel does not require a complex preanalytical method, it can be used and studied in other pathologies associated with OS, such as infectious pathologies or chronic diseases. ", doi="10.2196/66509", url="https://formative.jmir.org/2025/1/e66509" } @Article{info:doi/10.2196/56519, author="Burhan, Erlina and Azzumar, Farchan and Sinuraya, Gabriella Fira Alyssa and Rakasiwi, Dhiya Muhammad Ilham and Akbar, Ihya and Mubarak, Farhan and Rengganis, Tresna Anggit and Rachmadi, Abi Rizky and Afidjati, Hera", title="Real-World Effectiveness of COVID-19 Vaccines (ChAdOx-1s, CoronaVac, BBIBP-CorV, mRNA-1273, and BNT162b2) in Jakarta: Protocol for Test-Negative Design of Health Care Data", journal="JMIR Res Protoc", year="2025", month="Apr", day="10", volume="14", pages="e56519", keywords="COVID-19", keywords="protocol", keywords="vaccine", keywords="vaccine effectiveness", keywords="Delta", keywords="Omicron", abstract="Background: ChAdOx-1s, CoronaVac, BBIBP-CorV, mRNA-1273, and BNT162b2 are the five common COVID-19 vaccines used in Jakarta. Randomized controlled trials have provided robust evidence of the safety and efficacy profile of these vaccines, but their real-world vaccine effectiveness against symptomatic COVID-19 and deaths in communities with social inequalities and health care constraints remains unclear. Objective: This study aims to evaluate the real-world effectiveness of these COVID-19 vaccines during the waves associated with the Delta and Omicron variants by analyzing existing electronic health care sources. Methods: A population-based study with a test-negative case-control design will be used to evaluate COVID-19 vaccine effectiveness in Jakarta, focusing on the Delta and Omicron waves. It includes adults 18 years and older who underwent reverse transcription polymerase chain reaction testing for symptomatic COVID-19, classifying them as cases or controls based on their test results. The analysis will consider multiple COVID-19 vaccines introduced during these periods, with participants categorized by vaccination status. Several potential confounders will be assessed, including demographic factors and comorbidities. Data will be linked from various health datasets, and statistical analyses will be performed to determine vaccine effectiveness and potential waning immunity over time. After data linkage, patients' identities will be encrypted. Results: The research, funded from 2022 to 2024, involved proposal preparation and ethical review in 2023 and enrollment from early 2024 to July 2024, resulting in about 4 million linked data points. Data analysis is ongoing, with initial results expected for publication in early 2025. Conclusions: This study will be the first to evaluate the effectiveness of different types of COVID-19 vaccines (inactivated, viral-vector, and mRNA) used in Jakarta during the pandemic, providing valuable scientific evidence to inform future vaccination strategies in the country. International Registered Report Identifier (IRRID): DERR1-10.2196/56519 ", doi="10.2196/56519", url="https://www.researchprotocols.org/2025/1/e56519", url="http://www.ncbi.nlm.nih.gov/pubmed/39902869" } @Article{info:doi/10.2196/58436, author="Glover, Audrey Nicole and Sathar, Farzana and Mokome, Pride and Mathabela, Nkululeko and Taleni, Sipokazi and van Blydenstein, Alexandra Sarah and Mekota, Anna-Maria and Charalambous, Salome and Rachow, Andrea and Ivanova, Olena", title="Improving Health and Well-Being of People With Post--COVID-19 Consequences in South Africa: Situation Analysis and Pilot Intervention Design", journal="JMIR Form Res", year="2025", month="Apr", day="10", volume="9", pages="e58436", keywords="post--COVID-19", keywords="rehabilitation", keywords="support", keywords="quality of life", keywords="group care", keywords="well-being", keywords="South Africa", keywords="COVID-19", keywords="situation analysis", keywords="pilot", keywords="intervention", keywords="context-adapted", keywords="physical health", keywords="mental health", keywords="cross-sectional", keywords="mixed method", keywords="questionnaire", keywords="in-depth", keywords="interviews", keywords="survey", keywords="focus group", keywords="quantitative", keywords="qualitative", keywords="support group", keywords="hospital", keywords="patients", keywords="health care workers", keywords="health worker", abstract="Background: Multisystemic complications post--COVID-19 infection are increasingly described in the literature, yet guidance on the management remains limited. Objectives: This study aimed to assess the needs, preferences, challenges, and existing interventions for individuals with post--COVID-19 symptoms. Based on this, we aimed to develop a context-adapted intervention to improve the overall health and well-being of individuals with post--COVID-19 complications. Methods: We conducted a cross-sectional mixed-methods situation analysis assessing the needs, preferences, challenges, and existing interventions for patients with post--COVID-19 symptoms. We collected data through questionnaires, semistructured in-depth interviews, and focus group discussions (FGDs) from individuals diagnosed with COVID-19 within the previous 18-month period and health care providers who managed patients with COVID-19 in both inpatient and outpatient settings. Quantitative data were summarized using descriptive statistics, qualitative data were transcribed, and deductive analysis focused on suggestions for future interventions. Findings guided the development of a group intervention. Results: We conducted 60 questionnaires, 13 interviews, and 3 FGDs. Questionnaires showed limited knowledge of post--COVID-19 complications at 26.7\% (16/60). Of those who received any rehabilitation for COVID-19 (19/60, 31.7\%), 94.7\% (18/19) found it helpful for their recovery. Just over half (23/41, 56\%) of those who did not receive rehabilitation reported that they would have liked to. The majority viewed rehabilitation as an important adjunct to post--COVID-19 care (56/60, 93.3\%) and that support groups would be helpful (53/60, 88.3\%). Qualitative results highlighted the need for mental health support, structured post--COVID-19 follow-up, and financial aid in post--COVID-19 care. Based on the insights from the situation analysis, the theory of change framework, and existing post--COVID-19 evidence, we designed and conducted a pilot support group and rehabilitation intervention for individuals with post--COVID-19 complications. Our main objective was to assess the change in physical and psychological well-being pre- and postintervention. The intervention included 8 weekly themed group sessions supplemented by home tasks. Effectiveness of the intervention was evaluated by questionnaires pre- and postintervention on post--COVID-19 symptoms, quality of life with the EuroQoL 5-Dimension 5-Level, short Warwick-Edinburgh Mental Wellbeing Scale, and physical function by spirometry and 1-minute sit-to-stand test. We also assessed the feasibility and acceptability of the intervention by questionnaires and semistructured in-depth interviews. The intervention outcome analysis is yet to be conducted. Conclusions: Insights from patients and health care providers on the characteristics of post--COVID-19 complications helped guide the development of a context-adapted intervention program with potential to improve health and well-being post--COVID-19. ", doi="10.2196/58436", url="https://formative.jmir.org/2025/1/e58436" } @Article{info:doi/10.2196/66003, author="Nian, Hui and Bai, Yu and Yu, Hua", title="Assessing the Causal Association Between COVID-19 and Graves Disease: Mendelian Randomization Study", journal="JMIR Form Res", year="2025", month="Apr", day="8", volume="9", pages="e66003", keywords="Graves disease", keywords="COVID-19", keywords="Mendelian randomization", keywords="causal relationship", keywords="autoimmune disease", abstract="Background: Graves disease (GD) is an autoimmune thyroid disorder characterized by hyperthyroidism and autoantibodies. The COVID-19 pandemic has raised questions about its potential relationship with autoimmune diseases like GD. Objective: This study aims to investigate the causal association between COVID-19 and GD through Mendelian randomization (MR) analysis and assess the impact of COVID-19 on GD. Methods: We conducted an MR study using extensive genome-wide association study data for GD and COVID-19 susceptibility and its severity. We used stringent single nucleotide polymorphism selection criteria and various MR methodologies, including inverse-variance weighting, MR-Egger, and weighted median analyses, to assess causal relationships. We also conducted tests for directional pleiotropy and heterogeneity, as well as sensitivity analyses. Results: The MR analysis, based on the largest available dataset to date, did not provide evidence supporting a causal relationship between COVID-19 susceptibility (odds ratio [OR] 0.989, 95\% CI 0.405?2.851; P=.93), COVID-19 hospitalization (OR 0.974, 95\% CI 0.852?1.113; P=.70), COVID-19 severity (OR 0.979, 95\% CI 0.890?1.077; P=.66), and GD. Tests for directional pleiotropy and heterogeneity, as well as sensitivity analyses, supported these findings. Conclusions: This comprehensive MR study does not provide sufficient evidence to support a causal relationship between COVID-19 and the onset or exacerbation of GD. These results contribute to a better understanding of the potential association between COVID-19 and autoimmune diseases, alleviating concerns about a surge in autoimmune thyroid diseases due to the pandemic. Further research is warranted to explore this complex relationship thoroughly. ", doi="10.2196/66003", url="https://formative.jmir.org/2025/1/e66003" } @Article{info:doi/10.2196/50536, author="Kautsar, Prawira Angga and Sinuraya, Kurnia Rano and van der Schans, Jurjen and Postma, Jacobus Maarten and Suwantika, A. Auliya", title="Exploring Public Sentiment on the Repurposing of Ivermectin for COVID-19 Treatment: Cross-Sectional Study Using Twitter Data", journal="JMIR Form Res", year="2025", month="Mar", day="27", volume="9", pages="e50536", keywords="COVID-19", keywords="ivermectin", keywords="sentiment analysis", keywords="Twitter", keywords="social media", keywords="public health", keywords="misinformation", keywords="geolocation analysis", doi="10.2196/50536", url="https://formative.jmir.org/2025/1/e50536" } @Article{info:doi/10.2196/67487, author="Li, Mingyan and Sun, Changxuan and Ji, Chai and Gao, Meiying and Wang, Xia and Yao, Dan and Guo, Junxia and Sun, Lidan and Rafay, Abdul and George, Shereen Antonita and Muhandiramge, Samararathna Sanduni Hasara Samararathna and Bai, Guannan", title="Vaccine Hesitancy and Associated Factors Among Caregivers of Children With Special Health Care Needs in the COVID-19 Era in China: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2025", month="Mar", day="26", volume="11", pages="e67487", keywords="COVID-19", keywords="caregivers", keywords="children with special health care needs", keywords="vaccination hesitancy", keywords="decision-making", abstract="Background: Immunization is a cost-effective way to prevent infectious diseases in children, but parental hesitancy leads to low vaccination rates, leaving children at risk. Caregivers of children with special health care needs are more hesitant about vaccines than those of healthy children. Objective: The aim of the study is to investigate the changes in caregivers' vaccination hesitation of children with special health care needs before, during, and after the COVID-19 pandemic in China and to identify associated factors for caregivers' attitudes toward National Immunization Program (NIP) and non-NIP vaccines. Methods: We included 7770 caregivers of children with special health care needs (median age 7.0, IQR 2.4-24.1 months) who visited the Vaccination Consultation Clinic at Children's Hospital, Zhejiang University School of Medicine (Hangzhou, China) from May 2017 to May 2023. General and clinical information was extracted from the immunization evaluation system for children with special health care needs and medical records. We compared the differences in caregivers' willingness and hesitation for vaccinating their children across the 3 stages of the COVID-19 pandemic using chi-square tests. Multinomial logistic regression models were used to identify independent variables that were associated with caregivers' willingness and hesitation toward NIP and non-NIP vaccines. Results: There is a statistically significant difference in caregivers' vaccine hesitancy before, during, and after the COVID-19 pandemic (P<.05). During the COVID-19 pandemic, the percentages of choosing NIP, alternative non-NIP, and non-NIP vaccines are highest (n=1428, 26\%, n=3148, 57.4\%, and n=3442, 62.7\%, respectively) than those at other 2 stages. In comparison, caregivers' hesitation toward NIP and non-NIP vaccines is lowest (n=911, 16.6\% and n=2045, 37.3\%, respectively). Despite the stages of the COVID-19 pandemic, multiple factors, including children's age and sex, parents' educational level, comorbidities, and history of allergy, were significantly associated with caregivers' attitude toward NIP and non-NIP vaccines (P<.05). The profiles of risk factors for hesitancy toward NIP and non-NIP vaccines are different, as indicated by the results from the logistic regression models. Conclusions: This study demonstrated that caregivers' willingness to vaccinate their children with special health care needs with NIP and non-NIP vaccines was highest during the COVID-19 pandemic in China, and their hesitancy was lowest. Additionally, we have identified multiple factors associated with caregivers' willingness and hesitancy to vaccinate their children. These findings provide evidence-based support for developing personalized health education strategies. ", doi="10.2196/67487", url="https://publichealth.jmir.org/2025/1/e67487" } @Article{info:doi/10.2196/63681, author="Senathirajah, Yalini and Kaufman, R. David and Cato, Kenrick and Daniel, Pia and Roblin, Patricia and Kushniruk, Andre and Borycki, M. Elizabeth and Feld, Emanuel and Debi, Poli", title="The Impact of the Burden of COVID-19 Regulatory Reporting in a Small Independent Hospital and a Large Network Hospital: Comparative Mixed Methods Study", journal="Online J Public Health Inform", year="2025", month="Mar", day="26", volume="17", pages="e63681", keywords="regulatory reporting", keywords="human factors", keywords="reporting burden", keywords="emergency response", keywords="COVID-19", keywords="hospital resilience", keywords="pandemic response", abstract="Background: During the COVID-19 pandemic in 2020, hospitals encountered numerous challenges that compounded their difficulties. Some of these challenges directly impacted patient care, such as the need to expand capacities, adjust services, and use new knowledge to save lives in an ever-evolving situation. In addition, hospitals faced regulatory challenges. Objective: This paper presents the findings of a qualitative study that aimed to compare the effects of reporting requirements on a small independent hospital and a large network hospital during the COVID-19 pandemic. Methods: We used both quantitative and qualitative analyses and conducted 51 interviews, which were thematically analyzed. We quantified the changes in regulatory reporting requirements during the first 14 months of the pandemic. Results: Reporting requirements placed a substantial time burden on key clinical personnel at the small independent hospital, consequently reducing the time available for patient care. Conversely, the large network hospital had dedicated nonclinical staff responsible for reporting duties, and their robust health information system facilitated this work. Conclusions: The discrepancy in health IT capabilities suggests that there may be significant institutional inequities affecting smaller hospitals' ability to respond to a pandemic and adequately support public health efforts. Electronic certification guidelines are essential to addressing the substantial equity issues. We discuss in detail the health care policy implications of these findings. ", doi="10.2196/63681", url="https://ojphi.jmir.org/2025/1/e63681", url="http://www.ncbi.nlm.nih.gov/pubmed/40137048" } @Article{info:doi/10.2196/57905, author="Kaur, Harleen and Sachdeva, Jyoti and Bawaskar, Ramesh and Goyal, Twinkle", title="Comparative Evaluation of Effectiveness of Standard of Care Alone and in Combination With Homoeopathic Treatment in COVID-19--Related Rhino-Orbito-Cerebral Mucormycosis (ROCM): Protocol for a Single Blind, Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Mar", day="19", volume="14", pages="e57905", keywords="Rhino-orbital-cerebral mucormycosis, randomized controlled trial, homoeopathy, fungus, CE-MRI PNS mucormycosis", keywords="India", keywords="medical care", keywords="mortality rate", keywords="conventional therapy", keywords="ethical", keywords="mortality", keywords="survival", keywords="recovery", keywords="homoeopathic medicines", keywords="management", abstract="Background: Rhino-orbital-cerebral mucormycosis (ROCM) is the most common (45\%-74\%) mucormycosis in India. With contemporary medical care, ROCM has a mortality rate of 40\%-50\% and 70\% of survivors are left with residual defects. Recently, several cases of mucormycosis in people with COVID-19 have been increasingly reported worldwide, from India, due to immune dysregulation caused by SARS-CoV-2. To reduce the high mortality rate and residual defect in most survivors under the guidelines of the Ministry of AYUSH, the Government of India recommended homoeopathy as an add-on therapy to maximize the effectiveness of standard treatment in conventional therapy. Objective: This study aimed to evaluate the role of existing homoeopathic treatment as an adjuvant therapy in patients with COVID-19--related ROCM and enhancing the survival of the patients hospitalized due to COVID-19 infection and to access the initial treatment response and duration required for significant or complete recovery in patients receiving adjuvant treatment. Methods: This superiority, randomized controlled clinical trial would include two parallel comparator groups A and B. Group A would be the experimental group and would receive homoeopathic treatment along with the standard line of treatment as per investigational medicinal product (IMP) and group B would be the control arm and would receive standard line of treatment as per IMP along with identical placebo. Allocation would be 1:1 through randomization. Based on the inclusion and exclusion criteria, 36 participants per arm would be screened. Participants would be assessed clinically twice a day and magnetic resonance imagery or endoscopy cum-biopsy would be assessed on days 1, 14, and 28. Laboratory investigations may vary as per demand of disease conditions. Results: In India, the COVID-19 pandemic, particularly during the second wave, resulted in a surge of mucormycosis cases among patients with COVID-19. At the time this protocol was being developed, there was a significant spike in mucormycosis cases in India, particularly in Mumbai (June 2021). However, by the time the Central Council for Research in Homoeopathy obtained the necessary approvals and ethical clearance for the study, the incidence of mucormycosis had drastically declined (September 2021). As a result, the study was not initiated and registered. The authors feel it is their ethical responsibility to share the reviewed protocol with the medical community as a reference for future work. Conclusions: This study aims to evaluate the role of existing homoeopathic medicines as an adjuvant therapy in managing COVID-19--related ROCM, potentially contributing to the use of homoeopathy as an evidence-based medical approach. The protocol can also serve as a valuable resource for clinicians and researchers addressing mucormycosis cases unrelated to COVID-19, particularly in immunocompromised patients. It would help ensure preparedness, whether or not sufficient evidence is available, in the event of a future health emergency. International Registered Report Identifier (IRRID): PRR1-10.2196/57905 ", doi="10.2196/57905", url="https://www.researchprotocols.org/2025/1/e57905" } @Article{info:doi/10.2196/59687, author="Parveen, Sana and Pereira, Garcia Agustin and Garzon-Orjuela, Nathaly and McHugh, Patricia and Surendran, Aswathi and Vornhagen, Heike and Vellinga, Akke", title="COVID-19 Public Health Communication on X (Formerly Twitter): Cross-Sectional Study of Message Type, Sentiment, and Source", journal="JMIR Form Res", year="2025", month="Mar", day="19", volume="9", pages="e59687", keywords="public health communication", keywords="surveillance", keywords="COVID-19", keywords="SARS-CoV-2", keywords="coronavirus", keywords="respiratory", keywords="infectious", keywords="pulmonary", keywords="pandemic", keywords="public health messaging", keywords="healthcare information", keywords="social media", keywords="tweets", keywords="text mining", keywords="data mining", keywords="social marketing", keywords="infoveillance", keywords="intervention planning", abstract="Background: Social media can be used to quickly disseminate focused public health messages, increasing message reach and interaction with the public. Social media can also be an indicator of people's emotions and concerns. Social media data text mining can be used for disease forecasting and understanding public awareness of health-related concerns. Limited studies explore the impact of type, sentiment and source of tweets on engagement. Thus, it is crucial to research how the general public reacts to various kinds of messages from different sources. Objective: The objective of this paper was to determine the association between message type, user (source) and sentiment of tweets and public engagement during the COVID-19 pandemic. Methods: For this study, 867,485 tweets were extracted from January 1, 2020 to March 31, 2022 from Ireland and the United Kingdom. A 4-step analytical process was undertaken, encompassing sentiment analysis, bio-classification (user), message classification and statistical analysis. A combination of manual content analysis with abductive coding and machine learning models were used to categorize sentiment, user category and message type for every tweet. A zero-inflated negative binomial model was applied to explore the most engaging content mix. Results: Our analysis resulted in 12 user categories, 6 message categories, and 3 sentiment classes. Personal stories and positive messages have the most engagement, even though not for every user group; known persons and influencers have the most engagement with humorous tweets. Health professionals receive more engagement with advocacy, personal stories/statements and humor-based tweets. Health institutes observe higher engagement with advocacy, personal stories/statements, and tweets with a positive sentiment. Personal stories/statements are not the most often tweeted category (22\%) but have the highest engagement (27\%). Messages centered on shock/disgust/fear-based (32\%) have a 21\% engagement. The frequency of informative/educational communications is high (33\%) and their engagement is 16\%. Advocacy message (8\%) receive 9\% engagement. Humor and opportunistic messages have engagements of 4\% and 0.5\% and low frequenciesof 5\% and 1\%, respectively. This study suggests the optimum mix of message type and sentiment that each user category should use to get more engagement. Conclusions: This study provides comprehensive insight into Twitter (rebranded as X in 2023) users' responses toward various message type and sources. Our study shows that audience engages with personal stories and positive messages the most. Our findings provide valuable guidance for social media-based public health campaigns in developing messages for maximum engagement. ", doi="10.2196/59687", url="https://formative.jmir.org/2025/1/e59687" } @Article{info:doi/10.2196/64307, author="Shao, Anqi and Chen, Kaiping and Johnson, Branden and Miranda, Shaila and Xing, Qidi", title="Ubiquitous News Coverage and Its Varied Effects in Communicating Protective Behaviors to American Adults in Infectious Disease Outbreaks: Time-Series and Longitudinal Panel Study", journal="J Med Internet Res", year="2025", month="Mar", day="10", volume="27", pages="e64307", keywords="risk communication", keywords="panel study", keywords="computational method", keywords="intermedia agenda setting", keywords="protective behaviors", keywords="infectious disease", abstract="Background: Effective communication is essential for promoting preventive behaviors during infectious disease outbreaks like COVID-19. While consistent news can better inform the public about these health behaviors, the public may not adopt them. Objective: This study aims to explore the role of different media platforms in shaping public discourse on preventive measures to infectious diseases such as quarantine and vaccination, and how media exposure influences individuals' intentions to adopt these behaviors in the United States. Methods: This study uses data from 3 selected top national newspapers in the United States, Twitter discussions, and a US nationwide longitudinal panel survey from February 2020 to April 2021. We used the Intermedia Agenda-Setting Theory and the Protective Action Decision Model to develop the theoretical framework. Results: We found a 2-way agenda flow between selected national newspapers and the social media platform Twitter, particularly in controversial topics like vaccination (F1,426=16.39; P<.001 for newspapers; F1,426=44.46; P<.001 for Twitter). Exposure to media coverage increased individuals' perceived benefits of certain behaviors like vaccination but did not necessarily translate into behavioral adoption. For example, while individuals' media exposure increased perceived benefits of mask-wearing ($\beta$=.057; P<.001 for household benefits; $\beta$=.049; P<.001 for community benefits), it was not consistently linked to higher intentions to wear masks ($\beta$=--.026; P=.04). Conclusions: This study integrates media flow across platforms with US national panel survey data, offering a comprehensive view of communication dynamics during the early stage of an infectious disease outbreak. The findings caution against a one-size-fits-all approach in communicating different preventive behaviors, especially where individual and community benefits may not always align. ", doi="10.2196/64307", url="https://www.jmir.org/2025/1/e64307" } @Article{info:doi/10.2196/64667, author="Biliotti, Carolina and Fraccaroli, Nicol{\`o} and Puliga, Michelangelo and Bargagli-Stoffi, J. Falco and Riccaboni, Massimo", title="The Impact of Stay-At-Home Mandates on Uncertainty and Sentiments: Quasi-Experimental Study", journal="J Med Internet Res", year="2025", month="Mar", day="4", volume="27", pages="e64667", keywords="lockdown policy", keywords="sentiment analysis", keywords="uncertainty", keywords="social media", keywords="quasi-experiment", abstract="Background: As the spread of the SARS-CoV-2 virus coincided with lockdown measures, it is challenging to distinguish public reactions to lockdowns from responses to COVID-19 itself. Beyond the direct impact on health, lockdowns may have worsened public sentiment toward politics and the economy or even heightened dissatisfaction with health care, imposing a significant cost on both the public and policy makers. Objective: This study aims to analyze the causal effect of COVID-19 lockdown policies on various dimensions of sentiment and uncertainty, using the Italian lockdown of February 2020 as a quasi-experiment. At the time of implementation, communities inside and just outside the lockdown area were equally exposed to COVID-19, enabling a quasi-random distribution of the lockdown. Additionally, both areas had similar socioeconomic and demographic characteristics before the lockdown, suggesting that the delineation of the strict lockdown zone approximates a randomized experiment. This approach allows us to isolate the causal effects of the lockdown on public emotions, distinguishing the impact of the policy itself from changes driven by the virus's spread. Methods: We used Twitter data (N=24,261), natural language models, and a difference-in-differences approach to compare changes in sentiment and uncertainty inside (n=1567) and outside (n=22,694) the lockdown areas before and after the lockdown began. By fine-tuning the AlBERTo (Italian BERT optimized) pretrained model, we analyzed emotions expressed in tweets from 1124 unique users. Additionally, we applied dictionary-based methods to categorize tweets into 4 dimensions---economy, health, politics, and lockdown policy---to assess the corresponding emotional reactions. This approach enabled us to measure the direct impact of local policies on public sentiment using geo-referenced social media and can be easily adapted for other policy impact analyses. Results: Our analysis shows that the lockdown had no significant effect on economic uncertainty (b=0.005, SE 0.007, t125=0.70; P=.48) or negative economic sentiment (b=--0.011, SE 0.0089, t125=--1.32; P=.19). However, it increased uncertainty about health (b=0.036, SE 0.0065, t125=5.55; P<.001) and lockdown policy (b=0.026, SE 0.006, t125=4.47; P<.001), as well as negative sentiment toward politics (b=0.025, SE 0.011, t125=2.33; P=.02), indicating that lockdowns have broad externalities beyond health. Our key findings are confirmed through a series of robustness checks. Conclusions: Our findings reveal that lockdowns have broad externalities extending beyond health. By heightening health concerns and negative political sentiment, policy makers have struggled to secure explicit public support for government measures, which may discourage future leaders from implementing timely stay-at-home policies. These results highlight the need for authorities to leverage such insights to enhance future policies and communication strategies, reducing uncertainty and mitigating social panic. ", doi="10.2196/64667", url="https://www.jmir.org/2025/1/e64667", url="http://www.ncbi.nlm.nih.gov/pubmed/40053818" } @Article{info:doi/10.2196/60369, author="Tan, Jin Rayner Kay and Hensel, Devon and Ivanova, Olena and Bravo, Gomez Raquel and Olumide, Adesola and Adebayo, Emmanuel and Cleeve, Amanda and Gesselman, Amanda and Shah, Jyoti Sonam and Adesoba, Helen and Marley, Gifty and Tang, Weiming", title="Telemedicine Use During the COVID-19 Pandemic in 8 Countries From the International Sexual Health and Reproductive Health Consortium: Web-Based Cross-Sectional Survey Study", journal="J Med Internet Res", year="2025", month="Mar", day="4", volume="27", pages="e60369", keywords="COVID-19", keywords="telemedicine", keywords="sexual and reproductive health", keywords="pandemic", keywords="web-based survey", keywords="sexual health", keywords="reproductive health", keywords="communication technology", keywords="medical education", keywords="contraception", keywords="abortion", keywords="health care delivery", keywords="care", keywords="chronic condition", abstract="Background: Telemedicine is an important way to fill in the access gap to in-person health care services during challenging times like pandemics. Objective: This study aimed to investigate the role that telemedicine played during the COVID-19 pandemic by multicountry comparison of the use of telemedicine prior to and during the pandemic. Methods: This study analyzes data from the second wave of the International Sexual Health and Reproductive Health study. This included data collected between April 2021 and July 2022 in 8 countries, including Armenia (n=296), Egypt (n=889), Germany (n=138), Moldova (n=311), Nigeria (n=205), Portugal (n=951), Singapore (n=13), and Spain (n=54). This study covered sociodemographics, sexual and reproductive health (SRH), and telemedicine use. Descriptive statistics and multilevel modeling were used to assess the factors influencing the use of telemedicine. Results: Overall, 2857 participants were recruited. Approximately 57.6\% (n=1646) of participants had never used telemedicine prior to COVID-19 measures, while 45.9\% (n=1311) of participants required health care but reported not using telemedicine services following the introduction of COVID-19 measures. In high-income countries, the most common mode reported was audio-based telemedicine services, with 283 (71.8\%) and 417 (73.5\%) participants doing so before and during COVID-19, respectively. This was followed by text-based telemedicine services, with 152 (38.6\%) and 173 (30.5\%) participants doing so before and during COVID-19, respectively. In low- to middle-income countries, many participants also reported using audio-based telemedicine services, with 288 (35.3\%) and 237 (40.8\%) participants doing so before and during COVID-19, respectively. This was followed by chat-based telemedicine services, with 265 (32.4\%) and 217 (37.3\%) participants doing so before and during COVID-19, respectively. Multilevel modeling revealed that those who were older (adjusted odds ratio [aOR] 0.99, 95\% CI 0.99-1.00) and were in countries with a higher gross domestic product per capita (aOR 0.99, 95\% CI 0.98-1.00) were less likely to have ever used telemedicine. Participants who were of male sex assigned at birth (aOR 0.79, 95\% CI 0.65-0.96) were less likely to use telemedicine during the pandemic. Participants who perceived that they were worse off financially were more likely to have switched to telemedicine during COVID-19 (aOR 1.39, 95\% CI 1.02-1.89) and were more likely to report having a poor or fair experience of telemedicine services (aOR 1.75, 95\% CI 1.34-2.29). When sexual orientation was included in the model, nonheterosexual individuals were more likely to ever use telemedicine prior to COVID-19 (aOR 1.35, 95\% CI 1.08-1.69), more likely to have used telemedicine during COVID-19 (aOR 1.58, 95\% CI 1.24-2.02), and more likely to have switched to telemedicine during COVID-19 (aOR 1.55, 95\% CI 1.09-2.21). Conclusions: Telemedicine played a key role in addressing health care needs during the COVID-19 pandemic. Age, sex, economic status, and sexual orientation influenced its use. ", doi="10.2196/60369", url="https://www.jmir.org/2025/1/e60369", url="http://www.ncbi.nlm.nih.gov/pubmed/40053813" } @Article{info:doi/10.2196/69417, author="Li, Yadi and Zhou, Jianlong and Wei, Zheng and Liang, Lizhu and Xu, Hualing and Lv, Caihong and Liu, Gang and Li, Wenlin and Wu, Xin and Xiao, Yunhui and Sunzi, Kejimu", title="Efficacy and Safety of Acupuncture for Post--COVID-19 Insomnia: Protocol for a Systematic Review and Meta-Analysis", journal="JMIR Res Protoc", year="2025", month="Mar", day="3", volume="14", pages="e69417", keywords="acupuncture", keywords="traditional Chinese medicine", keywords="post--COVID-19 condition", keywords="long COVID-19", keywords="insomnia", keywords="sleep disorder", keywords="depression", keywords="complementary and alternative medicine", keywords="treatment", keywords="public health", keywords="study protocol", keywords="systematic review", abstract="Background: The COVID-19 pandemic has had a profound global impact, leading to a range of persistent sequelae referred to as post--COVID-19 condition or ``long COVID'' that continue to affect patients worldwide. Among these sequelae, post--COVID-19 insomnia (PCI) has emerged as a significant issue. Conventional treatments, including cognitive behavioral therapy and pharmacological interventions, face limitations such as variable efficacy, potential side effects, and substantial costs. Recently, acupuncture has gained traction due to its efficacy, cost-effectiveness, and safety profile. Objective: This study aims to conduct a meta-analysis and systematic review evaluating the efficacy and safety of acupuncture for the treatment of PCI to delineate the optimal modality, intervention frequency, and duration for achieving the most beneficial outcomes, thereby providing a comprehensive understanding of acupuncture's role in managing PCI, contributing to evidence-based clinical practice, and informing clinical decision-making. Methods: Electronic searches will be performed in 12 databases from inception to October 2024 without language restrictions. This includes both English databases (PubMed, Cochrane Library, Web of Science, Embase, OVID and Scopus), as well as Chinese databases (China National Knowledge Infrastructure, Wan-Fang Data, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, Duxiu Database and the Chinese Clinical Trial Registry Center). Randomized controlled trials on acupuncture for PCI will be included. Primary outcomes will include the response rate and insomnia severity; secondary outcomes will include the Traditional Chinese Medicine Symptom Scale (TCMSS) and adverse event rates. Data synthesis will use risk ratios for dichotomous data and mean differences for continuous data. Study selection, data extraction, and quality assessment will be conducted independently by 2 reviewers. Methodological quality of eligible studies will be evaluated following the Cochrane Handbook for Systematic Reviews of Interventions (version 6.3). Meta-analysis will be performed with RevMan 5.3. Results: Based on the data on response rate, insomnia severity, TCMSS score, and adverse event rates, this study will provide an evidence-based review of the efficacy and safety of acupuncture for PCI treatment. Conclusions: This systematic review will present the current evidence for acupuncture for PCI, aiming to inform clinical practices and decision-making and to enhance the understanding of acupuncture's role in managing PCI. Furthermore, it will identify research gaps and suggest potential areas for future investigation. Trial Registration: PROSPERO CRD42024499284; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=499284 International Registered Report Identifier (IRRID): DERR1-10.2196/69417 ", doi="10.2196/69417", url="https://www.researchprotocols.org/2025/1/e69417", url="http://www.ncbi.nlm.nih.gov/pubmed/40053784" } @Article{info:doi/10.2196/51154, author="Nagpal, Meghan and Jalali, Niloofar and Sherifali, Diana and Morita, Plinio and Cafazzo, A. Joseph", title="Investigating Reddit Data on Type 2 Diabetes Management During the COVID-19 Pandemic Using Latent Dirichlet Allocation Topic Modeling and Valence Aware Dictionary for Sentiment Reasoning Analysis: Content Analysis", journal="JMIR Form Res", year="2025", month="Feb", day="21", volume="9", pages="e51154", keywords="diabetes", keywords="diabetes mellitus", keywords="DM", keywords="COVID-19", keywords="pandemics", keywords="social media", keywords="health behavior", keywords="health knowledge", keywords="attitudes", keywords="practice", keywords="self-management", keywords="patient-generated health data", keywords="perspective", keywords="T2DM", abstract="Background: Type 2 diabetes (T2D) is a chronic disease that can be partially managed through healthy behaviors. However, the COVID-19 pandemic impacted how people managed T2D due to work and school closures and social isolation. Moreover, individuals with T2D were at increased risk of complications from COVID-19 and experienced worsened mental health due to stress and anxiety. Objective: This study aims to synthesize emerging themes related to the health behaviors of people living with T2D, and how they were affected during the early stages of the COVID-19 pandemic by examining Reddit forums dedicated to people living with T2D. Methods: Data from Reddit forums related to T2D, from January 2018 to early March 2021, were downloaded using the Pushshift API; support vector machines were used to classify whether a post was made in the context of the pandemic. Latent Dirichlet allocation topic modelling was performed to identify topics of discussion across the entire dataset and a subsequent iteration was performed to identify topics specific to the COVID-19 pandemic. Sentiment analysis using the VADER (Valence Aware Dictionary for Sentiment Reasoning) algorithm was performed to assess attitudes towards the pandemic. Results: From all posts, the identified topics of discussion were classified into the following themes: managing lifestyle (sentiment score 0.25, 95\% CI 0.25-0.26), managing blood glucose (sentiment score 0.19, 95\% CI 0.18-0.19), obtaining diabetes care (sentiment score 0.19, 95\% CI 0.18-0.20), and coping and receiving support (sentiment score 0.34, 95\% CI 0.33-0.35). Among the COVID-19--specific posts, the topics of discussion were coping with poor mental health (sentiment score 0.04, 95\% CI ?0.01 to0.11), accessing doctor and medications and controlling blood glucose (sentiment score 0.14, 95\% CI 0.09-0.20), changing food habits during the pandemic (sentiment score 0.25, 95\% CI 0.20-0.31), impact of stress on blood glucose levels (sentiment score 0.03, 95\% CI ?0.03 to 0.08), changing status of employment and insurance (sentiment score 0.17, 95\% CI 0.13-0.22), and risk of COVID-19 complications (sentiment score 0.09, 95\% CI 0.03-0.14). Overall, posts classified as COVID-19--related (0.12, 95\% CI 0.01-0.15) were associated with a lower sentiment score than those classified as nonCOVID (0.25, 95\% CI 0.24-0.25). This study was limited due to the lack of a method for assessing the demographics of users and verifying whether users had T2D. Conclusions: Themes identified from Reddit data suggested that the COVID-19 pandemic significantly influenced how people with T2D managed their disease, particularly in terms of accessing care and dealing with the complications of the virus. Overall, the early stages of the pandemic negatively impacted the attitudes of people living with T2D. This study demonstrates that social media data can be a qualitative data source for understanding patient perspectives. ", doi="10.2196/51154", url="https://formative.jmir.org/2025/1/e51154" } @Article{info:doi/10.2196/59317, author="Sillence, Elizabeth and Branley-Bell, Dawn and Moss, Mark and Briggs, Pam", title="A Model of Trust in Online COVID-19 Information and Advice: Cross-Sectional Questionnaire Study", journal="JMIR Infodemiology", year="2025", month="Feb", day="13", volume="5", pages="e59317", keywords="eHealth", keywords="electronic health", keywords="digital intervention", keywords="trust", keywords="online information seeking", keywords="scientific credibility", keywords="digital resources", keywords="COVID-19", keywords="SARS-CoV-2", keywords="respiratory", keywords="infectious", keywords="pulmonary", keywords="pandemic", keywords="public health", keywords="health information", keywords="global health", keywords="surveys", keywords="social media", abstract="Background: During the COVID-19 pandemic, many people sought information from websites and social media. Understanding the extent to which these sources were trusted is important in relation to health communication. Objective: This study aims to identify the key factors influencing UK citizens' trust and intention to act on advice about COVID-19 found via digital resources and to test whether an existing model of trust in eHealth provided a good fit for COVID-19--related information seeking online. We also wished to identify any differences between the evaluation of general information and information relating specifically to COVID-19 vaccines. Methods: In total, 525 people completed an online survey in January 2022 encompassing a general web trust questionnaire, measures of information corroboration, coping perceptions, and intention to act. Data were analyzed using principal component analysis and structural equation modeling. The evaluation responses of general information and COVID-19 vaccine information were also compared. Results: The principal component analysis revealed 5 trust factors: (1) credibility and impartiality, (2) familiarity, (3) privacy, (4) usability, and (5) personal experiences. In the final structural equation modeling model, trust had a significant direct effect on intention to act ($\beta$=.65; P<.001). Of the trust factors, credibility and impartiality had a significant positive direct effect on trust ($\beta$=.82; P<.001). People searching for vaccination information felt less at risk, less anxious, and more optimistic after reading the information. We noted that most people sought information from ``official'' sources. Finally, in the context of COVID-19, ``credibility and impartiality'' remain a key predictor of trust in eHealth resources, but in comparison with previous models of trust in online health information, checking and corroborating information did not form a significant part of trust evaluations. Conclusions: In times of uncertainty, when faced with a global emergent health concern, people place their trust in familiar websites and rely on the perceived credibility and impartiality of those digital sources above other trust factors. ", doi="10.2196/59317", url="https://infodemiology.jmir.org/2025/1/e59317" } @Article{info:doi/10.2196/62802, author="Zhang, Kehe and Hunyadi, V. Jocelyn and de Oliveira Otto, C. Marcia and Lee, Miryoung and Zhang, Zitong and Ramphul, Ryan and Yamal, Jose-Miguel and Yaseen, Ashraf and Morrison, C. Alanna and Sharma, Shreela and Rahbar, Hossein Mohammad and Zhang, Xu and Linder, Stephen and Marko, Dritana and Roy, White Rachel and Banerjee, Deborah and Guajardo, Esmeralda and Crum, Michelle and Reininger, Belinda and Fernandez, E. Maria and Bauer, Cici", title="Increasing COVID-19 Testing and Vaccination Uptake in the Take Care Texas Community-Based Randomized Trial: Adaptive Geospatial Analysis", journal="JMIR Form Res", year="2025", month="Feb", day="11", volume="9", pages="e62802", keywords="COVID-19 testing", keywords="COVID-19 vaccination", keywords="study design", keywords="community-based interventions", keywords="geospatial analysis", keywords="public health", keywords="social determinants of health", keywords="data dashboard", abstract="Background: Geospatial data science can be a powerful tool to aid the design, reach, efficiency, and impact of community-based intervention trials. The project titled Take Care Texas aims to develop and test an adaptive, multilevel, community-based intervention to increase COVID-19 testing and vaccination uptake among vulnerable populations in 3 Texas regions: Harris County, Cameron County, and Northeast Texas. Objective: We aimed to develop a novel procedure for adaptive selections of census block groups (CBGs) to include in the community-based randomized trial for the Take Care Texas project. Methods: CBG selection was conducted across 3 Texas regions over a 17-month period (May 2021 to October 2022). We developed persistent and recent COVID-19 burden metrics, using real-time SARS-CoV-2 monitoring data to capture dynamic infection patterns. To identify vulnerable populations, we also developed a CBG-level community disparity index, using 12 contextual social determinants of health (SDOH) measures from US census data. In each adaptive round, we determined the priority CBGs based on their COVID-19 burden and disparity index, ensuring geographic separation to minimize intervention ``spillover.'' Community input and feedback from local partners and health workers further refined the selection. The selected CBGs were then randomized into 2 intervention arms---multilevel intervention and just-in-time adaptive intervention---and 1 control arm, using covariate adaptive randomization, at a 1:1:1 ratio. We developed interactive data dashboards, which included maps displaying the locations of selected CBGs and community-level information, to inform the selection process and guide intervention delivery. Selection and randomization occurred across 10 adaptive rounds. Results: A total of 120 CBGs were selected and followed the stepped planning and interventions, with 60 in Harris County, 30 in Cameron County, and 30 in Northeast Texas counties. COVID-19 burden presented substantial temporal changes and local variations across CBGs. COVID-19 burden and community disparity exhibited some common geographical patterns but also displayed distinct variations, particularly at different time points throughout this study. This underscores the importance of incorporating both real-time monitoring data and contextual SDOH in the selection process. Conclusions: The novel procedure integrated real-time monitoring data and geospatial data science to enhance the design and adaptive delivery of a community-based randomized trial. Adaptive selection effectively prioritized the most in-need communities and allowed for a rigorous evaluation of community-based interventions in a multilevel trial. This methodology has broad applicability and can be adapted to other public health intervention and prevention programs, providing a powerful tool for improving population health and addressing health disparities. ", doi="10.2196/62802", url="https://formative.jmir.org/2025/1/e62802" } @Article{info:doi/10.2196/63708, author="Davoody, Nadia and Stathakarou, Natalia and Swain, Cara and Bonacina, Stefano", title="Exploring the Impact of the COVID-19 Pandemic on Learning Experience, Mental Health, Adaptability, and Resilience Among Health Informatics Master's Students: Focus Group Study", journal="JMIR Med Educ", year="2025", month="Feb", day="10", volume="11", pages="e63708", keywords="COVID-19 pandemic", keywords="eHealth", keywords="blended learning", keywords="health informatics", keywords="higher education adaptation", abstract="Background: The shift to online education due to the COVID-19 pandemic posed significant challenges and opportunities for students, affecting their academic performance, mental well-being, and engagement. Objective: This study aimed to explore the overall learning experience among health informatics master's students at Karolinska Institutet, Sweden, and the strategies they used to overcome learning challenges posed by the COVID-19 pandemic. Methods: Through 3 structured focus groups, this study explored health informatics master's students' experiences of shifting learning environments for classes that started in 2019, 2020, and 2021. All focus group sessions were recorded and transcribed verbatim. Inductive content analysis was used to analyze the data. Results: The results highlight the benefits of increased autonomy and flexibility and identify challenges such as technical difficulties, diminished social interactions, and psychological impacts. This study underscores the importance of effective online educational strategies, technological preparedness, and support systems to enhance student learning experiences during emergencies. The findings of this study highlight implications for educators, students, and higher education institutions to embrace adaptation and foster innovation. Implications for educators, students, and higher education institutions include the need for educators to stay current with the latest educational technologies and design teaching strategies and pedagogical approaches suited to both online and in-person settings to effectively foster student engagement. Students must be informed about the technological requirements for online learning and adequately prepared to meet them. Institutions play a critical role in ensuring equitable access to technology, guiding and supporting educators in adopting innovative tools and methods, and offering mental health resources to assist students in overcoming the challenges of evolving educational environments. Conclusions: This research contributes to understanding the complexities of transitioning to online learning in urgent circumstances and offers insights for better preparing educational institutions for future pandemics. ", doi="10.2196/63708", url="https://mededu.jmir.org/2025/1/e63708" } @Article{info:doi/10.2196/53434, author="Alshanik, Farah and Khasawneh, Rawand and Dalky, Alaa and Qawasmeh, Ethar", title="Unveiling Topics and Emotions in Arabic Tweets Surrounding the COVID-19 Pandemic: Topic Modeling and Sentiment Analysis Approach", journal="JMIR Infodemiology", year="2025", month="Feb", day="10", volume="5", pages="e53434", keywords="topic modeling", keywords="sentiment analysis", keywords="COVID-19", keywords="social media", keywords="Twitter", keywords="public discussion", abstract="Background: The worldwide effects of the COVID-19 pandemic have been profound, and the Arab world has not been exempt from its wide-ranging consequences. Within this context, social media platforms such as Twitter have become essential for sharing information and expressing public opinions during this global crisis. Careful investigation of Arabic tweets related to COVID-19 can provide invaluable insights into the common topics and underlying sentiments that shape discussions about the COVID-19 pandemic. Objective: This study aimed to understand the concerns and feelings of Twitter users in Arabic-speaking countries about the COVID-19 pandemic. This was accomplished through analyzing the themes and sentiments that were expressed in Arabic tweets about the COVID-19 pandemic. Methods: In this study, 1 million Arabic tweets about COVID-19 posted between March 1 and March 31, 2020, were analyzed. Machine learning techniques, such as topic modeling and sentiment analysis, were applied to understand the main topics and emotions that were expressed in these tweets. Results: The analysis of Arabic tweets revealed several prominent topics related to COVID-19. The analysis identified and grouped 16 different conversation topics that were organized into eight themes: (1) preventive measures and safety, (2) medical and health care aspects, (3) government and social measures, (4) impact and numbers, (5) vaccine development and research, (6) COVID-19 and religious practices, (7) global impact of COVID-19 on sports and countries, and (8) COVID-19 and national efforts. Across all the topics identified, the prevailing sentiments regarding the spread of COVID-19 were primarily centered around anger, followed by disgust, joy, and anticipation. Notably, when conversations revolved around new COVID-19 cases and fatalities, public tweets revealed a notably heightened sense of anger in comparison to other subjects. Conclusions: The study offers valuable insights into the topics and emotions expressed in Arabic tweets related to COVID-19. It demonstrates the significance of social media platforms, particularly Twitter, in capturing the Arabic-speaking community's concerns and sentiments during the COVID-19 pandemic. The findings contribute to a deeper understanding of the prevailing discourse, enabling stakeholders to tailor effective communication strategies and address specific public concerns. This study underscores the importance of monitoring social media conversations in Arabic to support public health efforts and crisis management during the COVID-19 pandemic. ", doi="10.2196/53434", url="https://infodemiology.jmir.org/2025/1/e53434", url="http://www.ncbi.nlm.nih.gov/pubmed/39928401" } @Article{info:doi/10.2196/56126, author="Bragazzi, Luigi Nicola and Buchinger, Mich{\`e}le and Atwan, Hisham and Tuma, Ruba and Chirico, Francesco and Szarpak, Lukasz and Farah, Raymond and Khamisy-Farah, Rola", title="Proficiency, Clarity, and Objectivity of Large Language Models Versus Specialists' Knowledge on COVID-19's Impacts in Pregnancy: Cross-Sectional Pilot Study", journal="JMIR Form Res", year="2025", month="Feb", day="5", volume="9", pages="e56126", keywords="COVID-19", keywords="vaccine", keywords="reproductive health", keywords="generative artificial intelligence", keywords="large language model", keywords="chatGPT", keywords="google bard", keywords="microsoft copilot", keywords="vaccination", keywords="natural language processing", keywords="obstetric", keywords="gynecology", keywords="women", keywords="text mining", keywords="sentiment", keywords="accuracy", keywords="zero shot", keywords="pregnancy", keywords="readability", keywords="infectious", abstract="Background: The COVID-19 pandemic has significantly strained health care systems globally, leading to an overwhelming influx of patients and exacerbating resource limitations. Concurrently, an ``infodemic'' of misinformation, particularly prevalent in women's health, has emerged. This challenge has been pivotal for health care providers, especially gynecologists and obstetricians, in managing pregnant women's health. The pandemic heightened risks for pregnant women from COVID-19, necessitating balanced advice from specialists on vaccine safety versus known risks. In addition, the advent of generative artificial intelligence (AI), such as large language models (LLMs), offers promising support in health care. However, they necessitate rigorous testing. Objective: This study aimed to assess LLMs' proficiency, clarity, and objectivity regarding COVID-19's impacts on pregnancy. Methods: This study evaluates 4 major AI prototypes (ChatGPT-3.5, ChatGPT-4, Microsoft Copilot, and Google Bard) using zero-shot prompts in a questionnaire validated among 159 Israeli gynecologists and obstetricians. The questionnaire assesses proficiency in providing accurate information on COVID-19 in relation to pregnancy. Text-mining, sentiment analysis, and readability (Flesch-Kincaid grade level and Flesch Reading Ease Score) were also conducted. Results: In terms of LLMs' knowledge, ChatGPT-4 and Microsoft Copilot each scored 97\% (32/33), Google Bard 94\% (31/33), and ChatGPT-3.5 82\% (27/33). ChatGPT-4 incorrectly stated an increased risk of miscarriage due to COVID-19. Google Bard and Microsoft Copilot had minor inaccuracies concerning COVID-19 transmission and complications. In the sentiment analysis, Microsoft Copilot achieved the least negative score (--4), followed by ChatGPT-4 (--6) and Google Bard (--7), while ChatGPT-3.5 obtained the most negative score (--12). Finally, concerning the readability analysis, Flesch-Kincaid Grade Level and Flesch Reading Ease Score showed that Microsoft Copilot was the most accessible at 9.9 and 49, followed by ChatGPT-4 at 12.4 and 37.1, while ChatGPT-3.5 (12.9 and 35.6) and Google Bard (12.9 and 35.8) generated particularly complex responses. Conclusions: The study highlights varying knowledge levels of LLMs in relation to COVID-19 and pregnancy. ChatGPT-3.5 showed the least knowledge and alignment with scientific evidence. Readability and complexity analyses suggest that each AI's approach was tailored to specific audiences, with ChatGPT versions being more suitable for specialized readers and Microsoft Copilot for the general public. Sentiment analysis revealed notable variations in the way LLMs communicated critical information, underscoring the essential role of neutral and objective health care communication in ensuring that pregnant women, particularly vulnerable during the COVID-19 pandemic, receive accurate and reassuring guidance. Overall, ChatGPT-4, Microsoft Copilot, and Google Bard generally provided accurate, updated information on COVID-19 and vaccines in maternal and fetal health, aligning with health guidelines. The study demonstrated the potential role of AI in supplementing health care knowledge, with a need for continuous updating and verification of AI knowledge bases. The choice of AI tool should consider the target audience and required information detail level. ", doi="10.2196/56126", url="https://formative.jmir.org/2025/1/e56126" } @Article{info:doi/10.2196/58981, author="Rowley, AK Elizabeth and Mitchell, K. Patrick and Yang, Duck-Hye and Lewis, Ned and Dixon, E. Brian and Vazquez-Benitez, Gabriela and Fadel, F. William and Essien, J. Inih and Naleway, L. Allison and Stenehjem, Edward and Ong, C. Toan and Gaglani, Manjusha and Natarajan, Karthik and Embi, Peter and Wiegand, E. Ryan and Link-Gelles, Ruth and Tenforde, W. Mark and Fireman, Bruce", title="Methods to Adjust for Confounding in Test-Negative Design COVID-19 Effectiveness Studies: Simulation Study", journal="JMIR Form Res", year="2025", month="Jan", day="27", volume="9", pages="e58981", keywords="disease risk score", keywords="propensity score", keywords="vaccine effectiveness", keywords="COVID-19", keywords="simulation study", keywords="usefulness", keywords="comorbidity", keywords="assessment", abstract="Background: Real-world COVID-19 vaccine effectiveness (VE) studies are investigating exposures of increasing complexity accounting for time since vaccination. These studies require methods that adjust for the confounding that arises when morbidities and demographics are associated with vaccination and the risk of outcome events. Methods based on propensity scores (PS) are well-suited to this when the exposure is dichotomous, but present challenges when the exposure is multinomial. Objective: This simulation study aimed to investigate alternative methods to adjust for confounding in VE studies that have a test-negative design. Methods: Adjustment for a disease risk score (DRS) is compared with multivariable logistic regression. Both stratification on the DRS and direct covariate adjustment of the DRS are examined. Multivariable logistic regression with all the covariates and with a limited subset of key covariates is considered. The performance of VE estimators is evaluated across a multinomial vaccination exposure in simulated datasets. Results: Bias in VE estimates from multivariable models ranged from --5.3\% to 6.1\% across 4 levels of vaccination. Standard errors of VE estimates were unbiased, and 95\% coverage probabilities were attained in most scenarios. The lowest coverage in the multivariable scenarios was 93.7\% (95\% CI 92.2\%-95.2\%) and occurred in the multivariable model with key covariates, while the highest coverage in the multivariable scenarios was 95.3\% (95\% CI 94.0\%-96.6\%) and occurred in the multivariable model with all covariates. Bias in VE estimates from DRS-adjusted models was low, ranging from --2.2\% to 4.2\%. However, the DRS-adjusted models underestimated the standard errors of VE estimates, with coverage sometimes below the 95\% level. The lowest coverage in the DRS scenarios was 87.8\% (95\% CI 85.8\%-89.8\%) and occurred in the direct adjustment for the DRS model. The highest coverage in the DRS scenarios was 94.8\% (95\% CI 93.4\%-96.2\%) and occurred in the model that stratified on DRS. Although variation in the performance of VE estimates occurred across modeling strategies, variation in performance was also present across exposure groups. Conclusions: Overall, models using a DRS to adjust for confounding performed adequately but not as well as the multivariable models that adjusted for covariates individually. ", doi="10.2196/58981", url="https://formative.jmir.org/2025/1/e58981" } @Article{info:doi/10.2196/62824, author="Valla, Guido Luca and Rossi, Michele and Gaia, Alessandra and Guaita, Antonio and Rolandi, Elena", title="The Impact of the COVID-19 Pandemic on Oldest-Old Social Capital and Health and the Role of Digital Inequalities: Longitudinal Cohort Study", journal="J Med Internet Res", year="2025", month="Jan", day="9", volume="27", pages="e62824", keywords="older adults", keywords="information and communication technology", keywords="ICT", keywords="ICT use", keywords="COVID-19", keywords="social capital", keywords="health", keywords="mental health", keywords="digital divide", abstract="Background: During the COVID-19 pandemic, information and communication technology (ICT) became crucial for staying connected with loved ones and accessing health services. In this scenario, disparities in ICT use may have exacerbated other forms of inequality, especially among older adults who were less familiar with technology and more vulnerable to severe COVID-19 health consequences. Objective: This study investigated changes in ICT use, psychological and physical health, and social capital before and after the pandemic among the oldest old population (aged 80 years or older after the pandemic) and explored how internet use influenced these changes. Methods: We leveraged data from the InveCe.Ab study, a population-based longitudinal cohort of people born between 1935 and 1939 and living in Abbiategrasso, a municipality on the outskirts of Milan, Italy. Participants underwent multidimensional assessment at baseline (2010) and after 2, 4, 8, and 12 years. We restricted our analysis to cohort members who participated in the last wave (ie, 2022) and who did not have a diagnosis of dementia (n=391). We used linear mixed models to assess the impact of COVID-19 and time on changes in social capital, physical and psychological health, and ICT use in a discontinuity regression design while controlling for age, sex, education, and income satisfaction. Then, we assessed the influence of internet use and its interaction with COVID-19 on these changes. Results: COVID-19 had a significant impact on social relationships ($\beta$=--4.35, 95\% CI 6.38 to --2.32; P<.001), cultural activities ($\beta$=--.55, 95\% CI --0.75 to --0.35; P<.001), cognitive functioning ($\beta$=--1.00, 95\% CI --1.28 to --0.72; P<.001), depressive symptoms ($\beta$=.42, 95\% CI 0.10-0.74; P=.009), physical health ($\beta$=.07, 95\% CI 0.04-0.10; P<.001), and ICT use ($\beta$=--.11, 95\% CI --0.18 to --0.03; P=.008). Internet use predicts reduced depressive symptoms ($\beta$=--.56, 95\% CI --1.07 to --0.06; P=.03) over time. The interaction between internet use and COVID-19 was significant for cultural activities ($\beta$=--.73, 95\% CI --1.22 to --0.24; P=.003) and cognitive functioning ($\beta$=1.36, 95\% CI 0.67-2.05; P<.001). Conclusions: The pandemic had adverse effects on older adults' health and social capital. Contrary to expectations, even ICT use dropped significantly after the pandemic. Internet users maintained higher psychological health regardless of time and COVID-19 status. However, COVID-19 was associated with a steeper decline in cognitive functioning among internet nonusers. Policy makers may develop initiatives to encourage ICT adoption among older adults or strengthen their digital skills. Trial Registration: ClinicalTrials.gov NCT01345110; https://clinicaltrials.gov/study/NCT01345110 ", doi="10.2196/62824", url="https://www.jmir.org/2025/1/e62824" } @Article{info:doi/10.2196/59230, author="Sasaki, Kenji and Ikeda, Yoichi and Nakano, Takashi", title="Quantifying the Regional Disproportionality of COVID-19 Spread: Modeling Study", journal="JMIR Form Res", year="2025", month="Jan", day="3", volume="9", pages="e59230", keywords="infectious disease", keywords="COVID-19", keywords="epidemiology", keywords="public health", keywords="SARS-CoV-2", keywords="pandemic", keywords="inequality measure", keywords="information theory", keywords="Kullback-Leibler divergence", abstract="Background: The COVID-19 pandemic has caused serious health, economic, and social consequences worldwide. Understanding how infectious diseases spread can help mitigate these impacts. The Theil index, a measure of inequality rooted in information theory, is useful for identifying geographic disproportionality in COVID-19 incidence across regions. Objective: This study focused on capturing the degrees of regional disproportionality in incidence rates of infectious diseases over time. Using the Theil index, we aim to assess regional disproportionality in the spread of COVID-19 and detect epicenters where the number of infected individuals was disproportionately concentrated. Methods: To quantify the degree of disproportionality in the incidence rates, we applied the Theil index to the publicly available data of daily confirmed COVID-19 cases in the United States over a 1100-day period. This index measures relative disproportionality by comparing daily regional case distributions with population proportions, thereby identifying regions where infections are disproportionately concentrated. Results: Our analysis revealed a dynamic pattern of regional disproportionality in the confirmed cases by monitoring variations in regional contributions to the Theil index as the pandemic progressed. Over time, the index reflected a transition from localized outbreaks to widespread transmission, with high values corresponding to concentrated cases in some regions. We also found that the peaks in the Theil index often preceded surges in confirmed cases, suggesting its potential utility as an early warning signal. Conclusions: This study demonstrated that the Theil index is one of the effective indices for quantifying regional disproportionality in COVID-19 incidence rates. Although the Theil index alone cannot fully capture all aspects of pandemic dynamics, it serves as a valuable tool when used alongside other indicators such as infection and hospitalization rates. This approach allows policy makers to monitor regional disproportionality efficiently, offering insights for early intervention and targeted resource allocation. ", doi="10.2196/59230", url="https://formative.jmir.org/2025/1/e59230" } @Article{info:doi/10.2196/54734, author="Sharma, Nikita and Wrede, Christian and Bastoni, Sofia and Braakman-Jansen, Annemarie and van Gemert-Pijnen, Lisette", title="Continued Implementation and Use of a Digital Informal Care Support Platform Before and After COVID-19: Multimethod Study", journal="JMIR Form Res", year="2024", month="Dec", day="31", volume="8", pages="e54734", keywords="digital care platform", keywords="eHealth", keywords="implementation", keywords="informal care", keywords="new digital normal", keywords="COVID", keywords="Caren", keywords="consolidated framework", abstract="Background: With the growing need of support for informal caregivers (ICs) and care recipients (CRs) during COVID-19, the uptake of digital care collaboration platforms such as Caren increased. Caren is a platform designed to (1) improve communication and coordination between ICs and health care professionals, (2) provide a better overview of the care process, and (3) enhance safe information sharing within the care network. Insights on the impact of COVID-19 on the implementation and use of informal care platforms such as Caren are still lacking. Objective: This study aimed to (1) identify technology developers' lessons learned from the continued implementation of Caren during COVID-19 and (2) examine pre-post COVID-19 changes in usage behavior and support functionality use of Caren. Methods: A focus group with developers of the Caren platform (N=3) was conducted to extract implementation lessons learned. Focus group data were first analyzed deductively, using the Consolidated Framework for Implementation Research domains (ie, individual characteristics, intervention characteristics, inner setting, and outer setting). Later, inductive analysis of overarching themes was performed. Furthermore, survey data were collected in 2019 (N=11,635) and 2022 (N=5573) among Caren platform users for comparing usage behavior and support functionality use. Data were analyzed using descriptive and inferential statistics. Results: Several lessons from the continued implementation of Caren during COVID-19 were identified. Those included, for example, alternative ways to engage with end users, incorporating automated user support and large-scale communication features, considering the fluctuation of user groups, and addressing data transparency concerns in health care. Quantitative results showed that the number of ICs and CRs who used Caren several times per day increased significantly (P<.001 for ICs and CRs) between 2019 (ICs: 23.8\%; CRs: 23.2\%) and 2022 (ICs: 35.2\%; CRs: 37\%), as well as the use of certain support functionalities such as a digital agenda to make and view appointments, a messaging function to receive updates and communicate with formal and informal caregivers, and digital notes to store important information. Conclusions: Our study offers insights into the influence of the COVID-19 pandemic on the usage and implementation of the digital informal care support platform Caren. The study shows how platform developers maintained the implementation during COVID-19 and which support functionalities gained relevance among ICs and CRs throughout the pandemic. The findings can be used to improve the design and implementation of current and future digital platforms to support informal care toward the ``new digital normal.'' ", doi="10.2196/54734", url="https://formative.jmir.org/2024/1/e54734" } @Article{info:doi/10.2196/58566, author="Wallraf, Simon and Dierks, Marie-Luise and John, Cosima and Lander, Jonas", title="Patient Organizations' Digital Responses to the COVID-19 Pandemic: Scoping Review", journal="J Med Internet Res", year="2024", month="Dec", day="20", volume="26", pages="e58566", keywords="patient organizations", keywords="COVID-19", keywords="digital adaptation", keywords="digital transformation", keywords="scoping review", abstract="Background: Patient organizations (POs) play a crucial role in supporting individuals with health conditions. Their activities range from counseling to support groups to advocacy. The COVID-19 pandemic and its related public health measures prompted rapid digital transformation efforts across multiple sectors, including health care. Objective: This study aimed to explore how POs digitally responded to pandemic-related circumstances, focusing on aspects such as the technologies used, positive outcomes, and challenges encountered. Methods: This scoping review followed the methodological guidance of the JBI (Joanna Briggs Institute) Scoping Review Methodology Group and adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting guidelines. A systematic search of PubMed, the Web of Science Core Collection, and the WHO (World Health Organization) COVID-19 database, supplemented by a citation search approach, was conducted. The initial search was performed on November 10, 2022, and updated on November 8, 2023. Publications were eligible if they were published after November 30, 2019, and addressed pandemic-related digitalization efforts of POs, defined as nonprofit organizations with a focus on health-related support. A 2-step screening process was used to identify relevant literature. Data were extracted using a standardized table to capture aspects such as digital adaptation activities (eg, types of technologies implemented, positive outcomes, challenges, and facilitating factors) and coded inductively to identify similarities across included publications, and the findings were synthesized narratively. Results: The search and its subsequent update yielded 2212 records, with 13 articles included in this review. These articles revealed a range of PO services that were digitally adapted during the pandemic, with videoconferencing software emerging as the most commonly used tool (n=9 articles). The digital adaptation of group-based support activities was the most frequently reported transformation (n=9). Other adaptations included the digitalization of counseling services (n=3) and the delivery of information and education (n=3), including educational workshops, weekly webinars, and the dissemination of information through digital newsletters. While the use of digital formats, particularly for POs' group activities, often increased accessibility by breaking down preexisting barriers (n=5), they also created new barriers for certain groups, such as those lacking digital skills or resources (n=4). Some participants experienced a loss of interpersonal aspects, like a sense of community (n=3). However, further findings suggest that the digital delivery of such group activities preserved essential interpersonal aspects (n=7) and a preference among some participants to continue digital group activities (n=4), suggesting the potential for sustainability of such options post the COVID-19 pandemic. Conclusions: The rapid digitalization efforts of POs demonstrate their adaptability and the potential of digital technologies to improve support services, despite some challenges. Future digitalization strategies should focus, among other things, on promoting digital literacy to ensure the accessibility and inclusiveness of digital services. Trial Registration: OSF Registries, https://osf.io/anvf4 ", doi="10.2196/58566", url="https://www.jmir.org/2024/1/e58566", url="http://www.ncbi.nlm.nih.gov/pubmed/39705075" } @Article{info:doi/10.2196/57580, author="Ahmed, Nisar and Hall, Alex and Poku, Brenda and McDermott, Jane and Astbury, Jayne and Todd, Chris", title="Experiences and Views of Older Adults of South Asian, Black African, and Caribbean Backgrounds About the Digitalization of Primary Care Services Since the COVID-19 Pandemic: Qualitative Focus Group Study", journal="JMIR Form Res", year="2024", month="Dec", day="18", volume="8", pages="e57580", keywords="digital health and primary care services", keywords="digital exclusion", keywords="digital divide", keywords="health inequalities", keywords="older adults", keywords="South Asian", keywords="Black African", keywords="Caribbean", keywords="COVID-19 pandemic", keywords="qualitative focus group study", abstract="Background: The COVID-19 pandemic from 2020 to 2022 prompted governments worldwide to enforce lockdowns and social restrictions, alongside the rapid adoption of digital health and care services. However, there are concerns about the potential exclusion of older adults, who face barriers to digital inclusion, such as age, socioeconomic status, literacy level, and ethnicity. Objective: This study aims to explore the experiences of older adults from the 3 largest minoritized ethnic groups in England and Wales---people of South Asian, Black African, and Caribbean backgrounds---in the use of digitalized primary care services since the beginning of the COVID-19 pandemic. Methods: In total, 27 individuals participated in 4 focus groups (April and May 2023) either in person or via online videoconferencing. Patient and public involvement and engagement were sought through collaboration with community organizations for focus group recruitment and feedback on the topic guide. Data were analyzed using framework analysis. Results: This paper summarizes the perspectives of 27 older adults from these 3 minoritized ethnic groups and identifies four key themes: (1) service accessibility through digital health (participants faced difficulties accessing digital health care services through online platforms, primarily due to language barriers and limited digital skills, with reliance on younger family members or community organizations for assistance; the lack of digital literacy among older community members was a prominent concern, and digital health care services were felt to be tailored for English speakers, with minimal consultation during the development phase), (2) importance of face-to-face (in-person) appointments for patient-clinician interactions (in-person appointments were strongly preferred, emphasizing the value of physical interaction and connection with health care professionals; video consultations were seen as an acceptable alternative), (3) stressors caused by the shift to remote access (the transition to remote digital access caused stress, fear, and anxiety; participants felt that digital health solutions were imposed without sufficient explanation or consent; and Black African and Caribbean participants reported experiences of racial discrimination within the health care system), and (4) digital solutions (evaluating technology acceptance; participants acknowledged the importance of digitalization but cautioned against viewing it as a one-size-fits-all solution; they advocated for offline alternatives and a hybrid approach, emphasizing the need for choice and a well-staffed clinical workforce). Conclusions: Digital health initiatives should address the digital divide, health inequalities, and the specific challenges faced by older adults, particularly those from minoritized ethnic backgrounds, ensuring accessibility, choice, and privacy. Overcoming language barriers involves more than mere translation. Maintaining in-person options for consultations, addressing sensitive issues, and implementing support systems at the practice level to support those struggling to access services are vital. This study recommends that policy makers ensure the inclusivity of older adults from diverse backgrounds in the design and implementation of digital health and social care services. ", doi="10.2196/57580", url="https://formative.jmir.org/2024/1/e57580", url="http://www.ncbi.nlm.nih.gov/pubmed/39693146" } @Article{info:doi/10.2196/54092, author="Na, Kilhoe and Zimdars, Melissa and Cullinan, E. Megan", title="Understanding Membership in Alternative Health Social Media Groups and Its Association with COVID-19 and Influenza Vaccination: Web-Based Cross-Sectional Survey", journal="JMIR Form Res", year="2024", month="Dec", day="5", volume="8", pages="e54092", keywords="alternative health", keywords="social media", keywords="misinformation", keywords="vaccination", keywords="COVID-19", keywords="Coronavirus", abstract="Background: Social media platforms have become home to numerous alternative health groups where people share health information and scientifically unproven treatments. Individuals share not only health information but also health misinformation in alternative health groups on social media. Yet, little research has been carried out to understand members of these groups. This study aims to better understand various characteristics of members in alternative health groups and the association between membership and attitudes toward vaccination and COVID-19 and influenza vaccination--related behaviors. Objective: This study aims to test hypotheses about different potential characteristics of members in alternative health groups and the association between membership and attitudes toward vaccination and vaccine-related behaviors. Methods: A web-based cross-sectional survey (N=1050) was conducted. Participants were recruited from 19 alternative health social media groups and Amazon's Mechanical Turk. A total of 596 participants were members of alternative health groups and 454 were nonmembers of alternative health groups. Logistic regressions were performed to test the hypotheses about the relationship between membership and the variables of interest. Results: Logistic regression revealed that there is a positive association between alternative health social media group membership and 3 personal characteristics: sharing trait (B=.83, SE=.11; P<.01; odds ratio [OR] 2.30, 95\% CI 1.85-2.86), fear of negative evaluations (B=.19, SE=.06; P<.001, OR 1.21, 95\% CI 1.06-1.37), and conspiratorial mentality (B=.33, SE=.08; P<.01; OR 1.40, 95\% CI 1.18-1.65). Also, the results indicate that there is a negative association between membership and 2 characteristics: health literacy (B=--1.09, SE=.17; P<.001; OR .33, 95\% CI 0.23-0.47) and attitudes toward vaccination (B=-- 2.33, SE=.09; P=.02; OR 0.79, 95\% CI 0.65-0.95). However, there is no association between membership and health consciousness (B=.12, SE=.10; P=.24; OR 1.13, 95\% CI 0.92-1.38). Finally, membership is negatively associated with COVID-19 vaccination status (B=--.84, SE=.17; P<.001; OR 48, 95\% CI 0.32-0.62), and influenza vaccination practice (B=--1.14, SE=.17; P<.001; OR .31, 95\% CI 0.22-0.45). Conclusions: Our findings indicate that people joining alternative health social media groups differ from nonmembers in different aspects, such as sharing, fear of negative evaluations, conspiratorial mentality, and health literacy. They also suggest that there is a significant relationship between membership and vaccination. By more thoroughly exploring the demographic, or by better understanding the people for whom interventions are designed, this study is expected to help researchers to more strategically and effectively develop and implement interventions. ", doi="10.2196/54092", url="https://formative.jmir.org/2024/1/e54092" } @Article{info:doi/10.2196/65541, author="Qiu, Yuanbo and Huang, Huang and Gai, Junjie and De Leo, Gianluca", title="The Effects of the COVID-19 Pandemic on Age-Based Disparities in Digital Health Technology Use: Secondary Analysis of the 2017-2022 Health Information National Trends Survey", journal="J Med Internet Res", year="2024", month="Dec", day="4", volume="26", pages="e65541", keywords="age-based disparities", keywords="health equity", keywords="digital health technology use", keywords="digital divide", keywords="health policy", keywords="COVID-19", keywords="mobile phone", abstract="Background: The COVID-19 pandemic accelerated the adoption of digital health technology, but it could also impact age-based disparities as existing studies have pointed out. Compared with the pre-pandemic period, whether the rapid digitalization of the health care system during the pandemic widened the age-based disparities over a long period remains unclear. Objective: This study aimed to analyze the long-term effects of the COVID-19 pandemic on the multifaceted landscape of digital health technology used across diverse age groups among US citizens. Methods: We conducted the retrospective observational study using the 2017-2022 Health Information National Trends Survey to identify the influence of the COVID-19 pandemic on a wide range of digital health technology use outcomes across various age groups. The sample included 15,505 respondents, which were categorized into 3 age groups: adults (18-44 years), middle-aged adults (45-64 years), and older adults (more than 65 years). We also designated the time point of March 11, 2020, to divide the pre- and post-pandemic periods. Based on these categorizations, multivariate linear probability models were used to assess pre-post changes in digital health technology use, controlling for demographic, socioeconomic, and health-related variables among different age groups. Results: Essentially, older adults were found to be significantly less likely to use digital health technology compared with adults, with a 26.28\% lower likelihood of using the internet for health information (P<.001) and a 32.63\% lower likelihood of using health apps (P<.001). The usage of digital health technology for all age groups had significantly increased after the onset of the pandemic, and the age-based disparities became smaller in terms of using the internet to look for health information. However, the disparities have widened for older adults in using the internet to look up test results (11.21\%, P<.001) and make appointments (10.03\%, P=.006) and using wearable devices to track health (8.31\%, P=.01). Conclusions: Our study reveals a significant increase in the use of digital health technology among all age groups during the pandemic. However, while the disparities in accessing online information have narrowed, age-based disparities, particularly for older adults, have widened in most areas such as looking up test results and making appointments with doctors. Therefore, older adults are more likely left behind by the rapidly digitalized US health care system during the pandemic. Policy makers and health care providers should focus on addressing these disparities to ensure equitable access to digital health resources for US baby boomers. ", doi="10.2196/65541", url="https://www.jmir.org/2024/1/e65541" } @Article{info:doi/10.2196/52871, author="B{\'e}chard, Beno{\^i}t and Gramaccia, A. Julie and Gagnon, Dominique and Laouan-Sidi, Anassour Elhadji and Dub{\'e}, {\`E}ve and Ouimet, Mathieu and de Hemptinne, Delphine and Tremblay, S{\'e}bastien", title="The Resilience of Attitude Toward Vaccination: Web-Based Randomized Controlled Trial on the Processing of Misinformation", journal="JMIR Form Res", year="2024", month="Dec", day="4", volume="8", pages="e52871", keywords="attitude toward vaccination", keywords="misinformation", keywords="reinformation", keywords="confidence", keywords="perceived tentativeness", keywords="vaccine hesitancy", keywords="COVID-19", abstract="Background: Before the COVID-19 pandemic, it was already recognized that internet-based misinformation and disinformation could influence individuals to refuse or delay vaccination for themselves, their families, or their children. Reinformation, which refers to hyperpartisan and ideologically biased content, can propagate polarizing messages on vaccines, thereby contributing to vaccine hesitancy even if it is not outright disinformation. Objective: This study aimed to evaluate the impact of reinformation on vaccine hesitancy. Specifically, the goal was to investigate how misinformation presented in the style and layout of a news article could influence the perceived tentativeness (credibility) of COVID-19 vaccine information and confidence in COVID-19 vaccination. Methods: We conducted a web-based randomized controlled trial by recruiting English-speaking Canadians aged 18 years and older from across Canada through the Qualtrics (Silver Lake) paid opt-in panel system. Participants were randomly assigned to 1 of 4 distinct versions of a news article on COVID-19 vaccines, each featuring variations in writing style and presentation layout. After reading the news article, participants self-assessed the tentativeness of the information provided, their confidence in COVID-19 vaccines, and their attitude toward vaccination in general. Results: The survey included 537 participants, with 12 excluded for not meeting the task completion time. The final sample comprised 525 participants distributed about equally across the 4 news article versions. Chi-square analyses revealed a statistically significant association between general attitude toward vaccination and the perceived tentativeness of the information about COVID-19 vaccines included in the news article ($\chi$21=37.8, P<.001). The effect size was small to moderate, with Cramer V=0.27. An interaction was found between vaccine attitude and writing style ($\chi$21=6.2, P=.01), with a small effect size, Cramer V=0.11. In addition, a Pearson correlation revealed a significant moderate to strong correlation between perceived tentativeness and confidence in COVID-19 vaccination, r(523)=0.48, P<.001. The coefficient of determination (r2) was 0.23, indicating that 23\% of the variance in perceived tentativeness was explained by confidence in COVID-19 vaccines. In comparing participants exposed to a journalistic-style news article with those exposed to an ideologically biased article, Cohen d was calculated to be 0.38, indicating a small to medium effect size for the difference in the perceived tentativeness between these groups. Conclusions: Exposure to a news article conveying misinformation may not be sufficient to change an individual's level of vaccine hesitancy. The study reveals that the predominant factor in shaping individuals' perceptions of COVID-19 vaccines is their attitude toward vaccination in general. This attitude also moderates the influence of writing style on perceived tentativeness; the stronger one's opposition to vaccines, the less pronounced the impact of writing style on perceived tentativeness. International Registered Report Identifier (IRRID): RR2-10.2196/41012 ", doi="10.2196/52871", url="https://formative.jmir.org/2024/1/e52871" } @Article{info:doi/10.2196/48882, author="Lungu, Adrian Daniel and R{\o}islien, Jo and Smeets, Ionica and Wiig, Siri and Br{\o}nnick, Kallesten Kolbj{\o}rn", title="Individual Characteristics in the Comprehension of Pandemic Video Communication: Randomized Controlled Between-Subjects Design", journal="J Med Internet Res", year="2024", month="Dec", day="4", volume="26", pages="e48882", keywords="video communication", keywords="COVID-19 pandemic", keywords="comprehension", keywords="health literacy", keywords="video", keywords="videos", keywords="health communication", keywords="psychology", keywords="perception", keywords="comprehend", keywords="understanding", keywords="coronavirus disease 2019", abstract="Background: Video played an important role in health communication throughout the COVID-19 pandemic. It was used to communicate pandemic information to the public, with a variety of formats, presenters, and topics. Evidence regarding the effectiveness of video features is available, while how individual characteristics of recipients influence communication comprehension is still limited. Objective: This study aimed to test 6 individual characteristics and assess their effect on the comprehension of pandemic video communication. Methods: Short health communication videos were presented to a large sample of subjects, receiving questionnaire responses from 1194 participants. Individual characteristics consisted of age, sex, living area, education level, income level, and belief in science. Communication comprehension consisted of both perceived and objective comprehension. The data were analyzed by multiple linear regression. Results: Age had a negative effect on both perceived and objective comprehension---age was negatively associated with comprehension. There were sex differences, with higher perceived comprehension and lower objective comprehension among female than male individuals. Living in an urban or a rural area had no significant effect (all P>.05). The level of education and income had a positive effect on both subjective and objective comprehension. Finally, the belief in science had a positive effect on perceived comprehension (P<.001) but did not have a statistically significant effect on objective comprehension (P=.87). Conclusions: The main differences between those who think they understand pandemic communication and those who comprehend it better are sex (female individuals have a higher perception of having comprehended, while male individuals have higher levels of objective comprehension) and belief in science (higher belief in science leads to higher perceived comprehension, while it does not have any impact on objectively understanding the message conveyed). ", doi="10.2196/48882", url="https://www.jmir.org/2024/1/e48882" } @Article{info:doi/10.2196/60461, author="Golsong, Konstanze and Kaufmann, Luisa and Baldofski, Sabrina and Kohls, Elisabeth and Rummel-Kluge, Christine", title="Acceptability, User Satisfaction, and Feasibility of an App-Based Support Service During the COVID-19 Pandemic in a Psychiatric Outpatient Setting: Prospective Longitudinal Observational Study", journal="JMIR Form Res", year="2024", month="Dec", day="4", volume="8", pages="e60461", keywords="mental health", keywords="eHealth", keywords="app", keywords="health care", keywords="app-based support", keywords="psychiatric symptoms", keywords="mobile phone", keywords="COVID-19", abstract="Background: Patients with mental disorders often have difficulties maintaining a daily routine, which can lead to exacerbated symptoms. It is known that apps can help manage mental health in a low-threshold way and can be used in therapeutic settings to complement existing therapies. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of an app-based support service specifically developed for outpatients with severe mental disorders in addition to regular face-to-face therapy during the COVID-19 pandemic. Methods: Patients in a psychiatric outpatient department at a German university hospital were invited to use an app-based support service designed transdiagnostically for mental disorders for 4 weeks. The app included 7 relaxation modules, consisting of video, audio, and psychoeducational text; ecological momentary assessment--like questionnaires on daily mood answered via a visual smiley-face scale; and an activity button to record and encourage daily activities. Standardized questionnaires at baseline (T0; preintervention time point) and after 4 weeks (T2; postintervention time point) were analyzed. Feedback via the smiley-face scale was provided after using the app components (T1; during the intervention). Measures included depressive symptoms, quality of life, treatment credibility and expectancy, and satisfaction. Furthermore, participation rates, use of app modules and the activity button, and daily mood and the provided feedback were analyzed (T2). Results: In total, 57 patients participated in the study, and the data of 38 (67\%) were analyzed; 17 (30\%) dropped out. Satisfaction with the app was high, with 53\% (30/57) of the participants stating being rather satisfied or satisfied. Furthermore, 79\% (30/38) of completers stated they would be more likely or were definitely likely to use an app-based support service again and recommend it. Feasibility and acceptability were high, with nearly half (18/38, 47\%) of the completers trying relaxation modules and 71\% (27/38) regularly responding to the ecological momentary assessment--like questionnaire between 15 and 28 times (mean 19.91, SD 7.57 times). The activity button was used on average 12 (SD 15.72) times per completer, and 58\% (22/38) felt ``definitely'' or ``rather'' encouraged to perform the corresponding activities. Depressive symptomatology improved significantly at the postintervention time point (P=.02). Quality of life showed a nonsignificant increase in the physical, psychological, and social domains (P=.59, P=.06, and P=.42, respectively) and a significant improvement in the environment domain (P=.004). Treatment credibility and expectancy scores were moderate and significantly decreased at T2 (P=.02 and P<.001, respectively). Posttreatment expectancy scores were negatively associated with posttreatment depressive symptomatology (r=--0.36; P=.03). Conclusions: App-based programs seem to be an accessible tool for stabilizing patients with severe mental disorders, supporting them in maintaining a daily routine, complementing existing face-to-face treatments, and overall helping respond to challenging situations such as the COVID-19 pandemic. ", doi="10.2196/60461", url="https://formative.jmir.org/2024/1/e60461", url="http://www.ncbi.nlm.nih.gov/pubmed/39630503" } @Article{info:doi/10.2196/57718, author="Jagomast, Tobias and Finck, Jule and Tangemann-M{\"u}nstedt, Imke and Auth, Katharina and Dr{\"o}mann, Daniel and Franzen, F. Klaas", title="Google Trends Assessment of Keywords Related to Smoking and Smoking Cessation During the COVID-19 Pandemic in 4 European Countries: Retrospective Analysis", journal="Online J Public Health Inform", year="2024", month="Dec", day="3", volume="16", pages="e57718", keywords="internet", keywords="coronavirus", keywords="COVID-19", keywords="SARS-CoV-2", keywords="pandemics", keywords="public health", keywords="smoking cessation", keywords="tobacco products", keywords="Google Trends", keywords="relative search volume", keywords="Europe", keywords="online", keywords="search", keywords="smoking", keywords="addiction", keywords="quit", keywords="cessation", keywords="trend", keywords="cluster", keywords="public interest", keywords="lockdown", keywords="vaccination", keywords="spread", keywords="incidence", abstract="Background: Smoking is a modifiable risk factor for SARS-CoV-2 infection. Evidence of smoking behavior during the pandemic is ambiguous. Most investigations report an increase in smoking. In this context, Google Trends data monitor real-time public information--seeking behavior and are therefore useful to characterize smoking-related interest over the trajectory of the pandemic. Objective: This study aimed to use Google Trends data to evaluate the effect of the pandemic on public interest in smoking-related topics with a focus on lockdowns, vaccination campaigns, and incidence. Methods: The weekly relative search volume was retrieved from Google Trends for England, Germany, Italy, and Spain from December 31, 2017, to April 18, 2021. Data were collected for keywords concerning consumption, cessation, and treatment. The relative search volume before and during the pandemic was compared, and general trends were evaluated using the Wilcoxon rank-sum test. Short-term changes and hereby temporal clusters linked to lockdowns or vaccination campaigns were addressed by the flexible spatial scan statistics proposed by Takahashi and colleagues. Subsequently, the numbers of clusters after the onset of the pandemic were compared by chi-square test. Results: Country-wise minor differences were observed while 3 overarching trends prevailed. First, regarding cessation, the statistical comparison revealed a significant decline in interest for 58\% (7/12) of related keywords, and fewer clusters were present during the pandemic. Second, concerning consumption, significantly reduced relative search volume was observed for 58\% (7/12) of keywords, while treatment-related keywords exhibited heterogeneous trends. Third, substantial clusters of increased interest were sparsely linked to lockdowns, vaccination campaigns, or incidence. Conclusions: This study reports a substantial decline in overall relative search volume and clusters for cessation interest. These results underline the importance of intensifying cessation aid during times of crisis. Lockdowns, vaccination, and incidence had less impact on information-seeking behavior. Other public measures that positively affect smoking behavior remain to be determined. ", doi="10.2196/57718", url="https://ojphi.jmir.org/2024/1/e57718", url="http://www.ncbi.nlm.nih.gov/pubmed/39626237" } @Article{info:doi/10.2196/53430, author="Richardson, Leanne and Noori, Nihal and Fantham, Jack and Timlin, Gregor and Siddle, James and Godec, Thomas and Taylor, Mike and Baum, Charles", title="Personalized Smartphone-Enabled Assessment of Blood Pressure and Its Treatment During the SARS-CoV-2 COVID-19 Pandemic in Patients From the CURE-19 Study: Longitudinal Observational Study", journal="JMIR Mhealth Uhealth", year="2024", month="Dec", day="3", volume="12", pages="e53430", keywords="digital diary", keywords="hypertension", keywords="blood pressure", keywords="remote monitoring", keywords="smartphone app", keywords="mobile phone", keywords="app", keywords="monitoring", keywords="COVID-19", keywords="SARS-CoV-2", keywords="digital intervention", keywords="management", keywords="observational study", keywords="deployment", keywords="feasibility", keywords="use", keywords="safety", keywords="medication", keywords="symptoms", keywords="community", keywords="systolic", keywords="diastolic", keywords="utilization", abstract="Background: The use of digital interventions by patients for remote monitoring and management of health and disease is increasing. This observational study examined the feasibility, use, and safety of a digital smartphone app for routine monitoring of blood pressure (BP), medication, and symptoms of COVID-19 during the COVID-19 pandemic. Objective: The objective of this study was to deploy and test electronic data recording using a smartphone app developed for routine monitoring of BP in patients with primary hypertension. We tested the app for ease of data entry in BP management and tracking symptoms of new-onset COVID-19 to determine if participants found this app approach useful and sustainable. Methods: This remote, decentralized, 12-week, prospective, observational study was conducted in a community setting within the United States. Participants were approached and recruited from affiliated sites where they were enrolled in an ongoing remote decentralized study (CURE-19) of participants experiencing the COVID-19 pandemic. Potential participants were asked to complete a digital screener to determine eligibility and given informed consent forms to read and consent to using the Curebase digital platform. Following enrollment, participants downloaded the digital app to their smartphones for all data collection. Participants recorded daily BP, associated medication use, and emergent symptoms associated with SARS-CoV-2 infection. In addition, usability (adherence, acceptability, and user experience) was assessed using standard survey questions. Adverse events were collected based on participant self-report. Compliance and engagement were determined from user data entry rates. Feasibility and participant feedback were assessed upon study completion using the User Experience Questionnaire. Results: Of the 389 participants who enrolled in and completed the study, 380 (98\%) participants downloaded and entered BP routines in week 1. App engagement remained high; 239 (62.9\%) of the 380 participants remained in the study for the full 12-week observation period, and 201 (84.1\%) of the 239 participants entered full BP routines into the digital app 80\% or more of the time. The smartphone app scored an overall positive evaluation as assessed by the User Experience Questionnaire and was benchmarked as ``excellent'' for domains of perspicuity, efficiency, and dependability and ``above average'' for domains of attractiveness and stimulation. Highly adherent participants with hypertension demonstrated well-controlled BP, with no significant changes in average systolic or diastolic BP between week 1 and week 12 (all P>.05). Participants were able to record BP medications and symptoms of SARS-CoV-2 infection. No adverse events attributable to the use of the smartphone app were reported during the observational period. Conclusions: The high retention, engagement and acceptability and positive feedback in this study demonstrates that routine monitoring of BP and medications using a smartphone app is feasible for patients with hypertension in a community setting. Remote monitoring of BP and data collection could be coupled with hypertensive medication in a combination product (drug+digital) for precision management of hypertension. ", doi="10.2196/53430", url="https://mhealth.jmir.org/2024/1/e53430" } @Article{info:doi/10.2196/60574, author="Charles, Lesley and Tang, Eileen and Tian, Jaminal Peter George and Chan, Karenn and Br{\'e}mault-Phillips, Suzette and Dobbs, Bonnie and Vokey, Camelia and Polard, Sharna and Parmar, Jasneet", title="Characteristics, Barriers, and Facilitators of Virtual Decision-Making Capacity Assessments During the COVID-19 Pandemic: Online Survey", journal="JMIR Form Res", year="2024", month="Nov", day="25", volume="8", pages="e60574", keywords="decision making capacity", keywords="mental competency", keywords="aged", keywords="mobile applications", keywords="mobile phone", keywords="Canada", keywords="covid-19", keywords="pandemics", keywords="dementia", keywords="survey", keywords="virtual capacity assessment", keywords="characteristics", keywords="barriers", keywords="facilitators", keywords="virtual decision making", keywords="assessment", abstract="Background: With a growing older adult population, the number of persons with dementia is expected to rise. Consequently, the number of persons needing decision-making capacity assessments (DMCA) will increase. The COVID-19 pandemic has impacted how we deliver patient care including DMCAs with a much more rapid shift to virtual assessments. Virtual DMCAs offer patients and health care professionals distinct advantages over in-person delivery by improving reach, access, and timely provision of health care. However, questions have arisen as to whether DMCAs can be effectively conducted virtually. Objective: This study aimed to determine the characteristics, barriers, and facilitators of conducting virtual DMCA during the COVID-19 pandemic. Methods: We conducted an online survey among health care providers who perform DMCAs in Alberta from March 2022 to February 2023. The survey consisted of 25 questions on demographics, preferences, and experience in conducting DMCAs virtually, and risks and barriers to doing virtual DMCAs. The data were analyzed using descriptive statistics. Results: There were 31 respondents with a mean age of 51.1 (SD 12.7) years. The respondents consisted of physicians (45.2\%, 14/31), occupational therapists (29\%, 9/31), and social workers (16.1\%, 5/31), with a majority (93.6\%, 29/31) based in Edmonton. The mean number of years of experience conducting DMCAs was 12.3 (SD 10.7), with a median of 8 DMCAs (IQR 18.5) conducted per year. Most respondents conduct capacity interviews, with a majority (55.2\%, 16/29) being associated primarily with acute care services. Furthermore, 54.8\% (17/31) were interested in conducting DMCAs virtually; however, only 25.8\% (8/31) had administered DMCAs virtually. Barriers and facilitators to virtual DMCAs relate to patients' characteristics and environment (such as communication difficulties, hearing or visual impairment, language barriers, ease of use of technology, or cognitive impairment), technology and technical support (need for technical support in both the client's and assessor's sides, the unreliability of internet connection in rural settings, and the availability of high-fidelity equipment), and assessors' ability to perform DMCA's virtually (ability to observe body language, interact with the client physically when needed, and build rapport can all be affected when conducting a DMCA virtually). In terms of implications for clinical practice, it is recommended that the patient or caregiver be familiar with technology, have a stable internet connection, use a private room, not be recorded, use a standardized assessment template, and have a backup plan in case of technical difficulties. Conclusions: Conducting DMCAs virtually is a relatively infrequent undertaking. Barriers and facilitators to adequate assessment need to be addressed given that virtual assessments are time-saving and expand reach. ", doi="10.2196/60574", url="https://formative.jmir.org/2024/1/e60574", url="http://www.ncbi.nlm.nih.gov/pubmed/39585735" } @Article{info:doi/10.2196/59138, author="Kang, Ye Ji and Jung, Weon and Kim, Ji Hyun and An, Hyun Ji and Yoon, Hee and Kim, Taerim and Chang, Hansol and Hwang, Yeon Sung and Park, Eun Jong and Lee, Tak Gun and Cha, Chul Won and Heo, Sejin and Lee, Uk Se", title="Temporary Telemedicine Policy and Chronic Disease Management in South Korea: Retrospective Analysis Using National Claims Data", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="20", volume="10", pages="e59138", keywords="telemedicine", keywords="public health", keywords="medication adherence", keywords="COVID-19", keywords="chronic diseases", abstract="Background: Since its introduction, telemedicine for patients with chronic diseases has been studied in various clinical settings. However, there is limited evidence of the effectiveness and medical safety of the nationwide adoption of telemedicine. Objective: This study aimed to analyze the effects of telemedicine on chronic diseases during the COVID-19 pandemic under a temporary telemedicine policy in South Korea using national claims data. Methods: Health insurance claims data were extracted over 2 years: 1 year before (from February 24, 2019, to February 23, 2020) and 1 year after the policy was implemented (from February 24, 2020, to February 23, 2021). We included all patients who used telemedicine at least once in the first year after the policy was implemented and compared them with a control group of patients who never used telemedicine. The comparison focused on health care use; the medication possession ratio (MPR); and admission rates to general wards (GWs), emergency departments (EDs), and intensive care units (ICUs) using difference-in-differences analysis. A total of 4 chronic diseases were targeted: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and common mental disorders. Results: A total of 1,773,454 patients with hypertension; 795,869 patients with DM; 37,460 patients with COPD; and 167,084 patients with common mental disorders were analyzed in this study. Patients diagnosed with hypertension or DM showed increased MPRs without an increase in GW, ED, or ICU admission rates during the policy year. Moreover, patients in the DM group who did not use telemedicine had higher rates of ED, GW, and ICU admissions, and patients in the hypertension group had higher rates of GW or ICU admissions after 1 year of policy implementation. This trend was not evident in COPD and common mental disorders. Conclusions: The temporary telemedicine policy was effective in increasing medication adherence and reducing admission rates for patients with hypertension and DM; however, the efficacy of the policy was limited for patients with COPD and common mental disorders. Future studies are required to demonstrate the long-term effects of telemedicine policies with various outcome measures reflecting disease characteristics. ", doi="10.2196/59138", url="https://publichealth.jmir.org/2024/1/e59138" } @Article{info:doi/10.2196/44580, author="Cornelis, Justien and Christiaens, Wendy and de Meester, Christophe and Mistiaen, Patriek", title="Remote Patient Monitoring at Home in Patients With COVID-19: Narrative Review", journal="JMIR Nursing", year="2024", month="Nov", day="19", volume="7", pages="e44580", keywords="COVID-19", keywords="coronavirus disease", keywords="telemonitoring", keywords="remote patient monitoring", keywords="review", keywords="pandemic", keywords="at-home monitoring", keywords="implementation", keywords="health care", keywords="patient care", abstract="Background: During the pandemic, health care providers implemented remote patient monitoring (RPM) for patients experiencing COVID-19. RPM is an interaction between health care professionals and patients who are in different locations, in which certain patient functioning parameters are assessed and followed up for a certain duration of time. The implementation of RPM in these patients aimed to reduce the strain on hospitals and primary care. Objective: With this literature review, we aim to describe the characteristics of RPM interventions, report on patients with COVID-19 receiving RPM, and provide an overview of outcome variables such as length of stay (LOS), hospital readmission, and mortality. Methods: A combination of different searches in several database types (traditional databases, trial registers, daily [Google] searches, and daily PubMed alerts) was run daily from March 2020 to December 2021. A search update for randomized controlled trials (RCTs) was performed in April 2022. Results: The initial search yielded more than 4448 articles (not including daily searches). After deduplication and assessment for eligibility, 241 articles were retained describing 164 telemonitoring studies from 160 centers. None of the 164 studies covering 248,431 patients reported on the presence of a randomized control group. Studies described a ``prehosp'' group (96 studies) with patients who had a suspected or confirmed COVID-19 diagnosis and who were not hospitalized but closely monitored at home or a ``posthosp'' group (32 studies) with patients who were monitored at home after hospitalization for COVID-19. Moreover, 34 studies described both groups, and in 2 studies, the description was unclear. In the prehosp and posthosp groups, there were large variations in the number of emergency department (ED) visits (0\%-36\% and 0\%-16\%, respectively) and no convincing evidence that RPM leads to less or more ED visits or hospital readmissions (0\%-30\% and 0\%-22\%, respectively). Mortality was generally low, and there was weak to no evidence that RPM is associated with lower mortality. Moreover, there was no evidence that RPM shortens previous LOS. A literature update identified 3 small-scale RCTs, which could not demonstrate statistically significant differences in these outcomes. Most papers claimed savings; however, the scientific base for these claims was doubtful. The overall patient experiences with RPM were positive, as patients felt more reassured, although many patients declined RPM for several reasons (eg, technological embarrassment, digital literacy). Conclusions: Based on these results, there is no convincing evidence that RPM in COVID-19 patients avoids ED visits or hospital readmissions and shortens LOS or reduces mortality. On the other hand, there is no evidence that RPM has adverse outcomes. Further research should focus on developing, implementing, and evaluating an RPM framework. ", doi="10.2196/44580", url="https://nursing.jmir.org/2024/1/e44580", url="http://www.ncbi.nlm.nih.gov/pubmed/39287362" } @Article{info:doi/10.2196/49708, author="Phadnis, Rachael and Perera, Udara and Lea, Veronica and Davlin, Stacy and Lee, Juliette and Siesel, Casey and Abeygunathilaka, Dhanushka and Wickramasinghe, C. S.", title="Designing and Validating a Survey for National-Level Data During the COVID-19 Pandemic in Sri Lanka: Cross-Sectional Mobile Phone Surveys", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e49708", keywords="pilot study", keywords="mobile phone survey", keywords="survey methodology", keywords="COVID-19", keywords="data collection", keywords="national survey", keywords="pandemic", keywords="population-based study", keywords="Sri Lanka", keywords="middle-income countries", keywords="low-income countries", keywords="vaccine acceptability", keywords="vaccine", keywords="COVID-19 vaccination", abstract="Background: The COVID-19 pandemic has generated a demand for timely data, resulting in a surge of mobile phone surveys for tracking the impacts of and responses to the pandemic. Mobile phone surveys have become a preferred mode of data collection across low- and middle-income countries. Objective: This study piloted 2 population-based, cross-sectional mobile phone surveys among Sri Lankan residents in 2020 and 2021 during the COVID-19 pandemic. The surveys aimed to gather data on knowledge, attitudes, and practices, vaccine acceptability, availability, and barriers to COVID-19 testing, and use of a medicine distribution service. Methods: The study used Surveda, an open-source survey tool developed by the NCD (noncommunicable disease) Mobile Phone Survey Data 4 Health Initiative, for data collection and management. The surveys were conducted through interactive voice response using automated, prerecorded messages in Sinhala, Tamil, and English. The sample design involved random sampling of mobile phone numbers, stratified by sex, proportional to the general population. Eligibility criteria varied between surveys, targeting adults aged 35 years and older with any noncommunicable disease for the first survey and all adults for the second survey. The data were adjusted to population estimates, and statistical analysis was conducted using SAS (SAS Institute) and R software (R Core Team). Descriptive statistics, Rao-Scott chi-square tests, and z tests were used to analyze the data. Response rates, cooperation rates, and productivity of the sampling approach were calculated. Results: In the first survey, n=5001, the overall response rate was 7.5\%, with a completion rate of 85.6\%. In the second survey, n=1250, the overall response rate was 10.9\%, with a completion rate of 61.9\%. Approximately 3 out of 4 adults reported that they avoided public places (888/1175, 75.6\%), more than two-thirds avoided public transportation (808/1173, 68.9\%), and 9 out of 10 practiced physical distancing (1046/1167, 89.7\%). Approximately 1 out of 10 Sri Lankan persons reported being tested for COVID-19, and the majority of those received a polymerase chain reaction test (112/161, 70\%). Significantly more males than females reported being tested for COVID-19 (98/554, 17.8\% vs 61/578, 10.6\%, respectively; P<.001). Finally, the majority of adult Sri Lankan people reported that they definitely or probably would get the COVID-19 vaccination (781/1190, 65.7\%). Conclusions: The surveys revealed that, overall, the adult Sri Lankan population adhered to COVID-19 mitigation strategies. These findings underscore the use of mobile phone surveys in swiftly and easily providing essential data to inform a country's response during the COVID-19 pandemic, obviating the need for face-to-face data collection. ", doi="10.2196/49708", url="https://formative.jmir.org/2024/1/e49708" } @Article{info:doi/10.2196/60000, author="Chen, En-ling and Bai, Chyi-Huey and Kocis, T. Paul and Hwang, Wenke", title="The Perspectives of Community Pharmacists Toward the Name-Based Rationing System During the COVID-19 Pandemic in Taiwan: Cross-Sectional Survey Study", journal="JMIR Form Res", year="2024", month="Oct", day="24", volume="8", pages="e60000", keywords="name-based rationing system", keywords="NBRS", keywords="community pharmacy", keywords="community pharmacist", keywords="COVID-19", keywords="SARS-CoV-2", keywords="KAP", keywords="knowledge, attitude, and practices", keywords="public health", keywords="health emergencies", keywords="government strategy", keywords="mobile phone", abstract="Background: In Taiwan's public health system, community-based pharmacists are key first-line health care providers due to their high accessibility. During the COVID-19 pandemic, the pharmacists played a central role in the distribution of these supplies through the Name-Based Rationing System (NBRS), during an acute shortage of masks and testing kits, that helped reduce the spread of the disease. The NBRS, an innovative government-guided strategy developed after the COVID-19 outbreak, provided equitable and convenient access to masks and COVID-19 test kits. Objective: This study aimed to investigate (1) Taiwanese pharmacists' knowledge, attitude, and practices (KAPs) of COVID-19, with the intention to assess their preparedness for public health emergencies and their capabilities to implement COVID-19--related policies effectively; (2) their perspectives toward the NBRS; and (3) the association between individual's KAP and corresponding perspectives toward the NBRS. Methods: A cross-sectional, web-based survey was conducted in 2 major cities in Taiwan, from June 18 to September 11, 2022, during the peak of the COVID-19 pandemic. To gauge community pharmacists' KAP, a 66-question instrument was developed using guidelines from the Taiwanese Centers for Disease Control, the International Pharmaceutical Federation, and the Taiwanese Pharmacist Association. The instrument's internal consistency reliability was ascertained using Cronbach $\alpha$ (0.819), and its content validity was verified by field experts. Results: Overall, 343 Taiwanese community pharmacists were recruited in the study. Among them, 88\% (303/343) scored high on knowledge domain questions related to SARS-CoV-2; 58\% (201/343) and 39\% (136/343) held positive and neutral attitudes toward COVID-19--related policies, respectively; and 77\% (266/343) practiced infectious disease prevention measures in compliance with official guidelines. The results demonstrated a high level of competency in pharmacists in a public health crisis. It revealed that factors including age, pharmacy characteristics, and the number of customers were associated with their perceptions and willingness to continuously participate in the NBRS. Overall, the community pharmacists showed greater support for the COVID-19--testing NBRS compared with the mask NBRS, because of the more favorable influence on the revenue and workforce of the pharmacies and the well-being of the pharmacists. Responses also highlighted concerns about rapid government policy changes and supply dynamics, underscoring the importance of effective communication and considering supply availability in facilitating a successful NBRS. Conclusions: The strong KAP of the community pharmacists justified the government leveraging their expertise in Taiwan's COVID-19 response. While community pharmacies have proven to be essential distribution centers through the NBRS, improving community connections, communication with the government, and supply management are recommended to strengthen the system. These potential approaches aim to ensure successful NBRS implementation and better preparedness for future public health emergencies. Overall, pharmacists have demonstrated their integral role in achieving equitable outcomes and their dedication to public health efforts during crises. ", doi="10.2196/60000", url="https://formative.jmir.org/2024/1/e60000" } @Article{info:doi/10.2196/58242, author="Kilaberia, R. Tina and Hu, Yuanyuan and Bell, F. Janice", title="Habit and Help---Experiences of Technology Use During the COVID-19 Pandemic: Interview Study Among Older Adults", journal="JMIR Form Res", year="2024", month="Oct", day="18", volume="8", pages="e58242", keywords="pandemic", keywords="older people", keywords="technology habit", keywords="subjective experience", keywords="acceptance of technology", abstract="Background: The COVID-19 pandemic compelled older adults to engage with technology to a greater extent given emergent public health observance and home-sheltering restrictions in the United States. This study examined subjective experiences of technology use among older adults as a result of unforeseen and widespread public health guidance catalyzing their use of technology differently, more often, or in new ways. Objective: This study aimed to explore whether older adults scoring higher on the Unified Theory of Acceptance and Use of Technology questionnaire fared better in aspects of technology use, and reported better subjective experiences, in comparison with those scoring lower. Methods: A qualitative study using prevalence and thematic analyses of data from 18 older adults (mean age 79 years) in 2 groups: 9 scoring higher and 9 scoring lower on the Unified Theory of Acceptance and Use of Technology questionnaire. Results: Older adults were fairly competent technology users across both higher- and lower-scoring groups. The higher-scoring group noted greater use of technology in terms of telehealth and getting groceries and household items. Cognitive difficulty was described only among the lower-scoring group; they used technology less to get groceries and household items and to obtain health information. Qualitative themes depict the role of habit in technology use, enthusiasm about technology buttressed by the protective role of technology, challenges in technology use, and getting help regardless of technology mastery. Conclusions: Whereas the pandemic compelled older adults to alter or increase technology use, it did not change their global outlook on technology use. Older adults' prepandemic habits of technology use and available help influenced the degree to which they made use of technology during the COVID-19 pandemic. ", doi="10.2196/58242", url="https://formative.jmir.org/2024/1/e58242", url="http://www.ncbi.nlm.nih.gov/pubmed/39422990" } @Article{info:doi/10.2196/50396, author="Szeto, D. Mindy and Laughter, R. Melissa and Maymone, C. Mayra B. and Patel, M. Payal and Sivesind, E. Torunn and Presley, L. Colby and Lada, M. Steven and Pulsipher, J. Kayd and De La Garza, Henriette and Dellavalle, P. Robert", title="Gender Representation in Authorship of Academic Dermatology Publications During the COVID-19 Pandemic: Cross-Sectional Study", journal="JMIR Dermatol", year="2024", month="Oct", day="16", volume="7", pages="e50396", keywords="women", keywords="gender", keywords="representation", keywords="authorship", keywords="academic", keywords="leadership", keywords="diversity", keywords="equity", keywords="inclusion", keywords="dermatology", keywords="journals", keywords="publications", keywords="COVID-19", keywords="pandemic", keywords="bibliometric", doi="10.2196/50396", url="https://derma.jmir.org/2024/1/e50396" } @Article{info:doi/10.2196/55697, author="Hirschtick, L. Jana and Slocum, Elizabeth and Xie, Yanmei and Power, E. Laura and Elliott, R. Michael and Orellana, C. Robert and Fleischer, L. Nancy", title="Associations Between Acute COVID-19 Symptom Profiles and Long COVID Prevalence: Population-Based Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Oct", day="1", volume="10", pages="e55697", keywords="SARS-CoV-2", keywords="COVID-19", keywords="post-acute COVID-19 syndrome", keywords="epidemiology", keywords="surveillance", abstract="Background: Growing evidence suggests that severe acute COVID-19 illness increases the risk of long COVID (also known as post--COVID-19 condition). However, few studies have examined associations between acute symptoms and long COVID onset. Objective: This study aimed to examine associations between acute COVID-19 symptom profiles and long COVID prevalence using a population-based sample. Methods: We used a dual mode (phone and web-based) population-based probability survey of adults with polymerase chain reaction--confirmed SARS-CoV-2 between June 2020 and May 2022 in the Michigan Disease Surveillance System to examine (1) how acute COVID-19 symptoms cluster together using latent class analysis, (2) sociodemographic and clinical predictors of symptom clusters using multinomial logistic regression accounting for classification uncertainties, and (3) associations between symptom clusters and long COVID prevalence using modified Poisson regression. Results: In our sample (n=4169), 15.9\% (n=693) had long COVID, defined as new or worsening symptoms at least 90 days post SARS-CoV-2 infection. We identified 6 acute COVID-19 symptom clusters resulting from the latent class analysis, with flu-like symptoms (24.7\%) and fever (23.6\%) being the most prevalent in our sample, followed by nasal congestion (16.4\%), multi-symptomatic (14.5\%), predominance of fatigue (10.8\%), and predominance of shortness of breath (10\%) clusters. Long COVID prevalence was highest in the multi-symptomatic (39.7\%) and predominance of shortness of breath (22.4\%) clusters, followed by the flu-like symptom (15.8\%), predominance of fatigue (14.5\%), fever (6.4\%), and nasal congestion (5.6\%) clusters. After adjustment, females (vs males) had greater odds of membership in the multi-symptomatic, flu-like symptom, and predominance of fatigue clusters, while adults who were Hispanic or another race or ethnicity (vs non-Hispanic White) had greater odds of membership in the multi-symptomatic cluster. Compared with the nasal congestion cluster, the multi-symptomatic cluster had the highest prevalence of long COVID (adjusted prevalence ratio [aPR] 6.1, 95\% CI 4.3?8.7), followed by the predominance of shortness of breath (aPR 3.7, 95\% CI 2.5?5.5), flu-like symptom (aPR 2.8, 95\% CI 1.9?4.0), and predominance of fatigue (aPR 2.2, 95\% CI 1.5?3.3) clusters. Conclusions: Researchers and clinicians should consider acute COVID-19 symptom profiles when evaluating subsequent risk of long COVID, including potential mechanistic pathways in a research context, and proactively screen high-risk patients during the provision of clinical care. ", doi="10.2196/55697", url="https://publichealth.jmir.org/2024/1/e55697" } @Article{info:doi/10.2196/53767, author="Dominguez-Rodriguez, Alejandro and Sanz-Gomez, Sergio and Gonz{\'a}lez Ram{\'i}rez, Patricia Leivy and Herdoiza-Arroyo, Erika Paulina and Trevino Garcia, Edith Lorena and de la Rosa-G{\'o}mez, Anabel and Gonz{\'a}lez-Cantero, Omar Joel and Macias-Aguinaga, Valeria and Arenas Landgrave, Paulina and Ch{\'a}vez-Valdez, Margarita Sarah", title="Evaluation and Future Challenges in a Self-Guided Web-Based Intervention With and Without Chat Support for Depression and Anxiety Symptoms During the COVID-19 Pandemic: Randomized Controlled Trial", journal="JMIR Form Res", year="2024", month="Sep", day="30", volume="8", pages="e53767", keywords="self-guided web-based intervention", keywords="chat support", keywords="depression", keywords="anxiety", keywords="COVID-19", keywords="opinion", keywords="usability", keywords="randomized control trial", abstract="Background: The COVID-19 pandemic has had an impact on mental health worldwide. Low- and middle-income countries were largely affected by it. Mexico was one of the most affected countries. Extended periods of lockdowns, isolation, and social distancing, among other factors, highlighted the need to introduce web-based psychological interventions to the Mexican population. In this context, Mental Health COVID-19 emerged as a self-guided web-based intervention (SGWI) aimed at adults to improve mental health during the COVID-19 pandemic. Objective: This study aims to assess the efficacy of 2 modalities of a self-guided intervention (with and without chat support) in reducing depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation. In addition, it aimed to compare the moderating role of coping strategies, acceptance, and satisfaction in participants' symptom reduction. We hypothesize that the self-guided, chat-supported modality will show higher efficacy than the modality without chat support in achieving clinical change and better performance as a moderator of depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation, as well as an increase in participants' satisfaction and acceptability. Methods: A randomized controlled trial was conducted. Data were collected from May 2020 to June 2022. We performed intrasubject measures at 4 evaluation periods: pretest, posttest, and follow-up measurements at 3 and 6 months. Differences between intervention groups were assessed through the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables. Changes due to intervention were analyzed using Wilcoxon W test. Moderated regression analysis was performed to test the hypothesized moderating role of coping strategies, usability, and opinion about treatment on clinical change. Results: A total of 36 participants completed the intervention; of these, 5 (14\%) were part of the SGWI group, and 31 (86\%) were on the SGWI plus chat support (SGWI+C) group, which included a chat service with therapists. The perceived high complexity of the system for the SGWI group had a moderating effect associated with a lack of efficacy of the intervention regarding depression, but not when controlled for sociodemographic variables. A perception of lower helpfulness of the intervention was associated with poorer outcomes. Coping strategies did not show moderating effects. Conclusions: Enhancing the utility of web-based interventions for reducing clinical symptoms by incorporating a support chat to boost treatment adherence seemed to improve the perception of the intervention's usefulness. Web-based interventions face several challenges, such as eliminating complexities in platform use and increasing the users' perceived utility of the intervention, among other issues identified in the study. Trial Registration: ClinicalTrials.gov NCT04468893; https://clinicaltrials.gov/study/NCT04468893?tab=results International Registered Report Identifier (IRRID): RR2-10.2196/23117 ", doi="10.2196/53767", url="https://formative.jmir.org/2024/1/e53767" } @Article{info:doi/10.2196/51237, author="Escobar-Agreda, Stefan and Silva-Valencia, Javier and Soto-Becerra, Percy and Reategui-Rivera, Mahony C. and De la Cruz-Torralva, Kelly and Chahuara-Rojas, Max and Hernandez-Iriarte, Bruno and Espinoza-Herrera, Hector Daniel and Delgado, Alberto Carlos and Matassini, Silvana and Vargas-Herrera, Javier and Rojas-Mezarina, Leonardo", title="Patient Engagement With and Perceptions of the COVIDA Project, a Volunteer-Led Telemonitoring and Teleorientation Service for COVID-19 Community Management: Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Sep", day="13", volume="8", pages="e51237", keywords="telemonitoring", keywords="volunteers", keywords="engagement", keywords="COVID-19", keywords="Peru", keywords="telehealth", keywords="perceptions", abstract="Background: During the pandemic in Peru, the COVIDA (Collaboration Network of Volunteer Brigade Members for the Investigation, Detection, and Primary Management of Community Cases Affected by COVID-19) project proposed an innovative way to provide telemonitoring and teleorientation to COVID-19 patients, led by health care student volunteers. However, it has not been described how this interaction is perceived from the patient's perspective and which factors increase their engagement with this service. Objective: The aim of this study is to describe the perceptions of patients about COVIDA and identify factors associated with their engagement with this service. Methods: A mixed methods study was conducted to evaluate perceptions of patients that participated in the COVIDA project. This telehealth intervention organized by the National University of San Marcos was implemented in Peru from August to December 2020. The service involved daily phone calls by volunteer students to monitor registered COVID-19 patients until the completion of the 14th day of the illness or if a warning sign was identified. The volunteers also provided teleorientation to address the patients' needs and concerns. Quantitative analysis was performed to describe the characteristics of the patients and to assess the factors related to their engagement with the service, which was defined by the percentage of participants who completed the follow-up according to their individual schedule. Qualitative analysis through semistructured interviews evaluated the patients' perceptions of the service regarding the aspects of communication, interaction, and technology. Results: Of the 770 patients enrolled in COVIDA, 422 (55.7\%) were female; the median age was 39 (IQR 28-52) years. During the monitoring, 380 patients (49.4\%) developed symptoms, and 471 (61.2\%) showed warning signs of COVID-19. The overall median for engagement was 93\% (IQR 35.7\%-100\%). Among those patients who did not develop warning signs, engagement was associated with the presence of symptoms (OR 3.04, 95\% CI 2.22-4.17), a positive COVID-19 test at the start of follow-up (OR 1.97, 95\% CI 1.48-2.61), and the presence of comorbidities (OR 1.83, 95\% CI 1.29-2.59). Patients reported that the volunteers provided clear and valuable information and emotional support. Communication via phone calls took place smoothly and without interruptions. Conclusions: COVIDA represents a well-accepted and well-perceived alternative model for student volunteers to provide telemonitoring, teleorientation, and emotional support to patients with COVID-19 in the context of overwhelmed demand for health care services. The deployment of this kind of intervention should be prioritized among patients with symptoms and comorbidities, as they show more engagement with these services. ", doi="10.2196/51237", url="https://formative.jmir.org/2024/1/e51237" } @Article{info:doi/10.2196/53978, author="Abascal Miguel, Luc{\'i}a and Forster, Maeve and Gallalee, Sarah and Carson, Mariam and Fieldhouse, K. Jane and Keir, Alexandra and Maya, Sigal and Rahman, Sabahat and Reid, A. Michael J. and Vasilopoulos, Hariclea and Lima Sanchez, Nimbe Dania", title="Bridging Language Barriers in COVID-19 Research: Descriptive Study of AccesoCovid.com's Reach and User Engagement", journal="JMIR Form Res", year="2024", month="Sep", day="9", volume="8", pages="e53978", keywords="COVID-19 research dissemination", keywords="multilingual scientific platform", keywords="language barriers in science", keywords="Spanish scientific communication", keywords="equitable access to research", keywords="global health equity", abstract="Background: The COVID-19 pandemic underscored the challenge of swiftly disseminating research findings to a global audience. Language barriers further exacerbated disparities in access to timely scientific information, particularly for non-English speaking communities. The majority of COVID-19 research was published in English, limiting accessibility for Spanish-speaking populations. Objective: This paper aims to assess the reach and effectiveness of AccesoCovid.com, a platform designed to disseminate up-to-date COVID-19 research in both English and Spanish, addressing the language gap in scientific communication. Methods: AccesoCovid.com was developed through a partnership between the University of California, San Francisco (UCSF) and Universidad Nacional Aut{\'o}noma de M{\'e}xico (UNAM). The website's performance and user engagement were evaluated using Google Analytics over a span of 2 years. Key metrics included user language preference, geographical distribution, and site traffic. The website summarized and translated 1032 articles on various COVID-19 topics, such as ``Pharmaceutical Interventions and Vaccines.'' Results: From February 2021 to February 2023, the platform attracted 57,000 users. Of the 43,000 unique new visitors, 84.2\% (n=36,219) hailed from Spanish-speaking regions. The majority accessed the site organically through search engines, with 88.4\% (n=38,000) of users arriving this way, while 5000 (11.6\%) users accessed the site directly. Most users (n=30,894, 72.1\%) preferred the Spanish version of the site. The website's most accessed category was ``Pharmaceutical Interventions and Vaccines,'' followed by ``Clinical Presentation and Management'' and ``Mental Health.'' Regarding language distribution, 72.1\% (n=30,894) of users primarily used Spanish; 21.4\% (n=9215) used English; and 6.7\% (n=2891) spoke other languages, including Portuguese, Chinese, and German. Geographically, the website attracted visitors from 179 countries, with the highest visitor counts from Mexico (n=12,342, 28.7\%), Spain (n=6405, 14.9\%), the United States (n=4416, 10.3\%), and Peru (n=3821, 8.9\%). Conclusions: AccesoCovid.com successfully bridged a critical language gap in the dissemination of COVID-19 research. Its success underscores the pressing need for multilingual scientific resources. The platform demonstrated significant user engagement and reach, particularly in Spanish-speaking countries. This highlights the potential for similar platforms to ensure equitable access to scientific knowledge across diverse linguistic communities. Future efforts should focus on expanding to other languages and conducting formal evaluations to enhance user satisfaction and impact. ", doi="10.2196/53978", url="https://formative.jmir.org/2024/1/e53978", url="http://www.ncbi.nlm.nih.gov/pubmed/39250219" } @Article{info:doi/10.2196/52120, author="Victoria-Castro, Maria Angela and Arora, Tanima and Simonov, Michael and Biswas, Aditya and Alausa, Jameel and Subair, Labeebah and Gerber, Brett and Nguyen, Andrew and Hsiao, Allen and Hintz, Richard and Yamamoto, Yu and Soufer, Robert and Desir, Gary and Wilson, Perry Francis and Villanueva, Merceditas", title="Promoting Collaborative Scholarship During the COVID-19 Pandemic Through an Innovative COVID-19 Data Explorer and Repository at Yale School of Medicine: Development and Usability Study", journal="JMIR Form Res", year="2024", month="Sep", day="3", volume="8", pages="e52120", keywords="COVID-19", keywords="database", keywords="data access", keywords="interdepartmental communication", keywords="collaborative scholarship", keywords="clinical data", keywords="repository", keywords="researchers", keywords="large-scale database", keywords="innovation", abstract="Background: The COVID-19 pandemic sparked a surge of research publications spanning epidemiology, basic science, and clinical science. Thanks to the digital revolution, large data sets are now accessible, which also enables real-time epidemic tracking. However, despite this, academic faculty and their trainees have been struggling to access comprehensive clinical data. To tackle this issue, we have devised a clinical data repository that streamlines research processes and promotes interdisciplinary collaboration. Objective: This study aimed to present an easily accessible up-to-date database that promotes access to local COVID-19 clinical data, thereby increasing efficiency, streamlining, and democratizing the research enterprise. By providing a robust database, a broad range of researchers (faculty and trainees) and clinicians from different areas of medicine are encouraged to explore and collaborate on novel clinically relevant research questions. Methods: A research platform, called the Yale Department of Medicine COVID-19 Explorer and Repository (DOM-CovX), was constructed to house cleaned, highly granular, deidentified, and continually updated data from over 18,000 patients hospitalized with COVID-19 from January 2020 to January 2023, across the Yale New Haven Health System. Data across several key domains were extracted including demographics, past medical history, laboratory values during hospitalization, vital signs, medications, imaging, procedures, and outcomes. Given the time-varying nature of several data domains, summary statistics were constructed to limit the computational size of the database and provide a reasonable data file that the broader research community could use for basic statistical analyses. The initiative also included a front-end user interface, the DOM-CovX Explorer, for simple data visualization of aggregate data. The detailed clinical data sets were made available for researchers after a review board process. Results: As of January 2023, the DOM-CovX Explorer has received 38 requests from different groups of scientists at Yale and the repository has expanded research capability to a diverse group of stakeholders including clinical and research-based faculty and trainees within 15 different surgical and nonsurgical specialties. A dedicated DOM-CovX team guides access and use of the database, which has enhanced interdepartmental collaborations, resulting in the publication of 16 peer-reviewed papers, 2 projects available in preprint servers, and 8 presentations in scientific conferences. Currently, the DOM-CovX Explorer continues to expand and improve its interface. The repository includes up to 3997 variables across 7 different clinical domains, with continued growth in response to researchers' requests and data availability. Conclusions: The DOM-CovX Data Explorer and Repository is a user-friendly tool for analyzing data and accessing a consistently updated, standardized, and large-scale database. Its innovative approach fosters collaboration, diversity of scholarly pursuits, and expands medical education. In addition, it can be applied to other diseases beyond COVID-19. ", doi="10.2196/52120", url="https://formative.jmir.org/2024/1/e52120" } @Article{info:doi/10.2196/53389, author="Luong, Nguyen and Mark, Gloria and Kulshrestha, Juhi and Aledavood, Talayeh", title="Sleep During the COVID-19 Pandemic: Longitudinal Observational Study Combining Multisensor Data With Questionnaires", journal="JMIR Mhealth Uhealth", year="2024", month="Sep", day="3", volume="12", pages="e53389", keywords="computational social science", keywords="digital health", keywords="COVID-19", keywords="sleep", keywords="longitudinal", keywords="wearables", keywords="surveys", keywords="observational study", keywords="isolation", keywords="sleep patterns", keywords="sleep pattern", keywords="questionnaires", keywords="Finland", keywords="fitness trackers", keywords="fitness tracker", keywords="wearable", keywords="sleeping habits", keywords="sleeping habit", keywords="work from home", abstract="Background: The COVID-19 pandemic prompted various containment strategies, such as work-from-home policies and reduced social contact, which significantly altered people's sleep routines. While previous studies have highlighted the negative impacts of these restrictions on sleep, they often lack a comprehensive perspective that considers other factors, such as seasonal variations and physical activity (PA), which can also influence sleep. Objective: This study aims to longitudinally examine the detailed changes in sleep patterns among working adults during the COVID-19 pandemic using a combination of repeated questionnaires and high-resolution passive measurements from wearable sensors. We investigate the association between sleep and 5 sets of variables: (1) demographics; (2) sleep-related habits; (3) PA behaviors; and external factors, including (4) pandemic-specific constraints and (5) seasonal variations during the study period. Methods: We recruited working adults in Finland for a 1-year study (June 2021-June 2022) conducted during the late stage of the COVID-19 pandemic. We collected multisensor data from fitness trackers worn by participants, as well as work and sleep-related measures through monthly questionnaires. Additionally, we used the Stringency Index for Finland at various points in time to estimate the degree of pandemic-related lockdown restrictions during the study period. We applied linear mixed models to examine changes in sleep patterns during this late stage of the pandemic and their association with the 5 sets of variables. Results: The sleep patterns of 27,350 nights from 112 working adults were analyzed. Stricter pandemic measures were associated with an increase in total sleep time (TST) ($\beta$=.003, 95\% CI 0.001-0.005; P<.001) and a delay in midsleep (MS) ($\beta$=.02, 95\% CI 0.02-0.03; P<.001). Individuals who tend to snooze exhibited greater variability in both TST ($\beta$=.15, 95\% CI 0.05-0.27; P=.006) and MS ($\beta$=.17, 95\% CI 0.03-0.31; P=.01). Occupational differences in sleep pattern were observed, with service staff experiencing longer TST ($\beta$=.37, 95\% CI 0.14-0.61; P=.004) and lower variability in TST ($\beta$=--.15, 95\% CI --0.27 to --0.05; P<.001). Engaging in PA later in the day was associated with longer TST ($\beta$=.03, 95\% CI 0.02-0.04; P<.001) and less variability in TST ($\beta$=--.01, 95\% CI --0.02 to 0.00; P=.02). Higher intradaily variability in rest activity rhythm was associated with shorter TST ($\beta$=--.26, 95\% CI --0.29 to --0.23; P<.001), earlier MS ($\beta$=--.29, 95\% CI --0.33 to --0.26; P<.001), and reduced variability in TST ($\beta$=--.16, 95\% CI --0.23 to --0.09; P<.001). Conclusions: Our study provided a comprehensive view of the factors affecting sleep patterns during the late stage of the pandemic. As we navigate the future of work after the pandemic, understanding how work arrangements, lifestyle choices, and sleep quality interact will be crucial for optimizing well-being and performance in the workforce. ", doi="10.2196/53389", url="https://mhealth.jmir.org/2024/1/e53389", url="http://www.ncbi.nlm.nih.gov/pubmed/39226100" } @Article{info:doi/10.2196/45689, author="Lanza, T. Stephanie and Whetzel, Courtney and Bhandari, Sandesh", title="Health and Well-Being Among College Students in the United States During the COVID-19 Pandemic: Daily Diary Study", journal="Interact J Med Res", year="2024", month="Aug", day="23", volume="13", pages="e45689", keywords="daily diary", keywords="college student", keywords="young adult", keywords="mental health", keywords="substance use", keywords="stress", keywords="well-being", keywords="belonging", abstract="Background: There is evidence that anxiety and stress increased among college students during the COVID-19 pandemic. However, less is known about daily experiences of affect, worry, substance use behaviors, experiences of pleasure, concern over food security, experiences of bias or discrimination, feelings of belongingness, and other indicators of well-being and how they vary across days in this population. Objective: This study surveyed a wide range of indicators of health and well-being in daily life over 21 days with a sample of college students in a large university system in the United States during the pandemic. The overall variance in each daily measure was partitioned to reflect the proportion due to (1) between-person differences versus (2) within-person, day-to-day variability. This is important because measures that vary primarily due to between-person differences may be more amenable to interventions that target particular students, whereas measures that vary more due to day-to-day variability may be more amenable to interventions that target day-level contextual factors. Methods: A sample of 2068 young adult college students (aged 18-24, mean 19.8, SD 1.3 years; 66.6\% women) completed a baseline survey; 97.3\% (n=2012) then completed up to 21 consecutive daily surveys that assessed a comprehensive set of daily markers of health, behavior, and well-being. The daily diary study produced a total of 33,722 person-days. Results: Among all person-days, a minority were substance use days (eg, 14.5\% of days involved alcohol use, 5.6\% vaping, and 5.5\% cannabis). Experiences of pleasure were reported on most (73.5\%) days. Between-person differences explained more than 50\% of the variance in numerous indicators of health and well-being, including daily vaping, cannabis use, other illicit substance use, experiences of bias or discrimination, positive affect, negative affect, worry, food insecurity, and feelings of belonging at the university. In contrast, within-person differences explained more than 50\% of the variance in daily alcohol use, cigarette use, stress, experiences of pleasure, where the student slept last night, and physical activity. Conclusions: College student health and well-being are multifaceted, with some aspects likely driven by person-level characteristics and experiences and other aspects by more dynamic, contextual risk factors that occur in daily life. These findings implicate services and interventions that should target individual students versus those that should target days on which students are at high risk for poor experiences or behaviors. ", doi="10.2196/45689", url="https://www.i-jmr.org/2024/1/e45689", url="http://www.ncbi.nlm.nih.gov/pubmed/39178037" } @Article{info:doi/10.2196/50125, author="Marley, Gifty and Dako-Gyeke, Phyllis and Nepal, Prajwol and Rajgopal, Rohini and Koko, Evelyn and Chen, Elizabeth and Nuamah, Kwabena and Osei, Kingsley and Hofkirchner, Hubertus and Marks, Michael and Tucker, D. Joseph and Eggo, Rosalind and Ampofo, William and Sylvia, Sean", title="Collective Intelligence--Based Participatory COVID-19 Surveillance in Accra, Ghana: Pilot Mixed Methods Study", journal="JMIR Infodemiology", year="2024", month="Aug", day="12", volume="4", pages="e50125", keywords="information markets", keywords="participatory disease surveillance", keywords="collective intelligence", keywords="community engagement", keywords="the wisdom of the crowds", keywords="Ghana", keywords="mobile phone", abstract="Background: Infectious disease surveillance is difficult in many low- and middle-income countries. Information market (IM)--based participatory surveillance is a crowdsourcing method that encourages individuals to actively report health symptoms and observed trends by trading web-based virtual ``stocks'' with payoffs tied to a future event. Objective: This study aims to assess the feasibility and acceptability of a tailored IM surveillance system to monitor population-level COVID-19 outcomes in Accra, Ghana. Methods: We designed and evaluated a prediction markets IM system from October to December 2021 using a mixed methods study approach. Health care workers and community volunteers aged ?18 years living in Accra participated in the pilot trading. Participants received 10,000 virtual credits to trade on 12 questions on COVID-19--related outcomes. Payoffs were tied to the cost estimation of new and cumulative cases in the region (Greater Accra) and nationwide (Ghana) at specified future time points. Questions included the number of new COVID-19 cases, the number of people likely to get the COVID-19 vaccination, and the total number of COVID-19 cases in Ghana by the end of the year. Phone credits were awarded based on the tally of virtual credits left and the participant's percentile ranking. Data collected included age, occupation, and trading frequency. In-depth interviews explored the reasons and factors associated with participants' user journey experience, barriers to system use, and willingness to use IM systems in the future. Trading frequency was assessed using trend analysis, and ordinary least squares regression analysis was conducted to determine the factors associated with trading at least once. Results: Of the 105 eligible participants invited, 21 (84\%) traded at least once on the platform. Questions estimating the national-level number of COVID-19 cases received 13 to 19 trades, and obtaining COVID-19--related information mainly from television and radio was associated with less likelihood of trading (marginal effect: ?0.184). Individuals aged <30 years traded 7.5 times more and earned GH {\textcent}134.1 (US \$11.7) more in rewards than those aged >30 years (marginal effect: 0.0135). Implementing the IM surveillance was feasible; all 21 participants who traded found using IM for COVID-19 surveillance acceptable. Active trading by friends with communal discussion and a strong onboarding process facilitated participation. The lack of bidirectional communication on social media and technical difficulties were key barriers. Conclusions: Using an IM system for disease surveillance is feasible and acceptable in Ghana. This approach shows promise as a cost-effective source of information on disease trends in low- and middle-income countries where surveillance is underdeveloped, but further studies are needed to optimize its use. ", doi="10.2196/50125", url="https://infodemiology.jmir.org/2024/1/e50125" } @Article{info:doi/10.2196/56000, author="Palmer, Anna and Sharma, Shaishab and Nagpal, Jayesh and Kimani, Victor and Mai, Florence and Ahmed, Zara", title="Identifying Barriers to the Adoption of Digital Contact Tracing Apps in England: Semistructured Interview Study With Professionals Involved in the Pandemic Response", journal="JMIR Form Res", year="2024", month="Aug", day="12", volume="8", pages="e56000", keywords="COVID-19", keywords="global health", keywords="public health", keywords="qualitative study", keywords="tracing", keywords="England", keywords="apps", keywords="effectiveness", keywords="contact tracing", keywords="barrier", keywords="digital health", keywords="thematic analysis", keywords="privacy", keywords="communication", keywords="social support", keywords="tracing app", keywords="digital illiteracy", keywords="technology", keywords="support", abstract="Background: The NHS (National Health Service) COVID-19 app was a digital contact tracing app (DCTA) used in England in response to the COVID-19 pandemic. The aim of which was to limit the spread of COVID-19 by providing exposure alerts. At the time of the pandemic, questions were raised regarding the effectiveness and cost of the NHS COVID-19 app and whether DCTAs have a role in future pandemics. Objective: This study aims to explore key barriers to DCTAs in England during the COVID-19 pandemic. Methods: This is a qualitative study using semistructured video interviews conducted with professionals in public health, digital health, clinicians, health care law, and health executives who had an active role in the COVID-19 pandemic. These interviews aimed to explore the perspective of different experts involved in the pandemic response and gauge their opinions on the key barriers to DCTAs in England during the COVID-19 pandemic. The initial use of maximum variation sampling combined with a snowball sampling approach ensured diversity within the cohort of interviewees. Interview transcripts were then analyzed using Braun and Clarke's 6 steps for thematic analysis. Results: Key themes that acted as barriers to DCTAs were revealed by interviewees such as privacy concerns, poor communication, technological accessibility, digital literacy, and incorrect use of the NHS COVID-19 app. Interviewees believed that some of these issues stemmed from poor governmental communication and a lack of transparency regarding how the NHS COVID-19 app worked, resulting in decreased public trust. Moreover, interviewees highlighted that a lack of social support integration within the NHS COVID-19 app and delayed app notification period also contributed to the poor adoption rates. Conclusions: Qualitative findings from interviews highlighted barriers to the NHS COVID-19 app, which can be applied to DCTAs more widely and highlight some important implications for the future use of DCTAS. There was no consensus among interviewees as to whether the NHS COVID-19 app was a success; however, all interviewees provided recommendations for improvements in creating and implementing DCTAs in the future. ", doi="10.2196/56000", url="https://formative.jmir.org/2024/1/e56000" } @Article{info:doi/10.2196/53145, author="Philippi, A. Keito F. and Zeier, Peter and Brahmer, Alexandra and Neuberger, I. Elmo W. and Sandner, Magdalena and Hagenah, Matthias and Porten, Thilo and Lenz, Regina and Ochmann, T. David and Wedekink, Florian and Wischhusen, J{\"o}rg and Lutz, Beat and Lieb, Klaus and Wessa, Mich{\`e}le and Simon, Perikles", title="Remote Exercise Training Intervention During the COVID-19 Pandemic: Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Aug", day="8", volume="26", pages="e53145", keywords="physical exercise", keywords="web-based", keywords="COVID-19", keywords="lockdown", keywords="aerobic capacity", keywords="depression", keywords="feasibility", keywords="aerobic", keywords="anxiety", keywords="randomized controlled trial", keywords="prepandemic cohort", keywords="mental health", keywords="pandemic", keywords="remote exercise", keywords="intervention", keywords="pre-COVID-19", keywords="lockdown cohort", keywords="pandemic-related", keywords="adult", keywords="adults", abstract="Background: Societal measures to contain the spread of COVID-19 (eg, lockdown and contact restrictions) have been associated with decreased health and well-being. A multitude of prepandemic studies identified the beneficial effects of physical exercise on both physical and mental health. Objective: We report on the feasibility of a remote physical exercise intervention and its stress-buffering potential in 2 untrained cohorts: a pre--COVID-19 cohort that completed the intervention in 2019 and a lockdown cohort that started the intervention shortly before pandemic-related restrictions were implemented. Methods: In a randomized controlled trial, participants were assigned to either an intervention group (IG; pre--COVID-19 cohort: n=7 and lockdown cohort: n=9) or a control group (CG; pre--COVID-19 cohort: n=6 and lockdown cohort: n=6). IG participants received weekly individualized training recommendations delivered via web-based support. The intervention period was initially planned for 8 weeks, which was adhered to in the pre--COVID-19 cohort (mean 8.3, SD 0.5 weeks) but was extended to an average of 17.7 (SD 2.0) weeks in the lockdown cohort. Participants' health parameters were assessed before and after the intervention: aerobic capacity was measured as peak oxygen uptake (VO2peak) via cardiopulmonary exercise testing. Depressive symptoms were scored via the depression subscale of the Brief Symptom Inventory-18. Results: Dropout rates were low in both cohorts in the IG (pre--COVID-19 cohort: n=0, 0\% and lockdown cohort: n=2, 16.7\%) and the CG (pre--COVID-19 cohort: n=0, 0\% and lockdown cohort: n=2, 20\%). The mean adherence to the training sessions of the IG for both cohorts was 84\% (pre--COVID-19 cohort: SD 5.5\% and lockdown cohort: SD 11.6\%). Aligned rank transform ANOVAs in the lockdown cohort indicated deterioration of VO2peak and depressive symptoms from before to after the intervention in the CG but no longitudinal changes in the IG. Analyses in the pre--COVID-19 cohort revealed significant increases in VO2peak for the IG compared to the CG (P=.04) but no intervention effects on depressive symptoms. Conclusions: With low dropout rates and high adherence, the remote intervention was feasible for healthy adults under regular conditions and in the face of pandemic-related stressors. Moreover, our results hint at a stress-buffering effect as well as a buffering of a lockdown-induced deconditioning of remote physical exercise interventions in the pandemic scenario, which can be used in future studies to overcome equally stressful periods of life. However, due to limited statistical power, these findings should be replicated in similar scenarios. Trial Registration: German Clinical Trials Register DRKS00018078; https://drks.de/search/en/trial/DRKS00018078 ", doi="10.2196/53145", url="https://www.jmir.org/2024/1/e53145" } @Article{info:doi/10.2196/49073, author="Nagpal, S. Meghan and Jalali, Niloofar and Sherifali, Diana and Morita, P. Plinio and Cafazzo, A. Joseph", title="Managing Type 2 Diabetes During the COVID-19 Pandemic: Scoping Review and Qualitative Study Using Systematic Literature Review and Reddit", journal="Interact J Med Res", year="2024", month="Aug", day="8", volume="13", pages="e49073", keywords="type 2 diabetes", keywords="social media", keywords="patient-generated health data", keywords="big data", keywords="machine learning", keywords="natural language processing", keywords="COVID-19, COVID-19 stress syndrome, health behaviors", keywords="Reddit", keywords="qualitative", keywords="analysis", keywords="diabetes", keywords="scoping review", abstract="Background: The COVID-19 pandemic impacted how people accessed health services and likely how they managed chronic conditions such as type 2 diabetes (T2D). Social media forums present a source of qualitative data to understand how adaptation might have occurred from the perspective of the patient. Objective: Our objective is to understand how the care-seeking behaviors and attitudes of people living with T2D were impacted during the early part of the pandemic by conducting a scoping literature review. A secondary objective is to compare the findings of the scoping review to those presented on a popular social media platform Reddit. Methods: A scoping review was conducted in 2021. Inclusion criteria were population with T2D, studies are patient-centered, and study objectives are centered around health behaviors, disease management, or mental health outcomes during the COVID-19 pandemic. Exclusion criteria were populations with other noncommunicable diseases, examining COVID-19 as a comorbidity to T2D, clinical treatments for COVID-19 among people living with T2D, genetic expressions of COVID-19 among people living with T2D, gray literature, or studies not published in English. Bias was mitigated by reviewing uncertainties with other authors. Data extracted from the studies were classified into thematic categories. These categories reflect the findings of this study as per our objective. Data from the Reddit forums related to T2D from March 2020 to early March 2021 were downloaded, and support vector machines were used to classify if a post was published in the context of the pandemic. Latent Dirichlet allocation topic modeling was performed to gather topics of discussion specific to the COVID-19 pandemic. Results: A total of 26 studies conducted between February and September 2020, consisting of 13,673 participants, were included in this scoping literature review. The studies were qualitative and relied mostly on qualitative data from surveys or questionnaires. Themes found from the literature review were ``poorer glycemic control,'' ``increased consumption of unhealthy foods,'' ``decreased physical activity,'' ``inability to access medical appointments,'' and ``increased stress and anxiety.'' Findings from latent Dirichlet allocation topic modeling of Reddit forums were ``Coping With Poor Mental Health,'' ``Accessing Doctor \& Medications and Controlling Blood Glucose,'' ``Changing Food Habits During Pandemic,'' ``Impact of Stress on Blood Glucose Levels,'' ``Changing Status of Employment \& Insurance,'' and ``Risk of COVID Complications.'' Conclusions: Topics of discussion gauged from the Reddit forums provide a holistic perspective of the impact of the pandemic on people living with T2D, which were found to be comparable to the findings of the literature review. The study was limited by only having 1 reviewer for the literature review, but biases were mitigated by consulting authors when there were uncertainties. Qualitative analysis of Reddit forms can supplement traditional qualitative studies of the behaviors of people living with T2D. ", doi="10.2196/49073", url="https://www.i-jmr.org/2024/1/e49073" } @Article{info:doi/10.2196/51120, author="Markovic, Andjela and Kovacevic, Vladimir and Brakenhoff, B. Timo and Veen, Duco and Klaver, Paul and Mitratza, Marianna and Downward, S. George and Grobbee, E. Diederick and Cronin, Maureen and Goodale, M. Brianna and ", title="Physiological Response to the COVID-19 Vaccine: Insights From a Prospective, Randomized, Single-Blinded, Crossover Trial", journal="J Med Internet Res", year="2024", month="Jul", day="31", volume="26", pages="e51120", keywords="wearable technology", keywords="biosignals", keywords="digital health", keywords="SARS-CoV-2", keywords="vaccine reactogenicity", keywords="menstrual cycle", keywords="vaccine", keywords="wearables", keywords="sex", keywords="development", keywords="implementation", keywords="medical device", keywords="breathing rate", keywords="heart rate", keywords="biological mechanism", keywords="immune response", keywords="vaccination", abstract="Background: Rapid development and implementation of vaccines constituted a crucial step in containing the COVID-19 pandemic. A comprehensive understanding of physiological responses to these vaccines is important to build trust in medicine. Objective: This study aims to investigate temporal dynamics before and after COVID-19 vaccination in 4 physiological parameters as well as the duration of menstrual cycle phases. Methods: In a prospective trial, 17,825 adults in the Netherlands wore a medical device on their wrist for up to 9 months. The device recorded their physiological signals and synchronized with a complementary smartphone app. By means of multilevel quadratic regression, we examined changes in wearable-recorded breathing rate, wrist skin temperature, heart rate, heart rate variability, and objectively assessed the duration of menstrual cycle phases in menstruating participants to assess the effects of COVID-19 vaccination. Results: The recorded physiological signals demonstrated short-term increases in breathing rate and heart rate after COVID-19 vaccination followed by a prompt rebound to baseline levels likely reflecting biological mechanisms accompanying the immune response to vaccination. No sex differences were evident in the measured physiological responses. In menstruating participants, we found a 0.8\% decrease in the duration of the menstrual phase following vaccination. Conclusions: The observed short-term changes suggest that COVID-19 vaccines are not associated with long-term biophysical issues. Taken together, our work provides valuable insights into continuous fluctuations of physiological responses to vaccination and highlights the importance of digital solutions in health care. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05241-5 ", doi="10.2196/51120", url="https://www.jmir.org/2024/1/e51120" } @Article{info:doi/10.2196/43119, author="Unlu, Ozan and Pikcilingis, Aaron and Letourneau, Jonathan and Landman, Adam and Patel, Rajesh and Shenoy, S. Erica and Hashimoto, Dean and Kim, Marvel and Pellecer, Johnny and Zhang, Haipeng", title="Implementation of a Web-Based Chatbot to Guide Hospital Employees in Returning to Work During the COVID-19 Pandemic: Development and Before-and-After Evaluation", journal="JMIR Form Res", year="2024", month="Jul", day="25", volume="8", pages="e43119", keywords="chatbot", keywords="return to work", keywords="employee", keywords="health care personnel", keywords="COVID-19", keywords="conversational agent", keywords="occupational health", keywords="support service", keywords="health care delivery", keywords="agile methodology", keywords="digital intervention", keywords="digital support", keywords="work policy", keywords="hospital staff", abstract="Background: Throughout the COVID-19 pandemic, multiple policies and guidelines were issued and updated for health care personnel (HCP) for COVID-19 testing and returning to work after reporting symptoms, exposures, or infection. The high frequency of changes and complexity of the policies made it difficult for HCP to understand when they needed testing and were eligible to return to work (RTW), which increased calls to Occupational Health Services (OHS), creating a need for other tools to guide HCP. Chatbots have been used as novel tools to facilitate immediate responses to patients' and employees' queries about COVID-19, assess symptoms, and guide individuals to appropriate care resources. Objective: This study aims to describe the development of an RTW chatbot and report its impact on demand for OHS support services during the first Omicron variant surge. Methods: This study was conducted at Mass General Brigham, an integrated health care system with over 80,000 employees. The RTW chatbot was developed using an agile design methodology. We mapped the RTW policy into a unified flow diagram that included all required questions and recommendations, then built and tested the chatbot using the Microsoft Azure Healthbot Framework. Using chatbot data and OHS call data from December 10, 2021, to February 17, 2022, we compared OHS resource use before and after the deployment of the RTW chatbot, including the number of calls to the OHS hotline, wait times, call length, and time OHS hotline staff spent on the phone. We also assessed Centers for Disease Control and Prevention data for COVID-19 case trends during the study period. Results: In the 5 weeks post deployment, 5575 users used the RTW chatbot with a mean interaction time of 1 minute and 17 seconds. The highest engagement was on January 25, 2022, with 368 users, which was 2 weeks after the peak of the first Omicron surge in Massachusetts. Among users who completed all the chatbot questions, 461 (71.6\%) met the RTW criteria. During the 10 weeks, the median (IQR) number of daily calls that OHS received before and after deployment of the chatbot were 633 (251-934) and 115 (62-167), respectively (U=163; P<.001). The median time from dialing the OHS phone number to hanging up decreased from 28 minutes and 22 seconds (IQR 25:14-31:05) to 6 minutes and 25 seconds (IQR 5:32-7:08) after chatbot deployment (U=169; P<.001). Over the 10 weeks, the median time OHS hotline staff spent on the phone declined from 3 hours and 11 minutes (IQR 2:32-4:15) per day to 47 (IQR 42-54) minutes (U=193; P<.001), saving approximately 16.8 hours per OHS staff member per week. Conclusions: Using the agile methodology, a chatbot can be rapidly designed and deployed for employees to efficiently receive guidance regarding RTW that complies with the complex and shifting RTW policies, which may reduce use of OHS resources. ", doi="10.2196/43119", url="https://formative.jmir.org/2024/1/e43119" } @Article{info:doi/10.2196/53904, author="Roschke, Kristy and Koskan, M. Alexis and Sivanandam, Shalini and Irby, Jonathan", title="Partisan Media, Trust, and Media Literacy: Regression Analysis of Predictors of COVID-19 Knowledge", journal="JMIR Form Res", year="2024", month="Jul", day="24", volume="8", pages="e53904", keywords="COVID-19", keywords="misinformation", keywords="media literacy", keywords="news consumption", keywords="institutional trust", keywords="media", keywords="trust", keywords="prevention", keywords="control", keywords="health care professional", keywords="health care", abstract="Background: The COVID-19 pandemic was a devastating public health event that spurred an influx of misinformation. The increase in questionable health content was aided by the speed and scale of digital and social media and certain news agencies' and politicians' active dissemination of misinformation about the virus. The popularity of certain COVID-19 myths created confusion about effective health protocols and impacted trust in the health care and government sectors deployed to manage the pandemic. Objective: This study explored how people's information habits, their level of institutional trust, the news media outlets they consume and the technologies in which they access it, and their media literacy skills influenced their COVID-19 knowledge. Methods: We administered a web-based survey using Amazon Mechanical Turk (MTurk) to assess US adults' (n=1498) COVID-19 knowledge, media and news habits, media literacy skills, and trust in government and health-related institutions. The data were analyzed using a hierarchical linear regression to examine the association between trust, media literacy, news use, and COVID-19 knowledge. Results: The regression model of demographic variables, political affiliation, trust in institutions, media literacy, and the preference for watching Fox or CNN was statistically significant (R2=0.464; F24,1434=51.653; P<.001; adjusted R2=0.455) in predicting COVID-19 knowledge scores. People who identified as politically conservative, watched Fox News, and reported lower levels of institutional trust and media literacy, scored lower on COVID-19 knowledge questions than those who identified as politically liberal, did not watch Fox News and reported higher levels of institutional trust and media literacy. Conclusions: This study suggests that the media outlets people turn to, their trust in institutions, and their perceived degree of agency to discern credible information can impact people's knowledge of COVID-19, which has potential implications for managing communication in other public health events. ", doi="10.2196/53904", url="https://formative.jmir.org/2024/1/e53904" } @Article{info:doi/10.2196/52278, author="Turzhitsky, Vladimir and Bash, D. Lori and Urman, D. Richard and Kattan, Michael and Hofer, Ira", title="Factors Influencing Neuromuscular Blockade Reversal Choice in the United States Before and During the COVID-19 Pandemic: Retrospective Longitudinal Analysis", journal="JMIR Perioper Med", year="2024", month="Jul", day="22", volume="7", pages="e52278", keywords="neuromuscular blockade", keywords="sugammadex", keywords="neostigmine", keywords="rocuronium, vecuronium, intubation, counterfactual", keywords="anesthesia", keywords="anesthetic", keywords="anesthesiologist", keywords="anesthesiologists", keywords="surgery", keywords="surgical", keywords="preference", keywords="preferences", keywords="retrospective", keywords="utilization", keywords="pattern", keywords="patterns", keywords="trend", keywords="trends", keywords="national", keywords="healthcare database", keywords="healthcare databases", keywords="COVID-19", keywords="time-trend analysis", keywords="neuromuscular", keywords="longitudinal analysis", keywords="longitudinal", keywords="neuromuscular blockade agent", keywords="clinical", keywords="surgical procedure", keywords="inpatient", keywords="inpatient surgery", keywords="retrospective analysis", keywords="USA", keywords="United States", abstract="Background: Neuromuscular blockade (NMB) agents are a critical component of balanced anesthesia. NMB reversal methods can include spontaneous reversal, sugammadex, or neostigmine and the choice of reversal strategy can depend on various factors. Unanticipated changes to clinical practice emerged due to the COVID-19 pandemic, and a better understanding of how NMB reversal trends were affected by the pandemic may help provide insight into how providers view the tradeoffs in the choice of NMB reversal agents. Objective: We aim to analyze NMB reversal agent use patterns for US adult inpatient surgeries before and after the COVID-19 outbreak to determine whether pandemic-related practice changes affected use trends. Methods: A retrospective longitudinal analysis of a large all-payer national electronic US health care database (PINC AI Healthcare Database) was conducted to identify the use patterns of NMB reversal during early, middle, and late COVID-19 (EC, MC, and LC, respectively) time periods. Factors associated with NMB reversal choices in inpatient surgeries were assessed before and after the COVID-19 pandemic reached the United States. Multivariate logistic regression assessed the impact of the pandemic on NMB reversal, accounting for patient, clinical, procedural, and site characteristics. A counterfactual framework was used to understand if patient characteristics affected how COVID-19--era patients would have been treated before the pandemic. Results: More than 3.2 million inpatients experiencing over 3.6 million surgical procedures across 931 sites that met all inclusion criteria were identified between March 1, 2017, and December 31, 2021. NMB reversal trends showed a steady increase in reversal with sugammadex over time, with the trend from January 2018 onwards being linear with time (R2>0.99). Multivariate analysis showed that the post--COVID-19 time periods had a small but statistically significant effect on the trend, as measured by the interaction terms of the COVID-19 time periods and the time trend in NMB reversal. A slight increase in the likelihood of sugammadex reversal was observed during EC relative to the pre--COVID-19 trend (odds ratio [OR] 1.008, 95\% CI 1.003-1.014; P=.003), followed by negation of that increase during MC (OR 0.992, 95\% CI 0.987-0.997; P<.001), and no significant interaction identified during LC (OR 1.001, 95\% CI 0.996-1.005; P=.81). Conversely, active reversal (using either sugammadex or neostigmine) did not show a significant association relative to spontaneous reversal, or a change in trend, during EC or MC (P>.05), though a slight decrease in the active reversal trend was observed during LC (OR 0.987, 95\% CI 0.983-0.992; P<.001). Conclusions: We observed a steady increase in NMB active reversal overall, and specifically with sugammadex compared to neostigmine, during periods before and after the COVID-19 outbreak. Small, transitory alterations in the NMB reversal trends were observed during the height of the COVID-19 pandemic, though these alterations were independent of the underlying NMB reversal time trends. ", doi="10.2196/52278", url="https://periop.jmir.org/2024/1/e52278" } @Article{info:doi/10.2196/50751, author="Hamline, Y. Michelle and Xing, Guibo and Kravitz, L. Richard and Miller, Marykate and Melnikow, Joy", title="Physician and Practice Characteristics Influencing Telemedicine Uptake Among Frontline Clinicians in the Early COVID-19 Pandemic Response: National Survey Study", journal="JMIR Form Res", year="2024", month="Jul", day="17", volume="8", pages="e50751", keywords="telemedicine", keywords="telehealth", keywords="COVID-19 pandemic", keywords="frontline clinicians", keywords="telemonitoring", keywords="frontliners", keywords="virtual care", keywords="influence", keywords="clinician", keywords="physician", keywords="pre-pandemic", keywords="pandemic", keywords="survey", keywords="health outcome", abstract="Background: ?Telemedicine expanded rapidly during the COVID-19 pandemic, as key policy changes, financial support, and pandemic fears tipped the balance toward internet-based care. Despite this increased support and benefits to patients and clinicians, telemedicine uptake was variable across clinicians and practices. Little is known regarding physician and institutional characteristics underlying this variability. Objective: ?This study aimed to evaluate factors influencing telemedicine uptake among frontline physicians in the early pandemic response. Methods: ?We surveyed a national stratified sample of frontline clinicians drawn from the American Medical Association Physician Professional Data in June or July 2020. The survey inquired about the first month and most recent month (June 2020) of pandemic telemedicine use; sample data included clinician gender, specialty, census region, and years in practice. Local pandemic conditions were estimated from county-level data on COVID-19 rates at the time of survey response. Data were analyzed in a weighted logistic regression, controlling for county-specific pandemic data, and weighted to account for survey data stratification and nonresponse. Results: ?Over the first 3-4 months of the pandemic, the proportion of physicians reporting use of telemedicine in >30\% of visits increased from 29.2\% (70/239) to 35.7\% (85/238). Relative to primary care, odds of substantial telemedicine use (>30\%) both during the first month of the pandemic and in June 2020 were increased among infectious disease and critical care physicians and decreased among hospitalists and emergency medicine physicians. At least minimal prepandemic telemedicine use (odds ratio [OR] 11.41, 95\% CI 1.34-97.04) and a high 2-week moving average of local COVID-19 cases (OR 10.16, 95\% CI 2.07-49.97) were also associated with substantial telemedicine use in June 2020. There were no significant differences according to clinician gender, census region, or years in practice. Conclusions: ?Prepandemic telemedicine use, high local COVID-19 case counts, and clinician specialty were associated with higher levels of substantial telemedicine use during the early pandemic response. These results suggest that telemedicine uptake in the face of the pandemic may have been heavily influenced by the level of perceived threat and the resources available for implementation. Such understanding has important implications for reducing burnout and preparation for future public health emergencies. ", doi="10.2196/50751", url="https://formative.jmir.org/2024/1/e50751", url="http://www.ncbi.nlm.nih.gov/pubmed/39018095" } @Article{info:doi/10.2196/51292, author="Peprah, Emmanuel and Amesimeku, Etornam and Angulo, Brian and Chhetri, Himani and Fordjuoh, Judy and Ruan, Christina and Wang, Cong and Patena, John and Vieira, Dorice and Ryan, Nessa and Iloegbu, Chukwuemeka and Gyamfi, Joyce and Odumegwu, Jonathan", title="How College Students Used Information From Institutions of Higher Education in the United States During COVID-19: Web-Based Cross-Sectional Survey Study", journal="JMIR Form Res", year="2024", month="Jun", day="17", volume="8", pages="e51292", keywords="COVID-19", keywords="pandemic", keywords="public health", keywords="preventative", keywords="prevention", keywords="social distancing", keywords="masks", keywords="personal protective equipment", keywords="cross-sectional", keywords="surveys", keywords="higher learning", keywords="higher education", keywords="university students", keywords="information source", keywords="web-based information", keywords="health information", keywords="dissemination", keywords="awareness", keywords="information spread", keywords="young adults", keywords="social media", keywords="university", keywords="postsecondary", keywords="students", keywords="young adult", keywords="college", keywords="concern", keywords="worry", keywords="anxiety", keywords="perceptions", abstract="Background: The start of the COVID-19 pandemic resulted in the implementation of nonpharmaceutical interventions by US institutions of higher education at an unprecedented level. During the backdrop of an emerging pandemic, younger adults (eg, college students) had an overall lower risk for severe outcomes for SARS-CoV-2, making this population a potential source of transmission for age groups with high susceptibility and negative health outcomes. We examine how college students' level of concern for COVID-19 was influenced by different sources of information, their living status, income level, and other demographic identifiers and its association with prevention behavior change. Objective: We sought to examine the level of concern, defined as the extent to which the participant would take corrective action to mitigate contracting or spreading the virus (to family or friends) by using personal protective equipment such as a face mask, practicing social distancing, and following other public health recommendations, among college students during the COVID-19 pandemic. Methods: A cross-sectional, web-based survey was conducted in 2021 among 185 college students aged 18-41 years, with most living in New York City and the United States (n=134, 72.4\%). Out of 185 college students, 94 provided their zip codes, with 51 of those college students indicating they lived in New York City areas. The participants completed the survey via a QR code. Study participants who did not complete the full survey or were not college students in any US college or university were excluded. Analyses were conducted using R (version 4.2.2; R Foundation for Statistical Computing). Results: Of 185 respondents participated in the study, 25 (13.5.\%) used emails from their schools, 51 (27.6\%) used mainstream media, and 109 (58.9\%) used social media and other sources to obtain information about COVID-19. Of the 109 participants who learned about the pandemic from social media, 91 (83.5\%) were concerned; however, only 63\% (32/51) and 60\% (15/25) of the participants who sourced information from mainstream media and their schools' email, respectively, were concerned. Further, the participants who received information from social media and other sources were about 3 times more likely to be concerned about COVID-19 than participants who received information from the university via email (P=.036; OR=3.07, 95\% CI: 1.06-8.83).. Conclusions: College students who received information from social media and other sources were more likely to be concerned about COVID-19 than students who received information from their school via emails. ", doi="10.2196/51292", url="https://formative.jmir.org/2024/1/e51292", url="http://www.ncbi.nlm.nih.gov/pubmed/38885019" } @Article{info:doi/10.2196/53574, author="Pienkowska, Anita and Ravaut, Mathieu and Mammadova, Maleyka and Ang, Chin-Siang and Wang, Hanyu and Ong, Chwen Qi and Bojic, Iva and Qin, Mengqi Vicky and Sumsuzzman, Md Dewan and Ajuebor, Onyema and Boniol, Mathieu and Bustamante, Paola Juana and Campbell, James and Cometto, Giorgio and Fitzpatrick, Siobhan and Kane, Catherine and Joty, Shafiq and Car, Josip", title="Understanding COVID-19 Impacts on the Health Workforce: AI-Assisted Open-Source Media Content Analysis", journal="JMIR Form Res", year="2024", month="Jun", day="13", volume="8", pages="e53574", keywords="World Health Organization", keywords="WHO", keywords="public surveillance", keywords="natural language processing", keywords="NLP", keywords="artificial intelligence", keywords="AI", keywords="COVID-19", keywords="SARS-COV-2", keywords="COVID-19 pandemic", keywords="human-generated analysis", keywords="decision-making", keywords="strategic policy", keywords="health workforce", keywords="news article", keywords="media content analysis", keywords="news coverage", keywords="health care worker", keywords="mental health", keywords="death risk", keywords="intervention", keywords="efficiency", keywords="public health", keywords="surveillance", keywords="innovation", keywords="innovative method", abstract="Background: To investigate the impacts of the COVID-19 pandemic on the health workforce, we aimed to develop a framework that synergizes natural language processing (NLP) techniques and human-generated analysis to reduce, organize, classify, and analyze a vast volume of publicly available news articles to complement scientific literature and support strategic policy dialogue, advocacy, and decision-making. Objective: This study aimed to explore the possibility of systematically scanning intelligence from media that are usually not captured or best gathered through structured academic channels and inform on the impacts of the COVID-19 pandemic on the health workforce, contributing factors to the pervasiveness of the impacts, and policy responses, as depicted in publicly available news articles. Our focus was to investigate the impacts of the COVID-19 pandemic and, concurrently, assess the feasibility of gathering health workforce insights from open sources rapidly. Methods: We conducted an NLP-assisted media content analysis of open-source news coverage on the COVID-19 pandemic published between January 2020 and June 2022. A data set of 3,299,158 English news articles on the COVID-19 pandemic was extracted from the World Health Organization Epidemic Intelligence through Open Sources (EIOS) system. The data preparation phase included developing rules-based classification, fine-tuning an NLP summarization model, and further data processing. Following relevancy evaluation, a deductive-inductive approach was used for the analysis of the summarizations. This included data extraction, inductive coding, and theme grouping. Results: After processing and classifying the initial data set comprising 3,299,158 news articles and reports, a data set of 5131 articles with 3,007,693 words was devised. The NLP summarization model allowed for a reduction in the length of each article resulting in 496,209 words that facilitated agile analysis performed by humans. Media content analysis yielded results in 3 sections: areas of COVID-19 impacts and their pervasiveness, contributing factors to COVID-19--related impacts, and responses to the impacts. The results suggest that insufficient remuneration and compensation packages have been key disruptors for the health workforce during the COVID-19 pandemic, leading to industrial actions and mental health burdens. Shortages of personal protective equipment and occupational risks have increased infection and death risks, particularly at the pandemic's onset. Workload and staff shortages became a growing disruption as the pandemic progressed. Conclusions: This study demonstrates the capacity of artificial intelligence--assisted media content analysis applied to open-source news articles and reports concerning the health workforce. Adequate remuneration packages and personal protective equipment supplies should be prioritized as preventive measures to reduce the initial impact of future pandemics on the health workforce. Interventions aimed at lessening the emotional toll and workload need to be formulated as a part of reactive measures, enhancing the efficiency and maintainability of health delivery during a pandemic. ", doi="10.2196/53574", url="https://formative.jmir.org/2024/1/e53574", url="http://www.ncbi.nlm.nih.gov/pubmed/38869940" } @Article{info:doi/10.2196/53056, author="Cermak, A. Carly and Read, Heather and Jeffs, Lianne", title="Health Care Professionals' Experiences With Using Information and Communication Technologies in Patient Care During the COVID-19 Pandemic: Qualitative Study", journal="JMIR Form Res", year="2024", month="May", day="28", volume="8", pages="e53056", keywords="COVID-19", keywords="information and communication technology", keywords="health care provider experiences", keywords="web-based care", keywords="interview", abstract="Background: The COVID-19 pandemic acted as a catalyst for the use of information and communication technology (ICT) in inpatient and outpatient health care settings. Digital tools were used to connect patients, families, and providers amid visitor restrictions, while web-based platforms were used to continue care amid COVID-19 lockdowns. What we have yet to learn is the experiences of health care providers (HCPs) regarding the use of ICT that supported changes to clinical care during the COVID-19 pandemic. Objective: The aim of this paper was to describe the experiences of HCPs in using ICT to support clinical care changes during the COVID-19 pandemic. This paper is reporting on a subset of a larger body of data that examined changes to models of care during the pandemic. Methods: This study used a qualitative, descriptive study design. In total, 30 HCPs were recruited from 3 hospitals in Canada. One-on-one semistructured interviews were conducted between December 2022 and June 2023. Qualitative data were analyzed using an inductive thematic approach to identify themes across participants. Results: A total of 30 interviews with HCPs revealed 3 themes related to their experiences using ICT to support changes to clinical care during the COVID-19 pandemic. These included the use of ICT (1) to support in-person communication with patients, (2) to facilitate connection between provider to patient and patient to family, and (3) to provide continuity of care. Conclusions: HCP narratives revealed the benefits of digital tools to support in-person communication between patient and provider, the need for thoughtful consideration for the use of ICT at end-of-life care, and the decision-making that is needed when choosing service delivery modality (eg, web based or in person). Moving forward, organizations are encouraged to provide education and training on how to support patient-provider communication, find ways to meet patient and family wishes at end-of-life care, and continue to give autonomy to HCPs in their clinical decision-making regarding service delivery modality. ", doi="10.2196/53056", url="https://formative.jmir.org/2024/1/e53056", url="http://www.ncbi.nlm.nih.gov/pubmed/38805250" } @Article{info:doi/10.2196/53154, author="Harnik, Alexander Michael and Scheidegger, Alina and Bl{\"a}ttler, Larissa and Nemecek, Zdenek and Sauter, C. Thomas and Limacher, Andreas and Reisig, Florian and grosse Holtforth, Martin and Streitberger, Konrad", title="Acceptance, Satisfaction, and Preference With Telemedicine During the COVID-19 Pandemic in 2021-2022: Survey Among Patients With Chronic Pain", journal="JMIR Form Res", year="2024", month="Apr", day="29", volume="8", pages="e53154", keywords="acceptance", keywords="satisfaction", keywords="patient preferences", keywords="COVID-19 pandemic", keywords="health care providers", keywords="phone consultations", keywords="pain therapy", keywords="eHealth services", keywords="patient care", keywords="health care delivery", keywords="telemedicine", keywords="chronic pain", keywords="preference", abstract="Background: The COVID-19 pandemic has forced many health care providers to make changes in their treatment, with telemedicine being expanded on a large scale. An earlier study investigated the acceptance of telephone calls but did not record satisfaction with treatment or patients' preferences. This warranted a follow-up study to investigate acceptance, satisfaction, and preferences regarding telemedicine, comprising of phone consultations, among health care recipients. Objective: The primary aim was to assess the acceptance and satisfaction of telemedicine during the subsequent months of 2021-2022, after the initial wave of the COVID-19 pandemic in Switzerland. Furthermore, we aimed to assess patients' preferences and whether these differed in patients who had already experienced telemedicine in the past, as well as correlations between acceptance and satisfaction, pain intensity, general condition, perception of telemedicine, and catastrophizing. Finally, we aimed to investigate whether more governmental restrictions were correlated with higher acceptance. Methods: An anonymous cross-sectional web-based survey was conducted between January 27, 2021, and February 4, 2022, enrolling patients undergoing outpatient pain therapy in a tertiary university clinic. We conducted a descriptive analysis of acceptance and satisfaction with telemedicine and investigated patients' preferences. Further, we conducted a descriptive and correlational analysis of the COVID-19 stringency index. Spearman correlation analysis and a chi-square test for categorical data were used with Cramer V statistic to assess effect sizes. Results: Our survey was completed by 60 patients. Telemedicine acceptance and satisfaction were high, with an average score of 7.6 (SD 3.3; on an 11-point Numeric Rating Scale from 0=not at all to 10=completely), and 8.8 (SD 1.8), respectively. Respondents generally preferred on-site consultations to telemedicine (n=35, 58\% vs n=24, 40\%). A subgroup analysis revealed that respondents who already had received phone consultation, showed a higher preference for telemedicine (n/N=21/42, 50\% vs n/N=3/18, 17\%; $\chi$22 [N=60]=7.5, P=.02, Cramer V=0.354), as well as those who had been treated for more than 3 months (n/N=17/31, 55\% vs n/N=7/29, 24\%; $\chi$22 [N=60]=6.5, P=.04, Cramer V=0.329). Acceptance of telemedicine showed a moderate positive correlation with satisfaction (rs\{58\}=0.41, P<.05), but there were no correlations between the COVID-19 stringency index and the other variables. Conclusions: Despite high acceptance of and satisfaction with telemedicine, patients preferred on-site consultations. Preference for telemedicine was markedly higher in patients who had already received phone consultations or had been treated for longer than 3 months. This highlights the need to convey knowledge of eHealth services to patients and the value of building meaningful relationships with patients at the beginning of treatment. During the COVID-19 pandemic, the modality of patient care should be discussed individually. ", doi="10.2196/53154", url="https://formative.jmir.org/2024/1/e53154", url="http://www.ncbi.nlm.nih.gov/pubmed/38684086" } @Article{info:doi/10.2196/50303, author="Gotra, Milena and Lindberg, Katharine and Jasinski, Nicholas and Scarisbrick, David and Reilly, Shannon and Perle, Jonathan and Miller, Liv and Mahoney III, James", title="Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study", journal="JMIR Form Res", year="2024", month="Apr", day="29", volume="8", pages="e50303", keywords="COVID-19 pandemic", keywords="mental health", keywords="social worker", keywords="psychologist", keywords="neuropsychologist", keywords="academic medical center", keywords="community mental health", keywords="private practice", keywords="Veteran's Affairs hospital", keywords="longitudinal questionnaire study", keywords="COVID-19", keywords="implementation", keywords="telemental health", keywords="hybrid model", keywords="availability", abstract="Background: The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services. Objective: The aim of this study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. We hypothesized that there would be an increase in the number of patients seen in person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings. Methods: This study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Time point 1) and at a 1-year follow-up in spring 2021 (Time point 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veterans Affairs hospital). Results: From Time point 1 to Time point 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (191/235, 81\% to 204/235, 87\%, P=.01) and there was a significant decline in canceled or rescheduled appointments (25\%-50\% in 2020 to 3\%-7\% in 2021, P<.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (P<.001), and providers working at AMCs and in private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (P<.001). The percent of time working remotely decreased overall (78\% to 59\%, P<.001), which was most notable among neuropsychologists and providers working at an AMC. There was an overall increase in the average number of patients seen in person per week compared with earlier in the pandemic (mean 4.3 to 8.7, P<.001), with no change in the number of patients seen via telehealth (mean 9.7 to 9.9, P=.66). Conclusions: These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in person. Although more providers reported returning to working on-site, over 50\% of providers continued to use a hybrid model, and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients. ", doi="10.2196/50303", url="https://formative.jmir.org/2024/1/e50303", url="http://www.ncbi.nlm.nih.gov/pubmed/38683653" } @Article{info:doi/10.2196/54326, author="Wang, Di and Li, Peifan and Huang, Xiaoling and Liu, Yixuan and Mao, Shihang and Yin, Haoning and Wang, Na and Luo, Yan and Sun, Shan", title="Exploring the Prevalence of Tinnitus and Ear-Related Symptoms in China After the COVID-19 Pandemic: Online Cross-Sectional Survey", journal="JMIR Form Res", year="2024", month="Apr", day="24", volume="8", pages="e54326", keywords="COVID-19 pandemic", keywords="tinnitus", keywords="ear-related symptoms", keywords="online survey", keywords="prevalence", keywords="ear-related", keywords="China", keywords="cross-sectional", keywords="complex", keywords="heterogeneous", keywords="symptom", keywords="symptoms", keywords="Chinese", keywords="population", keywords="investigate", keywords="health care", keywords="exploratory", keywords="teen", keywords="teens", keywords="teenager", keywords="teenagers", keywords="older adult", keywords="older adults", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="COVID-19", keywords="regression analysis", abstract="Background: Tinnitus is a complex and heterogeneous disease that has been identified as a common manifestation of COVID-19. To gain a comprehensive understanding of tinnitus symptoms in individuals following COVID-19 infection, we conducted an online survey called the China Ear Nose and Throat Symptom Survey in the COVID-19 Pandemic (CENTSS) among the Chinese population. Objective: Our objective was to investigate tinnitus and ear-related symptoms after COVID-19 infection in the Chinese population, with the aim of providing a solid empirical foundation for improved health care. The findings from CENTSS can contribute to the development of enhanced management strategies for tinnitus in the context of long COVID. By gaining a better understanding of the factors contributing to tinnitus in individuals with COVID-19, health care providers can tailor interventions to address the specific needs of affected patients. Furthermore, this study serves as a basis for research on the long-term consequences of COVID-19 infection and its associated tinnitus symptoms. Methods: A quantitative, online, cross-sectional survey study design was used to explore the impact of the COVID-19 pandemic on experiences with tinnitus in China. Data were collected through an online questionnaire designed to identify the presence of tinnitus and its impacts. Descriptive statistics were used to analyze individuals' demographic characteristics, COVID-19 infection--related ear symptoms, and the cognitive and emotional implications of tinnitus. Univariable and multivariable logistic regression analyses were used to model the cross-sectional baseline associations between demographic characteristics, noise exposure, educational level, health and lifestyle factors, and the occurrence of tinnitus. Results: Between December 19, 2022, and February 1, 2023, we obtained responses from 1262 Chinese participants representing 24 regions, with an average age of 37 years. Among them, 540 patients (42.8\%) reported experiencing ear-related symptoms after COVID-19 infection. Only 114 (9\%) of these patients sought medical attention specifically for their ear symptoms, while 426 (33.8\%) did not seek hospital care. Tinnitus emerged as the most prevalent and impactful symptom among all ear-related symptoms experienced after COVID-19 infection. Of the respondents, female participants (688/888, 77.78\%), younger individuals (<30 years), individuals with lower education levels, participants residing in western China, and those with a history of otolaryngology diseases were more likely to develop tinnitus following COVID-19 infection. Conclusions: In summary, tinnitus was identified as the most common ear-related symptom during COVID-19 infection. Individuals experiencing tinnitus after COVID-19 infection were found to have poorer cognitive and emotional well-being. Different ear-related symptoms in patients post--COVID-19 infection may suggest viral invasion of various parts of the ear. It is therefore crucial to monitor and manage hearing-related changes resulting from COVID-19 as clinical services resume. ", doi="10.2196/54326", url="https://formative.jmir.org/2024/1/e54326" } @Article{info:doi/10.2196/53608, author="Guan, Huixin and Wang, Wei", title="Factors Impacting Chinese Older Adults' Intention to Prevent COVID-19 in the Post--COVID-19 Pandemic Era: Survey Study", journal="JMIR Form Res", year="2024", month="Apr", day="17", volume="8", pages="e53608", keywords="COVID-19", keywords="SARS-CoV-2", keywords="health protection", keywords="social capital", keywords="media exposure", keywords="negative emotions", keywords="structural influence model of communication", keywords="SIM", keywords="protect", keywords="protection", keywords="protective", keywords="intent", keywords="intention", keywords="prevention", keywords="preventative", keywords="restriction", keywords="restrictions", keywords="public health measures", keywords="safety", keywords="news", keywords="newspaper", keywords="media", keywords="radio", keywords="health communication", keywords="influence", keywords="influencing", keywords="infectious", keywords="infection control", keywords="pandemic", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="older adult", keywords="older adults", keywords="older person", keywords="older people", keywords="aging", abstract="Background: Understanding the factors influencing individuals' health decisions is a dynamic research question. Particularly, after China announced the deregulation of the COVID-19 epidemic, health risks escalated rapidly. The convergence of ``no longer controlled'' viruses and the infodemic has created a distinctive social period during which multiple factors may have influenced people's decision-making. Among these factors, the precautionary intentions of older individuals, as a susceptible health group, deserve special attention. Objective: This study aims to examine the intention of older adults to engage in preventive behaviors and the influencing factors, including social, media, and individual factors, within the context of the postepidemic era. Drawing upon the structural influence model of communication, this study tests the potential mediating roles of 3 different types of media exposure between cognitive and structural social capital and protective behavior intention, as well as the moderating role of negative emotions between social capital and media exposure. Methods: In this study, a web survey was used to collect self-reported quantitative data on social capital, media exposure, negative emotions, and the intention to prevent COVID-19 among older adults aged ?60 years (N=399) in China. Results: The results indicate that cognitive social capital significantly influenced protective behavior intention (P<.001), with cell phone exposure playing an additional impactful role (P<.001). By contrast, newspaper and radio exposure and television exposure mediated the influence of structural social capital on protective behavior intention (P<.001). Furthermore, negative emotions played a moderating role in the relationship between cognitive social capital and cell phone exposure (P<.001). Conclusions: This study suggests that using tailored communication strategies across various media channels can effectively raise health awareness among older adults dealing with major pandemics in China, considering their diverse social capital characteristics and emotional states. ", doi="10.2196/53608", url="https://formative.jmir.org/2024/1/e53608", url="http://www.ncbi.nlm.nih.gov/pubmed/38630517" } @Article{info:doi/10.2196/47170, author="Verot, Elise and Chaux, Robin and Gagnaire, Julie and Bonjean, Paul and Gagneux-Brunon, Amandine and Berthelot, Philippe and Pelissier, Carole and Boulamail, Billal and Chauvin, Franck and Pozzetto, Bruno and Botelho-Nevers, Elisabeth", title="Evaluating the Knowledge of and Behavior Toward COVID-19 and the Possibility of Isolating at a City Level: Survey Study", journal="JMIR Public Health Surveill", year="2024", month="Apr", day="11", volume="10", pages="e47170", keywords="SARS-CoV-2", keywords="COVID-19", keywords="health literacy", keywords="knowledge, attitude, and perception/practices (KAP)", keywords="public health", keywords="population", keywords="mass testing", keywords="screening", keywords="pandemic", keywords="sociological trends", keywords="COVID-19 screening", abstract="Background: Mass testing campaigns were proposed in France during the first wave of the COVID-19 pandemic to detect and isolate asymptomatic individuals infected by SARS-CoV-2. During mass testing in Saint-{\'E}tienne (February 2021), we performed a survey of the general population. Objective: We evaluated, on the scale of a city's population, the literacy level about SARS-CoV-2 transmission, barrier gesture respect, and isolation acceptability or possibility in case of SARS-CoV-2 infection. Methods: We used the validated CovQuest-CC questionnaire. Data were analyzed and correlated with volunteer characteristics and their SARS-CoV-2 screening results using multivariate analysis. Results: In total, 4707 participants completed the CovQuest-CC questionnaire. Multivariate analysis revealed that female sex was a determinant of a higher score of knowledge about SARS-CoV-2 transmission (adjusted $\beta$ coefficient=0.14, 95\% CI 0.04-0.23; corrected P=.02). Older ages of 50-59 years (adjusted $\beta$ coefficient=0.25, 95\% CI 0.19-0.31; corrected P<.001) and ?60 years (adjusted $\beta$ coefficient=0.25, 95\% CI 0.15-0.34; corrected P<.001) were determinants of a higher score on barrier gesture respect compared to ages 20-49 years considered as reference. Female sex was also a determinant of a higher score on barrier gesture respect (adjusted $\beta$ coefficient=0.10, 95\% CI 0.02-4.63; corrected P<.001). The knowledge score was correlated with the score on barrier gesture respect measures (adjusted $\beta$ coefficient=0.03, 95\% CI 0.001-0.004; corrected P=.001). Older ages of 50-59 years (adjusted $\beta$ coefficient=0.21, 95\% CI 0.13-0.29; corrected P<.001) and ?60 years (adjusted $\beta$ coefficient=0.25, 95\% CI 0.1-0.38; corrected P<.001) were determinants of a higher score on isolation acceptability or possibility compared to the age of 20-49 years considered as reference. Finally, the knowledge score regarding SARS-CoV-2 transmission was significantly associated with a lower risk of RT-PCR (reverse transcriptase--polymerase chain reaction) positivity (adjusted odds ratio 0.80,?95\% CI 0.69-0.94; corrected?P<.03), implying that a 1-point increase in the knowledge score lowers the risk of positivity by 20\% on average. Conclusions: This study identified factors associated with health literacy regarding SARS-CoV-2 infection in asymptomatic individuals in a large French city's population. We can confirm that in the context of the COVID-19 pandemic, the determinants of better health literacy are not the same as those in other contexts. It seems critical to obtain a more detailed understanding of the determinants of individual citizens' behavior, as part of a strategy to combat the large-scale spread of the virus. The harsh experience of this pandemic should teach us how to nurture research to structure customized interventions to encourage the adoption of ad hoc behaviors to engage citizens in adapting behaviors more favorable to their health. ", doi="10.2196/47170", url="https://publichealth.jmir.org/2024/1/e47170", url="http://www.ncbi.nlm.nih.gov/pubmed/38602767" } @Article{info:doi/10.2196/54008, author="Palakshappa, A. Jessica and Hale, R. Erica and Brown, D. Joshua and Kittel, A. Carol and Dressler, Emily and Rosenthal, E. Gary and Cutrona, L. Sarah and Foley, L. Kristie and Haines, R. Emily and Houston II, K. Thomas", title="Longitudinal Monitoring of Clinician-Patient Video Visits During the Peak of the COVID-19 Pandemic: Adoption and Sustained Challenges in an Integrated Health Care Delivery System", journal="J Med Internet Res", year="2024", month="Apr", day="8", volume="26", pages="e54008", keywords="telehealth", keywords="telemedicine", keywords="e-health", keywords="eHealth", keywords="video visits", keywords="video", keywords="ICT", keywords="information and communication technology", keywords="survey", keywords="surveys", keywords="adoption", keywords="usability", keywords="experience", keywords="experiences", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", keywords="COVID-19", abstract="Background: Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic. Objective: This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges. Methods: A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations. Results: A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7\% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6\% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits (``Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video?'') was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5\% (156/511) selecting it as a challenge in 2020 and 37.1\% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3\% in 2020 and 137/615, 22.3\% in 2021, P=.73). Conclusions: During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology. ", doi="10.2196/54008", url="https://www.jmir.org/2024/1/e54008", url="http://www.ncbi.nlm.nih.gov/pubmed/38587889" } @Article{info:doi/10.2196/49058, author="van den Bosch, C. Stefanie and van Dalen, Demi and Meinders, Marjan and van Goor, Harry and Berg{\'e}, Stefaan and Stommel, Martijn and van Dulmen, Sandra", title="Outpatient Video Visits During the COVID-19 Pandemic: Cross-Sectional Survey Study of Patients' Experiences and Characteristics", journal="J Med Internet Res", year="2024", month="Mar", day="27", volume="26", pages="e49058", keywords="telemedicine", keywords="video visit", keywords="remote consultation", keywords="eHealth", keywords="patient-centered care", keywords="COVID-19", keywords="mobile phone", abstract="Background: During the first lockdown of the COVID-19 pandemic, an exponential increase in video consultations replacing in-person outpatient visits was observed in hospitals. Insight into patients' experiences with this type of consultation is helpful for a broad, sustainable, and patient-centered implementation of video consultation. Objective: This study aims to examine patients' experiences with video consultation during the COVID-19 pandemic and identify discriminative patient and consultation characteristics to determine when video consultation is most feasible. Methods: A cross-sectional survey study was conducted. Patients aged ?18 years and scheduled for a video consultation at the outpatient clinic of a Dutch university medical center from August 2020 to December 2020 for all medical specialties were eligible. Patients' experiences were explored through a study-specific survey using descriptive quantitative statistics. Open-ended questions were qualitatively analyzed and thematically categorized into appreciated aspects and aspects for improvement. Discriminative patient and consultation characteristics were identified using 3 distinctive survey items. Characteristics of patients who scored and those who did not score all 3 items positively were analyzed using binary logistic regression. Results: A total of 1054 patients were included in the analysis. Most patients (964/1054, 91.46\%) were satisfied with their video consultation, with a mean overall grade of 8.6 (SD 1.3) of 10. In the qualitative analyses, 70.02\% (738/1054) of the patients cited aspects they appreciated and 44.97\% (474/1054) mentioned aspects for improvement during their consultation. Patients with better self-rated health reported a positive evaluation significantly more often (P=.001), which also held true for other medical specialties (vs surgical and nonsurgical specialties; P<.001). Conclusions: Video consultation was perceived as highly satisfactory by patients during the COVID-19 pandemic, with the best experience reported by healthy participants and those undergoing their first consultation. Appreciated aspects are mainly at the individual professional level, organizational level, and innovation level itself. The aspects that were mentioned for improvement can be changed for the better. ", doi="10.2196/49058", url="https://www.jmir.org/2024/1/e49058", url="http://www.ncbi.nlm.nih.gov/pubmed/38536236" } @Article{info:doi/10.2196/51152, author="Ullah, Nazifa and Martin, Sam and Poduval, Shoba", title="A Snapshot of COVID-19 Vaccine Discourse Related to Ethnic Minority Communities in the United Kingdom Between January and April 2022: Mixed Methods Analysis", journal="JMIR Form Res", year="2024", month="Mar", day="26", volume="8", pages="e51152", keywords="COVID-19", keywords="ethnic minorities", keywords="vaccine", keywords="hesitancy", keywords="social media", keywords="discourse", keywords="minority groups", abstract="Background: Existing literature highlights the role of social media as a key source of information for the public during the COVID-19 pandemic and its influence on vaccination attempts. Yet there is little research exploring its role in the public discourse specifically among ethnic minority communities, who have the highest rates of vaccine hesitancy (delay or refusal of vaccination despite availability of services). Objective: This study aims to understand the discourse related to minority communities on social media platforms Twitter and YouTube. Methods: Social media data from the United Kingdom was extracted from Twitter and YouTube using the software Netlytics and YouTube Data Tools to provide a ``snapshot'' of the discourse between January and April 2022. A mixed method approach was used where qualitative data were contextualized into codes. Network analysis was applied to provide insight into the most frequent and weighted keywords and topics of conversations. Results: A total of 260 tweets and 156 comments from 4 YouTube videos were included in our analysis. Our data suggests that the most popular topics of conversation during the period sampled were related to communication strategies adopted during the booster vaccine rollout. These were noted to be divisive in nature and linked to wider conversations around racism and historical mistrust toward institutions. Conclusions: Our study suggests a shift in narrative from concerns about the COVID-19 vaccine itself, toward the strategies used in vaccination implementation, in particular the targeting of ethnic minority groups through vaccination campaigns. The implications for public health communication during crisis management in a pandemic context include acknowledging wider experiences of discrimination when addressing ethnic minority communities. ", doi="10.2196/51152", url="https://formative.jmir.org/2024/1/e51152", url="http://www.ncbi.nlm.nih.gov/pubmed/38530334" } @Article{info:doi/10.2196/51113, author="Xian, Xuechang and Neuwirth, J. Rostam and Chang, Angela", title="Government-Nongovernmental Organization (NGO) Collaboration in Macao's COVID-19 Vaccine Promotion: Social Media Case Study", journal="JMIR Infodemiology", year="2024", month="Mar", day="19", volume="4", pages="e51113", keywords="COVID-19", keywords="government", keywords="vaccine", keywords="automated content analysis", keywords="Granger causality test", keywords="network agenda setting", keywords="QAP", keywords="social media", abstract="Background: The COVID-19 pandemic triggered unprecedented global vaccination efforts, with social media being a popular tool for vaccine promotion. Objective: This study probes into Macao's COVID-19 vaccine communication dynamics, with a focus on the multifaceted impacts of government agendas on social media. Methods: We scrutinized 22,986 vaccine-related Facebook posts from January 2020 to August 2022 in Macao. Using automated content analysis and advanced statistical methods, we unveiled intricate agenda dynamics between government and nongovernment entities. Results: ``Vaccine importance'' and ``COVID-19 risk'' were the most prominent topics co-occurring in the overall vaccine communication. The government tended to emphasize ``COVID-19 risk'' and ``vaccine effectiveness,'' while regular users prioritized vaccine safety and distribution, indicating a discrepancy in these agendas. Nonetheless, the government has limited impact on regular users in the aspects of vaccine importance, accessibility, affordability, and trust in experts. The agendas of government and nongovernment users intertwined, illustrating complex interactions. Conclusions: This study reveals the influence of government agendas on public discourse, impacting environmental awareness, public health education, and the social dynamics of inclusive communication during health crises. Inclusive strategies, accommodating public concerns, and involving diverse stakeholders are paramount for effective social media communication during health crises. ", doi="10.2196/51113", url="https://infodemiology.jmir.org/2024/1/e51113", url="http://www.ncbi.nlm.nih.gov/pubmed/38502184" } @Article{info:doi/10.2196/50181, author="Blazek, Susanne E. and Bucher, Amy", title="Barriers to COVID-19 Vaccination in a Troop of Fleet Antiterrorism Security Team Marines: Observational Study", journal="JMIR Form Res", year="2024", month="Mar", day="19", volume="8", pages="e50181", keywords="behavioral barriers", keywords="benefits", keywords="COVID-19", keywords="Marine Corps", keywords="military", keywords="vaccine reluctance", abstract="Background: In 2019, the World Health Organization declared the reluctance to vaccinate despite the availability of vaccination services as one of the top 10 threats to global health. In early 2021, self-reported reluctance to vaccinate among military personnel might have been considered a significant threat to national security. Having a choice architecture that made COVID-19 vaccination optional rather than required for military personnel could have inadvertently undermined military readiness if vaccination uptake did not reach an acceptable threshold. Objective: The purpose of this observational study was to examine Marines' self-reported reasons for planning to decline the COVID-19 vaccine to understand their barriers to vaccination. Methods: As the vaccination became available to 1 company of Fleet Antiterrorism Security Team (FAST) Marines in early 2021, company command required those planning to decline vaccination to write an essay with up to 5 reasons for their choice. These essays provided the data for this study. Qualitative descriptive analysis with elements from grounded theory was used to thematically categorize FAST Marines' written reasons for planning to decline the COVID-19 vaccine into a codebook describing 8 key behavioral determinants. Interrater agreement among 2 qualitatively trained researchers was very good ($\kappa$=0.81). Results: A troop of 47 Marines provided 235 reasons why they planned to decline the COVID-19 vaccine. The most frequent reasons were difficulty understanding health information (105/235, 45\%), low estimates of risk (33/235, 14\%), and fear of physical discomfort (29/235, 12\%). Resulting interventions directly targeted Marines' self-reported reasons by reducing barriers (eg, normalized getting the vaccine), increasing vaccine benefits (eg, improved access to base gyms and recreational facilities), and increasing nonvaccine friction (eg, required in writing 5 reasons for declining the vaccine). Conclusions: Understanding the barriers military personnel experience toward COVID-19 vaccination remains critical as vaccine acquisition and availability continue to protect military personnel. Insights from subpopulations like FAST Marines can enhance our ability to identify barriers and appropriate intervention techniques to influence COVID-19 vaccination behaviors. ", doi="10.2196/50181", url="https://formative.jmir.org/2024/1/e50181", url="http://www.ncbi.nlm.nih.gov/pubmed/38502179" } @Article{info:doi/10.2196/51331, author="Gonz{\'a}lez-Salinas, I. Anna and Andrade, L. Elizabeth and Abroms, C. Lorien and G{\'o}mez, Kaitlyn and Favetto, Carla and G{\'o}mez, M. Valeria and Collins, K. Karen", title="Latino Parents' Reactions to and Engagement With a Facebook Group--Based COVID-19 Vaccine Promotion Intervention: Mixed Methods Pilot Study", journal="JMIR Form Res", year="2024", month="Mar", day="14", volume="8", pages="e51331", keywords="COVID-19", keywords="misinformation", keywords="social media", keywords="Latino parents", keywords="Spanish", keywords="vaccines", keywords="digital intervention", abstract="Background: Misinformation in Spanish on social media platforms has contributed to COVID-19 vaccine hesitancy among Latino parents. Brigada Digital de Salud was established to disseminate credible, science-based information about COVID-19 in Spanish on social media. Objective: This study aims to assess participants' reactions to and engagement with Brigada Digital content that sought to increase COVID-19 vaccine uptake among US Latino parents and their children. Methods: We conducted a 5-week intervention in a private, moderator-led Facebook (Meta Platforms, Inc) group with Spanish-speaking Latino parents of children aged ?18 years (N=55). The intervention participants received 3 to 4 daily Brigada Digital posts and were encouraged to discuss the covered topics through comments and polls. To assess participants' exposure, reactions, and engagement, we used participants' responses to a web-based survey administered at 2 time points (baseline and after 5 weeks) and Facebook analytics to calculate the average number of participant views, reactions, and comments. Descriptive statistics were assessed for quantitative survey items, qualitative responses were thematically analyzed, and quotes were selected to illustrate the themes. Results: Overall, 101 posts were published. Most participants reported visiting the group 1 to 3 times (22/55, 40\%) or 4 to 6 (18/55, 33\%) times per week and viewing 1 to 2 (23/55, 42\%) or 3 to 4 (16/55, 29\%) posts per day. Facebook analytics validated this exposure, with 36 views per participant on average. The participants reacted positively to the intervention. Most participants found the content informative and trustworthy (49/55, 89\%), easy to understand, and presented in an interesting manner. The participants thought that the moderators were well informed (51/55, 93\%) and helpful (50/55, 91\%) and praised them for being empathic and responsive. The participants viewed the group environment as welcoming and group members as friendly (45/55, 82\%) and supportive (19/55, 35\%). The 3 most useful topics for participants were the safety and efficacy of adult COVID-19 vaccines (29/55, 53\%), understanding child risk levels (29/55, 53\%), and the science behind COVID-19 (24/55, 44\%). The preferred formats were educational posts that could be read (38/55, 69\%) and videos, including expert (28/55, 51\%) and instructional (26/55, 47\%) interviews. Regarding engagement, most participants self-reported reacting to posts 1 to 2 (16/55, 29\%) or 3 to 4 (15/55, 27\%) times per week and commenting on posts 1 to 2 (16/55, 29\%) or <1 (20/55, 36\%) time per week. This engagement level was validated by analytics, with 10.6 reactions and 3 comments per participant, on average, during the 5 weeks. Participants recommended more opportunities for engagement, such as interacting with the moderators in real time. Conclusions: With adequate intervention exposure and engagement and overall positive participant reactions, the findings highlight the promise of this digital approach for COVID-19 vaccine--related health promotion. ", doi="10.2196/51331", url="https://formative.jmir.org/2024/1/e51331", url="http://www.ncbi.nlm.nih.gov/pubmed/38483457" } @Article{info:doi/10.2196/43875, author="Elliott, Mary and Khallouf, Camille and Hirsch, Jennifer and de Camps Meschino, Diane and Zamir, Orit and Ravitz, Paula", title="Novel Web-Based Drop-In Mindfulness Sessions (Pause-4-Providers) to Enhance Well-Being Among Health Care Workers During the COVID-19 Pandemic: Descriptive and Qualitative Study", journal="JMIR Form Res", year="2024", month="Mar", day="14", volume="8", pages="e43875", keywords="COVID-19", keywords="pandemic", keywords="health care worker", keywords="resilience", keywords="mental health", keywords="burnout", keywords="well-being", keywords="mindfulness meditation", keywords="web-based group", keywords="drop-in", keywords="mindfulness", keywords="health care staff", keywords="meditation", keywords="worker", keywords="job", keywords="occupational health", abstract="Background: The COVID-19 pandemic exerted extraordinary pressure on health care workers (HCWs), imperiling their well-being and mental health. In response to the urgent demand to provide barrier-free support for the health care workforce, Pause-4-Providers implemented 30-minute live web-based drop-in mindfulness sessions for HCWs. Objective: This study aims to evaluate the use, feasibility, satisfaction, and acceptability of a novel mindfulness program aimed at enhancing the well-being of HCWs during the COVID-19 pandemic. Methods: Accrual for the study continued throughout the first 3 pandemic waves, and attendees of ?1 session were invited to participate. The evaluation framework included descriptive characteristics, including participant demographics, resilience at work, and single-item burnout scores; feedback questionnaires on reasons attended, benefits, and satisfaction; qualitative interviews to further understand participant experience, satisfaction, benefits, enablers, and barriers; and the number of participants in each session summarized according to the pandemic wave. Results: We collected descriptive statistics from 50 consenting HCWs. Approximately half of the participants (24/50, 48\%) attended >1 session. The study participants were predominantly female individuals (40/50, 80\%) and comprised physicians (17/50, 34\%), nurses (9/50, 18\%), and other HCWs (24/50, 48\%), who were largely from Ontario (41/50, 82\%). Of 50 attendees, 26 (52\%) endorsed feeling burned out. The highest attendance was in May 2020 and January 2021, corresponding to the first and second pandemic waves. The participants endorsed high levels of satisfaction (43/47, 92\%). The most cited reasons for attending the program were to relax (38/48, 79\%), manage stress or anxiety (36/48, 75\%), wish for loving kindness or self-compassion (30/48, 64\%), learn mindfulness (30/48, 64\%), and seek help with emotional reactivity (25/48, 53\%). Qualitative interviews with 15 out of 50 (30\%) participants identified positive personal and professional impacts. Personal impacts revealed that participation helped HCWs to relax, manage stress, care for themselves, sleep better, reduce isolation, and feel recognized. Professional impacts included having a toolbox of mindfulness techniques, using mindfulness moments, and being calmer at work. Some participants noted that they shared techniques with their colleagues. The reported barriers included participants' needing time to prioritize themselves, fatigue, forgetting to apply skills on the job, and finding a private place to participate. Conclusions: The Pause-4-Providers participants reported that the web-based groups were accessible; appreciated the format, content, and faculty; and had high levels of satisfaction with the program. Both novel format (eg, drop-in, live, web-based, anonymous, brief, and shared activity with other HCWs) and content (eg, themed mindfulness practices including micropractices, with workplace applications) were enablers to participation. This study of HCW support sessions was limited by the low number of consenting participants and the rolling enrollment project design; however, the findings suggest that a drop-in web-based mindfulness program has the potential to support the well-being of HCWs. ", doi="10.2196/43875", url="https://formative.jmir.org/2024/1/e43875", url="http://www.ncbi.nlm.nih.gov/pubmed/38180869" } @Article{info:doi/10.2196/49462, author="Chou, Ya-Hsin and Lin, Chemin and Lee, Shwu-Hua and Lee, Yen-Fen and Cheng, Li-Chen", title="User-Friendly Chatbot to Mitigate the Psychological Stress of Older Adults During the COVID-19 Pandemic: Development and Usability Study", journal="JMIR Form Res", year="2024", month="Mar", day="13", volume="8", pages="e49462", keywords="geriatric psychiatry", keywords="mental health", keywords="loneliness", keywords="chatbot", keywords="user experience", keywords="health promotion", keywords="older adults", keywords="technology-assisted interventions", keywords="pandemic", keywords="lonely", keywords="gerontology", keywords="elderly", keywords="develop", keywords="design", keywords="development", keywords="conversational agent", keywords="geriatric", keywords="geriatrics", keywords="psychiatry", abstract="Background: To safeguard the most vulnerable individuals during the COVID-19 pandemic, numerous governments enforced measures such as stay-at-home orders, social distancing, and self-isolation. These social restrictions had a particularly negative effect on older adults, as they are more vulnerable and experience increased loneliness, which has various adverse effects, including increasing the risk of mental health problems and mortality. Chatbots can potentially reduce loneliness and provide companionship during a pandemic. However, existing chatbots do not cater to the specific needs of older adult populations. Objective: We aimed to develop a user-friendly chatbot tailored to the specific needs of older adults with anxiety or depressive disorders during the COVID-19 pandemic and to examine their perspectives on mental health chatbot use. The primary research objective was to investigate whether chatbots can mitigate the psychological stress of older adults during COVID-19. Methods: Participants were older adults belonging to two age groups (?65 years and <65 years) from a psychiatric outpatient department who had been diagnosed with depressive or anxiety disorders by certified psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria. The participants were required to use mobile phones, have internet access, and possess literacy skills. The chatbot's content includes monitoring and tracking health data and providing health information. Participants had access to the chatbot for at least 4 weeks. Self-report questionnaires for loneliness, depression, and anxiety were administered before and after chatbot use. The participants also rated their attitudes toward the chatbot. Results: A total of 35 participants (mean age 65.21, SD 7.51 years) were enrolled in the trial, comprising 74\% (n=26) female and 26\% (n=9) male participants. The participants demonstrated a high utilization rate during the intervention, with over 82\% engaging with the chatbot daily. Loneliness significantly improved in the older group ?65 years. This group also responded positively to the chatbot, as evidenced by changes in University of California Los Angeles Loneliness Scale scores, suggesting that this demographic can derive benefits from chatbot interaction. Conversely, the younger group, <65 years, exhibited no significant changes in loneliness after the intervention. Both the older and younger age groups provided good scores in relation to chatbot design with respect to usability (mean scores of 6.33 and 6.05, respectively) and satisfaction (mean scores of 5.33 and 5.15, respectively), rated on a 7-point Likert scale. Conclusions: The chatbot interface was found to be user-friendly and demonstrated promising results among participants 65 years and older who were receiving care at psychiatric outpatient clinics and experiencing relatively stable symptoms of depression and anxiety. The chatbot not only provided caring companionship but also showed the potential to alleviate loneliness during the challenging circumstances of a pandemic. ", doi="10.2196/49462", url="https://formative.jmir.org/2024/1/e49462", url="http://www.ncbi.nlm.nih.gov/pubmed/38477965" } @Article{info:doi/10.2196/50733, author="English, Andrew and McDaid, Darren and Lynch, M. Seodhna and McLaughlin, Joseph and Cooper, Eamonn and Wingfield, Benjamin and Kelly, Martin and Bhavsar, Manav and McGilligan, Victoria and Irwin, E. Rachelle and Bucholc, Magda and Zhang, Shu-Dong and Shukla, Priyank and Rai, Singh Taranjit and Bjourson, J. Anthony and Murray, Elaine and Gibson, S. David and Walsh, Colum", title="Genomic, Proteomic, and Phenotypic Biomarkers of COVID-19 Severity: Protocol for a Retrospective Observational Study", journal="JMIR Res Protoc", year="2024", month="Feb", day="14", volume="13", pages="e50733", keywords="COVID-19", keywords="clinical research", keywords="multiomics", keywords="comorbidity", keywords="severity", keywords="electronic health record", abstract="Background: Health organizations and countries around the world have found it difficult to control the spread of COVID-19. To minimize the future impact on the UK National Health Service and improve patient care, there is a pressing need to identify individuals who are at a higher risk of being hospitalized because of severe COVID-19. Early targeted work was successful in identifying angiotensin-converting enzyme-2 receptors and type II transmembrane serine protease dependency as drivers of severe infection. Although a targeted approach highlights key pathways, a multiomics approach will provide a clearer and more comprehensive picture of severe COVID-19 etiology and progression. Objective: The COVID-19 Response Study aims to carry out an integrated multiomics analysis to identify biomarkers in blood and saliva that could contribute to host susceptibility to SARS-CoV-2 and the development of severe COVID-19. Methods: The COVID-19 Response Study aims to recruit 1000 people who recovered from SARS-CoV-2 infection in both community and hospital settings on the island of Ireland. This protocol describes the retrospective observational study component carried out in Northern Ireland (NI; Cohort A); the Republic of Ireland cohort will be described separately. For all NI participants (n=519), SARS-CoV-2 infection has been confirmed by reverse transcription-quantitative polymerase chain reaction. A prospective Cohort B of 40 patients is also being followed up at 1, 3, 6, and 12 months postinfection to assess longitudinal symptom frequency and immune response. Data will be sourced from whole blood, saliva samples, and clinical data from the electronic care records, the general health questionnaire, and a 12-item general health questionnaire mental health survey. Saliva and blood samples were processed to extract DNA and RNA before whole-genome sequencing, RNA sequencing, DNA methylation analysis, microbiome analysis, 16S ribosomal RNA gene sequencing, and proteomic analysis were performed on the plasma. Multiomics data will be combined with clinical data to produce sensitive and specific prognostic models for severity risk. Results: An initial demographic and clinical profile of the NI Cohort A has been completed. A total of 249 hospitalized patients and 270 nonhospitalized patients were recruited, of whom 184 (64.3\%) were female, and the mean age was 45.4 (SD 13) years. High levels of comorbidity were evident in the hospitalized cohort, with cardiovascular disease and metabolic and respiratory disorders being the most significant (P<.001), grouped according to the International Classification of Diseases 10 codes. Conclusions: This study will provide a comprehensive opportunity to study the mechanisms of COVID-19 severity in recontactable participants. International Registered Report Identifier (IRRID): DERR1-10.2196/50733 ", doi="10.2196/50733", url="https://www.researchprotocols.org/2024/1/e50733", url="http://www.ncbi.nlm.nih.gov/pubmed/38354037" } @Article{info:doi/10.2196/47441, author="Swift, Jim and O'Kelly, Noel and Barker, Chris and Woodward, Alex and Ghosh, Sudip", title="A Digital Respiratory Ward in Leicester, Leicestershire, and Rutland, England, for Patients With COVID-19: Economic Evaluation of the Impact on Acute Capacity and Wider National Health Service Resource Use", journal="JMIR Form Res", year="2024", month="Feb", day="13", volume="8", pages="e47441", keywords="Covid-19", keywords="telemedicine", keywords="digital technology", keywords="home transition", keywords="length of stay", keywords="cost-effectiveness analysis", keywords="cost", keywords="costs", keywords="economic", keywords="economics", keywords="telehealth", keywords="hospitalization", keywords="hospital", keywords="hospitals", keywords="hospitalizations", keywords="resource", keywords="resources", keywords="hospital stay", keywords="ward", keywords="wards", keywords="virtual care", keywords="remote care", keywords="financial", keywords="finance", keywords="finances", keywords="remote", keywords="respiratory", keywords="SARS-CoV-2", keywords="pulmonary", keywords="lung", keywords="lungs", keywords="service", keywords="services", keywords="delivery", abstract="Background: The COVID-19 pandemic stressed global health care systems' acute capacity and caused a diversion of resources from elective care to the treatment of acute respiratory disease. In preparing for a second wave of COVID-19 infections, England's National Health Service (NHS) in Leicester, Leicestershire, and Rutland sought to protect acute capacity in the winter of 2020-2021. Their plans included the introduction of a digital ward where patients were discharged home early and supported remotely by community-based respiratory specialists, who were informed about patient health status by a digital patient monitoring system. Objective: The objective of the digital ward was to maintain acute capacity through safe, early discharge of patients with COVID-19 respiratory disease. The study objective was to establish what impact this digital ward had on overall NHS resource use. Methods: There were no expected differences in patient outcomes. A cost minimization was performed to demonstrate the impact on the NHS resource use from discharging patients into a digital COVID-19 respiratory ward, compared to acute care length of stay (LOS). This evaluation included all 310 patients enrolled in the service from November 2020 (service commencement) to November 2021. Two primary methods, along with sensitivity analyses, were used to help overcome the uncertainty associated with the estimated comparators for the observational data on COVID-19 respiratory acute LOS, compared with the actual LOS of the 279 (90\%) patients who were not discharged on oxygen nor were in critical care. Historic comparative LOS and an ordinary least squares model based on local monthly COVID-19 respiratory median LOS were used as comparators. Actual comparator data were sourced for the 31 (10\%) patients who were discharged home and into the digital ward for oxygen weaning. Resource use associated with delivering care in the digital ward was sourced from the digital system and respiratory specialists. Results: In the base case, the digital ward delivered estimated health care system savings of 846.5 bed-days and US \$504,197 in net financial savings across the 2 key groups of patients---those on oxygen and those not on oxygen at acute discharge (both P<.001). The mean gross and net savings per patient were US \$1850 and US \$1626 in the base case, respectively, without including any savings associated with a potential reduction in readmissions. The 30-day readmission rate was 2.9\%, which was below comparative data. The mean cost of the intervention was US \$223.53 per patient, 12.1\% of the estimated gross savings. It was not until the costs were increased and the effect reduced simultaneously by 78.4\% in the sensitivity analysis that the intervention was no longer cost saving. Conclusions: The digital ward delivered increased capacity and substantial financial savings and did so with a high degree of confidence, at a very low absolute and relative cost. ", doi="10.2196/47441", url="https://formative.jmir.org/2024/1/e47441", url="http://www.ncbi.nlm.nih.gov/pubmed/38349716" } @Article{info:doi/10.2196/37881, author="Ueda, Ryuichiro and Han, Feng and Zhang, Hongjian and Aoki, Tomohiro and Ogasawara, Katsuhiko", title="Verification in the Early Stages of the COVID-19 Pandemic: Sentiment Analysis of Japanese Twitter Users", journal="JMIR Infodemiology", year="2024", month="Feb", day="6", volume="4", pages="e37881", keywords="COVID-19", keywords="sentiment analysis", keywords="Twitter", keywords="infodemiology", keywords="NLP", keywords="Natural Language Processing", abstract="Background: The COVID-19 pandemic prompted global behavioral restrictions, impacting public mental health. Sentiment analysis, a tool for assessing individual and public emotions from text data, gained importance amid the pandemic. This study focuses on Japan's early public health interventions during COVID-19, utilizing sentiment analysis in infodemiology to gauge public sentiment on social media regarding these interventions. Objective: This study aims to investigate shifts in public emotions and sentiments before and after the first state of emergency was declared in Japan. By analyzing both user-generated tweets and retweets, we aim to discern patterns in emotional responses during this critical period. Methods: We conducted a day-by-day analysis of Twitter (now known as X) data using 4,894,009 tweets containing the keywords ``corona,'' ``COVID-19,'' and ``new pneumonia'' from March 23 to April 21, 2020, approximately 2 weeks before and after the first declaration of a state of emergency in Japan. We also processed tweet data into vectors for each word, employing the Fuzzy-C-Means (FCM) method, a type of cluster analysis, for the words in the sentiment dictionary. We set up 7 sentiment clusters (negative: anger, sadness, surprise, disgust; neutral: anxiety; positive: trust and joy) and conducted sentiment analysis of the tweet groups and retweet groups. Results: The analysis revealed a mix of positive and negative sentiments, with ``joy'' significantly increasing in the retweet group after the state of emergency declaration. Negative emotions, such as ``worry'' and ``disgust,'' were prevalent in both tweet and retweet groups. Furthermore, the retweet group had a tendency to share more negative content compared to the tweet group. Conclusions: This study conducted sentiment analysis of Japanese tweets and retweets to explore public sentiments during the early stages of COVID-19 in Japan, spanning 2 weeks before and after the first state of emergency declaration. The analysis revealed a mix of positive (joy) and negative (anxiety, disgust) emotions. Notably, joy increased in the retweet group after the emergency declaration, but this group also tended to share more negative content than the tweet group. This study suggests that the state of emergency heightened positive sentiments due to expectations for infection prevention measures, yet negative information also gained traction. The findings propose the potential for further exploration through network analysis. ", doi="10.2196/37881", url="https://infodemiology.jmir.org/2024/1/e37881", url="http://www.ncbi.nlm.nih.gov/pubmed/38127840" } @Article{info:doi/10.2196/46824, author="Yu, Chuen Chou and Tou, Xiang Nien and Low, Alvin James", title="Internet Use and Effects on Mental Well-being During the Lockdown Phase of the COVID-19 Pandemic in Younger Versus Older Adults: Observational Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Feb", day="6", volume="8", pages="e46824", keywords="COVID-19", keywords="digital divide", keywords="well-being", keywords="older adults", keywords="information and communication technology", keywords="internet of things", keywords="online", keywords="mental health", keywords="lockdown", keywords="depression", keywords="stress", keywords="anxiety", keywords="digital technology", keywords="pandemic", abstract="Background: Majority of individuals, including both younger and older adults, had to adapt to digital means to cope with lockdown measures and pandemic-induced lifestyle changes during the COVID-19 pandemic. While internet accessibility was beneficial during the pandemic, existing literature suggests that excessive use could lead to the rise of problematic internet use in adolescents and younger adults. However, the effects on older adults remain unclear. Objective: This study aimed to examine differences in internet use during the lockdown phase of the COVID-19 pandemic and explore how age differences in mental health could be explained by time spent on the internet. Methods: A door-to-door survey of a nationally representative sample of 602 adults in Singapore was carried out using computer-assisted personal interviewing during the early phase of the COVID-19 pandemic (October to November 2020). Participants were categorized into younger (21-59 years old) and older (60 years or above) age groups. We assessed self-reported measures of depression, anxiety, and stress; psychosocial adaptability; ability to perform essential activities; social support; health status; digital media use patterns, and time spent on the internet. Procedures complied with existing safe distancing measures. Results: Older adults reported being less able to use digital platforms to meet needs and acquire information updates compared with younger adults during the lockdown period of the pandemic. Older adults spent significantly less time on the internet for both work and personal uses per day (mean 146.00 min, SD 9.18 min) compared with younger adults (mean 433.27 min, SD 14.32 min). Significant age differences in depression, anxiety, and stress were found, with younger adults showing poorer mental health. Mediation analysis showed that age differences in depression, anxiety, and stress were partially explained by time spent on the internet. These variables together explained 43\%, 40\%, and 40\% of the variances in depression, anxiety, and stress scores, respectively. Conclusions: The findings showed that younger adults spent significantly more time on the internet compared with older adults during the lockdown phase of the pandemic. They were also ahead in their ability to use digital resources to meet needs and engage socially compared with older adults. Despite this, the mental health of younger adults was poor, and this was partially accounted for by the amount of time spent on the internet. Since past research suggests that excessive time spent on the internet could lead to disordered use, the benefits brought by digital technologies could have been attenuated during the lockdown phase of the pandemic. Considering this potential negative effect, it is imperative to educate both young and old adults in the appropriate use of information and communication technology. ", doi="10.2196/46824", url="https://formative.jmir.org/2024/1/e46824", url="http://www.ncbi.nlm.nih.gov/pubmed/38319700" } @Article{info:doi/10.2196/50388, author="Heaton, Dan and Nichele, Elena and Clos, J{\'e}r{\'e}mie and Fischer, E. Joel", title="Perceptions of the Agency and Responsibility of the NHS COVID-19 App on Twitter: Critical Discourse Analysis", journal="J Med Internet Res", year="2024", month="Feb", day="1", volume="26", pages="e50388", keywords="COVID-19", keywords="information system", keywords="automated decisions", keywords="agency metaphor", keywords="corpus linguistics", keywords="decision-making algorithm", keywords="transitivity", abstract="Background: Since September 2020, the National Health Service (NHS) COVID-19 contact-tracing app has been used to mitigate the spread of COVID-19 in the United Kingdom. Since its launch, this app has been a part of the discussion regarding the perceived social agency of decision-making algorithms. On the social media website Twitter, a plethora of views about the app have been found but only analyzed for sentiment and topic trajectories thus far, leaving the perceived social agency of the app underexplored. Objective: We aimed to examine the discussion of social agency in social media public discourse regarding algorithm-operated decisions, particularly when the artificial intelligence agency responsible for specific information systems is not openly disclosed in an example such as the COVID-19 contact-tracing app. To do this, we analyzed the presentation of the NHS COVID-19 App on Twitter, focusing on the portrayal of social agency and the impact of its deployment on society. We also aimed to discover what the presentation of social agents communicates about the perceived responsibility of the app. Methods: Using corpus linguistics and critical discourse analysis, underpinned by social actor representation, we used the link between grammatical and social agency and analyzed a corpus of 118,316 tweets from September 2020 to July 2021 to see whether the app was portrayed as a social actor. Results: We found that active presentations of the app---seen mainly through personalization and agency metaphor---dominated the discourse. The app was presented as a social actor in 96\% of the cases considered and grew in proportion to passive presentations over time. These active presentations showed the app to be a social actor in 5 main ways: informing, instructing, providing permission, disrupting, and functioning. We found a small number of occasions on which the app was presented passively through backgrounding and exclusion. Conclusions: Twitter users presented the NHS COVID-19 App as an active social actor with a clear sense of social agency. The study also revealed that Twitter users perceived the app as responsible for their welfare, particularly when it provided instructions or permission, and this perception remained consistent throughout the discourse, particularly during significant events. Overall, this study contributes to understanding how social agency is discussed in social media discourse related to algorithmic-operated decisions This research offers valuable insights into public perceptions of decision-making digital contact-tracing health care technologies and their perceptions on the web, which, even in a postpandemic world, may shed light on how the public might respond to forthcoming interventions. ", doi="10.2196/50388", url="https://www.jmir.org/2024/1/e50388", url="http://www.ncbi.nlm.nih.gov/pubmed/38300688" } @Article{info:doi/10.2196/47508, author="Guo, Feipeng and Liu, Zixiang and Lu, Qibei and Ji, Shaobo and Zhang, Chen", title="Public Opinion About COVID-19 on a Microblog Platform in China: Topic Modeling and Multidimensional Sentiment Analysis of Social Media", journal="J Med Internet Res", year="2024", month="Jan", day="31", volume="26", pages="e47508", keywords="COVID-19", keywords="social media public opinion", keywords="microblog", keywords="sentiment analysis", keywords="topic modeling", abstract="Background: The COVID-19 pandemic raised wide concern from all walks of life globally. Social media platforms became an important channel for information dissemination and an effective medium for public sentiment transmission during the COVID-19 pandemic. Objective: Mining and analyzing social media text information can not only reflect the changes in public sentiment characteristics during the COVID-19 pandemic but also help the government understand the trends in public opinion and reasonably control public opinion. Methods: First, this study collected microblog comments related to the COVID-19 pandemic as a data set. Second, sentiment analysis was carried out based on the topic modeling method combining latent Dirichlet allocation (LDA) and Bidirectional Encoder Representations from Transformers (BERT). Finally, a machine learning logistic regression (ML-LR) model combined with a sparse matrix was proposed to explore the evolutionary trend in public opinion on social media and verify the high accuracy of the model. Results: The experimental results show that, in different stages, the characteristics of public emotion are different, and the overall trend is from negative to positive. Conclusions: The proposed method can effectively reflect the characteristics of the different times and space of public opinion. The results provide theoretical support and practical reference in response to public health and safety events. ", doi="10.2196/47508", url="https://www.jmir.org/2024/1/e47508", url="http://www.ncbi.nlm.nih.gov/pubmed/38294856" } @Article{info:doi/10.2196/50572, author="Sharma, Pravesh and Kamath, Celia and Brockman, A. Tabetha and Roche, Anne and Sinicrope, Pamela and Jiang, Ruoxiang and Decker, A. Paul and Pazdernik, Vanessa and Patten, Christi", title="Demographics and Social Factors Associated With Persistent Nonuse of Video Appointments at a Multisite Health Care Institution: Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Jan", day="24", volume="8", pages="e50572", keywords="digital health", keywords="telemedicine", keywords="telehealth", keywords="video visits", keywords="appointments", keywords="SDoH, social determinants of health", keywords="social determinants", keywords="appointment", keywords="users", keywords="sociodemographic", keywords="prevention", keywords="discomfort", keywords="video communication", keywords="communication", keywords="willingness", keywords="mobile phone", abstract="Background: During the COVID-19 outbreak, video appointments became a popular method for health care delivery, particularly in the early stages of the pandemic. Although Mayo Clinic aimed to reduce face-to-face (F2F) appointments to prevent the spread of the virus, some patients continued seeing their health care providers in person. In the later stages of the pandemic, many patients became comfortable with video appointments, even if they were initially hesitant. However, a subset of patients continued to avoid video appointments. It is not yet clear what sociodemographic factors may be associated with this group of patients. Objective: This cross-sectional study aimed to examine demographic and social determinant of health (SDoH) factors associated with persistent nonusers of video appointments among a sample of patients within a multistate health care organization. We also explored patient beliefs about the use of video for health care appointments. Methods: We conducted a 1-time cross-sectional paper survey, mailed between July and December 2022, of patients matching the eligibility criteria: (1) aged ?18 years as of April 2020, (2) Mayo Clinic Midwest, Florida, or Arizona patient, (3) did not use video appointment services during April-December 2020 but attended F2F appointments in the departments of primary care and psychiatry/psychology. The survey asked patients, ``Have you ever had a video appointment with a healthcare provider?'' ``Yes'' respondents were defined as ``users'' (adapted to video appointments), and ``no'' respondents were defined as ``persistent nonusers'' of video appointments. We analyzed demographics, SDoH, and patient beliefs toward video appointments in 2 groups: persistent nonusers of video appointments and users. We used chi-square and 2-tailed t tests for analysis. Results: Our findings indicate that patients who were older, lived in rural areas, sought care at Mayo Clinic Midwest, and did not have access to the patient portal system were likely to be persistent nonusers of video appointments. Only 1 SDoH factor (not having a disability, handicap, or chronic disease) was associated with persistent nonuse of video appointments. Persistent nonusers of video appointments held personal beliefs such as discomfort with video communication, difficulty interpreting nonverbal cues, and personal preference for F2F appointments over video. Conclusions: Our study identified demographic (older age and rural residence), sociodemographic factors (not having a disability, handicap, or chronic disease), and personal beliefs associated with patients' decisions to choose between video versus F2F appointments for health care delivery. Health care institutions should assess patients' negative attitudes toward technology prior to introducing them to digital health care services. Failing to do so may result in its restricted usage, negative patient experience, and wasted resources. For patients who hold negative beliefs about technology but are willing to learn, a ``digital health coordinator'' could be assigned to assist with various digital health solutions. ", doi="10.2196/50572", url="https://formative.jmir.org/2024/1/e50572", url="http://www.ncbi.nlm.nih.gov/pubmed/38265855" } @Article{info:doi/10.2196/42753, author="Waheed, Atif Muhammad and Al Mannai, Lolwa and Khudadad, Hanan and Alenbawi, Jamil and Mansaray, Aminata Mariama and Al Abdulla, Samya", title="Assessment of Qatar's Health Care Community Call Center Efficacy in Addressing COVID-19 Pandemic Health Care Challenges: Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Jan", day="18", volume="8", pages="e42753", keywords="COVID-19", keywords="COVID Response Service", keywords="community call center", keywords="virtual consultations", abstract="Background: The global COVID-19 pandemic caused by SARS-CoV-2 created many unprecedented challenges for health care organizations worldwide, placing a great deal of strain on the health care systems, especially access to health care services. To address these challenges, Qatar established a centralized digital platform as a community call center, initially offering digital consultations via its hotline (number: 16000) and later expanding to include a COVID-19 vaccination hotline (number: 7077) for mass immunization. Objective: This study aims to comprehensively examine the community call center's operations and their significant role during the COVID-19 pandemic. Methods: Retrospective data were collected from the Health Information and Technology Department of the Primary Health Care Corporation, Qatar, from March 29, 2020, to January 27, 2022. Data analysis for the hotline (number: 16000) focused on telephone and video call volumes, call response rates, abandonment rates, and call classification. In addition, data from the COVID-19 vaccination hotline (number: 7077) were analyzed for call volumes, call response rates, abandonment rates, appointment booking rates, confirmations, rescheduling, and cancellations. Results: The hotline (number: 16000) received a substantial total of 429,212 calls, with 284,849 (66.37\%) calls effectively answered. The average number of calls received per day during the study period was 640.61 (SD 470.53), and the average number of calls answered per day was 425.14 (SD 206.64). Notably, of the total 128,468 consultations, video consultations were conducted for 3810 (2.96\%). Among the diverse call categories, diabetes mellitus (6284/84,299, 7.45\%), prescriptions and medications (4709/84,299, 5.59\%), hypertension (3874/84,299, 4.6\%), vitamin D-related issues (3770/84,299, 4.47\%), upper respiratory tract infections (2690/84,299, 3.19\%), and COVID-19--related inquiries (2590/84,299, 3.07\%) were most frequently addressed. For the COVID-19 vaccination hotline (number: 7077), an impressive total of 1,512,354 calls were received, with a 58.27\% (n=881,305) call response rate. The average number of calls per day during the study period was 3828.74 (SD 2931.94), and the average number of calls answered per day was 2231.15 (SD 1496.02). Appointment booking accounted for 26.37\% (265,721/1,007,596), appointment confirmation accounted for 10.24\% (103,136/1,007,596), rescheduling accounted for 7.95\% (80,124/1,007,596), and cancellations accounted for 1.6\% (16,128/1,007,596) of the calls. Conclusions: The findings of this research highlight the crucial significance of the community call center hotline (number: 16000) and the COVID-19 vaccination hotline (number: 7077) in effectively addressing the multifaceted challenges posed by the global COVID-19 pandemic. In Qatar, the community call center emerged as an indispensable and accessible centralized resource, facilitating streamlined digital consultations and vaccination appointments. The impressive call response rate highlights its operational efficiency, adeptly managing a diverse range of health-related issues. This study emphasizes the critical role of community call centers in health care emergency response, signaling their potential as invaluable assets for future preparedness and effective mitigation strategies during similar public health crises. ", doi="10.2196/42753", url="https://formative.jmir.org/2024/1/e42753", url="http://www.ncbi.nlm.nih.gov/pubmed/38085918" } @Article{info:doi/10.2196/45723, author="Bartl, Gabriel", title="Social and Ethical Implications of Digital Crisis Technologies: Case Study of Pandemic Simulation Models During the COVID-19 Pandemic", journal="J Med Internet Res", year="2024", month="Jan", day="16", volume="26", pages="e45723", keywords="public health technologies", keywords="simulation models", keywords="algorithmic governance", keywords="preparedness", keywords="crisis, uncertainty, and ignorance", keywords="social implications of mathematical modeling", keywords="normativity", keywords="transparency", keywords="legitimacy", abstract="Background: Responses to public health crises are increasingly technological in nature, as the prominence of COVID-19--related statistics and simulations amply demonstrates. However, the use of technologies is preconditional and has various implications. These implications can not only affect acceptance but also challenge the acceptability of these technologies with regard to the ethical and normative dimension. Objective: This study focuses on pandemic simulation models as algorithmic governance tools that played a central role in political decision-making during the COVID-19 pandemic. To assess the social implications of pandemic simulation models, the premises of data collection, sorting, and evaluation must be disclosed and reflected upon. Consequently, the social construction principles of digital health technologies must be revealed and examined for their effects with regard to social, ethical, and ultimately political issues. Methods: This case study starts with a systematization of different simulation approaches to create a typology of pandemic simulation models. On the basis of this, various properties, functions, and challenges of these simulation models are revealed and discussed in detail from a socioscientific point of view. Results: The typology of pandemic simulation methods reveals the diversity of model-driven handling of pandemic threats. However, it is reasonable to assume that the use of simulation models could increasingly shift toward agent-based or artificial intelligence models in the future, thus promoting the logic of algorithmic decision-making in response to public health crises. As algorithmic decision-making focuses more on predicting future dynamics than statistical practices of assessing pandemic events, this study discusses this development in detail, resulting in an operationalized overview of the key social and ethical issues related to pandemic crisis technologies. Conclusions: This study identifies 3 major recommendations for the future of pandemic crisis technologies. ", doi="10.2196/45723", url="https://www.jmir.org/2024/1/e45723", url="http://www.ncbi.nlm.nih.gov/pubmed/38227361" } @Article{info:doi/10.2196/47099, author="Apio, Catherine and Han, Kyulhee and Lee, Doeun and Lee, Bogyeom and Park, Taesung", title="Development of New Stringency Indices for Nonpharmacological Social Distancing Policies Implemented in Korea During the COVID-19 Pandemic: Random Forest Approach", journal="JMIR Public Health Surveill", year="2024", month="Jan", day="8", volume="10", pages="e47099", keywords="COVID-19", keywords="restriction policy", keywords="Stringency Index", keywords="Korea Stringency Index", keywords="social distancing", keywords="physical distancing", keywords="pandemic", keywords="government", keywords="restriction", keywords="effectiveness", keywords="policy", abstract="Background: In the absence of an effective treatment method or vaccine, the outbreak of the COVID-19 pandemic elicited a wide range of unprecedented restriction policies aimed at mitigating and suppressing the spread of the SARS-CoV-2 virus. These policies and their Stringency Index (SI) of more than 160 countries were systematically recorded in the Oxford COVID-19 Government Response Tracker (OxCGRT) data set. The SI is a summary measure of the overall strictness of these policies. However, the OxCGRT SI may not fully reflect the stringency levels of the restriction policies implemented in Korea. Korea implemented 33 COVID-19 restriction policies targeting 4 areas: public facilities, public events, social gatherings, and religious gatherings. Objective: This study aims to develop new Korea Stringency Indices (KSIs) that reflect the stringency levels of Korea's restriction policies better and to determine which government-implemented policies were most effective in managing the COVID-19 pandemic in Korea. Methods: The random forest method was used to calculate the new KSIs using feature importance values and determine their effectiveness in managing daily COVID-19 confirmed cases. Five analysis periods were considered, including November 01, 2020, to January 20, 2021 (Period 1), January 20, 2021, to June 27, 2021 (Period 2), November 01, 2020, to June 27, 2021 (Period 3), June 27, 2021, to November 01, 2021 (Period 4), and November 01, 2021, to April 24, 2022 (Period 5). Results: Among the KSIs, public facilities in period 4, public events in period 2, religious gatherings in periods 1 and 3, and social gatherings in period 5 had the highest importance. Among the public facilities, policies associated with operation hour restrictions in cinemas, restaurants, PC rooms, indoor sports facilities, karaoke, coffee shops, night entertainment facilities, and baths or saunas had the highest importance across all analysis periods. Strong positive correlations were observed between daily confirmed cases and public facilities, religious gatherings, and public events in period 1 of the pandemic. From then, weaker and negative correlations were observed in the remaining analysis periods. The comparison with the OxCGRT SI showed that the SI had a relatively lower feature importance and correlation with daily confirmed cases than the proposed KSIs, making KSIs more effective than SI. Conclusions: Restriction policies targeting public facilities were the most effective among the policies analyzed. In addition, different periods call for the enforcement of different policies given their effectiveness varies during the pandemic. ", doi="10.2196/47099", url="https://publichealth.jmir.org/2024/1/e47099", url="http://www.ncbi.nlm.nih.gov/pubmed/38190233" } @Article{info:doi/10.2196/43705, author="Monahan, Ken and Gould, Edward and Rice, Todd and Wright, Patty and Vasilevskis, Eduard and Harrell, Frank and Drago, Monique and Mitchell, Sarah", title="Impact of the COVID-19 Pandemic on Medical Grand Rounds Attendance: Comparison of In-Person and Remote Conferences", journal="JMIR Med Educ", year="2024", month="Jan", day="3", volume="10", pages="e43705", keywords="continuing medical education", keywords="COVID-19", keywords="distance education", keywords="professional development", keywords="virtual learning", abstract="Background: Many academic medical centers transitioned from in-person to remote conferences due to the COVID-19 pandemic, but the impact on faculty attendance is unknown. Objective: This study aims to evaluate changes in attendance at medical grand rounds (MGR) following the transition from an in-person to remote format and as a function of the COVID-19 census at Vanderbilt Medical Center. Methods: We obtained the faculty attendee characteristics from Department of Medicine records. Attendance was recorded using a SMS text message--based system. The daily COVID-19 census was recorded independently by hospital administration. The main attendance metric was the proportion of eligible faculty that attended each MGR. Comparisons were made for the entire cohort and for individual faculty. Results: The observation period was from March 2019 to June 2021 and included 101 MGR conferences with more than 600 eligible faculty. Overall attendance was unchanged during the in-person and remote formats (12,536/25,808, 48.6\% vs 16,727/32,680, 51.2\%; P=.44) and did not change significantly during a surge in the COVID-19 census. Individual faculty members attendance rates varied widely. Absolute differences between formats were less than --20\% or greater than 20\% for one-third (160/476, 33.6\%) of faculty. Pulmonary or critical care faculty attendance increased during the remote format compared to in person (1450/2616, 55.4\% vs 1004/2045, 49.1\%; P<.001). A cloud-based digital archive of MGR lectures was accessed by <1\% of faculty per conference. Conclusions: Overall faculty attendance at MGR did not change following the transition to a remote format, regardless of the COVID-19 census, but individual attendance habits fluctuated in a bidirectional manner. Incentivizing the use of a digital archive may represent an opportunity to increase faculty consumption of MGR. ", doi="10.2196/43705", url="https://mededu.jmir.org/2024/1/e43705", url="http://www.ncbi.nlm.nih.gov/pubmed/38029287" } @Article{info:doi/10.2196/43850, author="Danias, George and Appel, Jacob", title="Public Interest in Psilocybin and Psychedelic Therapy in the Context of the COVID-19 Pandemic: Google Trends Analysis", journal="JMIR Form Res", year="2023", month="Dec", day="29", volume="7", pages="e43850", keywords="psilocybin", keywords="Google Trends", keywords="COVID-19", keywords="medical informatics", keywords="depression", keywords="anxiety", keywords="substance use", keywords="social media", keywords="trend analysis", keywords="antidepressant", abstract="Background: Psychedelic substances have demonstrated promise in the treatment of depression, anxiety, and substance use disorders. Significant media coverage has been dedicated to psychedelic medicine, but it is unclear whether the public associates psilocybin with its potential therapeutic benefits. The COVID-19 pandemic led to an increase in depression, anxiety, and substance abuse in the general population. Objective: This study attempts to link increases in interest in these disorders with increases in interest in psilocybin using Google Trends. Methods: Weekly interest-over-time Google Trends data for 4 years, from the week of March 11, 2018, to the week of March 6, 2022, were obtained for the following terms: ``psilocybin,'' ``psychedelic therapy,'' ``cannabis,'' ``cocaine,'' ``antidepressant,'' ``depression,'' ``anxiety,'' and ``addiction.'' Important psilocybin-related news and the declaration of the pandemic were noted. Trends data for each of the queried terms were plotted, and multiple regression analysis was performed to determine the slope of the prepandemic and postpandemic data with 95\% CIs. Nonparametric Tau-U analysis was performed correcting for baseline trends. Results from this test were used to make inferences about the pre- and postpandemic trends and inferences about the change in overall level of searches between the 2 groups. Results: Tau values for prepandemic data were significant for stable trends, all ranging --0.4 to 0.4. Tau values for postpandemic data showed positive trends for ``psilocybin,'' ``psychedelic therapy,'' and ``antidepressant.'' All other trends remained stable in the range of --0.4 to 0.4. When comparing Tau values for pre- and postpandemic data, overall increases in relative search volume (RSV) were seen for ``psilocybin,'' ``psychedelic therapy,'' and ``anxiety,'' and overall decreases in RSV were seen for ``depression,'' ``addiction,'' and ``cocaine.'' Overall RSVs for ``cannabis'' and ``antidepressant'' remained stable as Tau values ranged between --0.4 and 0.4. In the immediate aftermath of the declaration of the pandemic, drop-offs in interest were seen for all terms except for ``anxiety'' and ``cannabis.'' After the initial shock of a global pandemic, ``psilocybin'' and ``psychedelic therapy'' groups demonstrated increases in interest trends and overall RSV. Conclusions: These data suggest that overall interest in ``psilocybin'' and ``psychedelic therapy'' increased at higher rates and to higher levels after than before the declaration of the pandemic. This is consistent with our hypothesis that interest increased for these treatments after the pandemic as incidence of depression, anxiety, and addiction increased. However, there may be other drivers of interest for these topics, since interest in antidepressants---the typical pharmacologic treatments for depression and anxiety---followed the expected pattern of drop-off and accelerated interest back to prepandemic levels. Interest in ``psilocybin'' and ``psychedelic therapy'' may have also been partially driven by popular culture hype and novelty, explaining why interest increased at a higher rate post pandemic and continued to grow, surpassing prior interest. ", doi="10.2196/43850", url="https://formative.jmir.org/2023/1/e43850", url="http://www.ncbi.nlm.nih.gov/pubmed/38064635" } @Article{info:doi/10.2196/42798, author="John, Alby and M, Jagadeesan and Rubeshkumar, Polani and Ganeshkumar, Parasuraman and Masanam Sriramulu, Hemalatha and Narnaware, Manish and Singh Bedi, Gagandeep and Kaur, Prabhdeep", title="Implementation of a Triage Protocol Outside the Hospital Setting for Timely Referral During the COVID-19 Second Wave in Chennai, India", journal="JMIR Form Res", year="2023", month="Dec", day="18", volume="7", pages="e42798", keywords="COVID-19", keywords="triage", keywords="low- and middle-income countries", keywords="LMIC", keywords="India", keywords="pulse oximeter", keywords="implementation", keywords="health care system", keywords="self-management", keywords="patient care", keywords="community health", keywords="low income", keywords="health disparity", keywords="low-resource setting", doi="10.2196/42798", url="https://formative.jmir.org/2023/1/e42798", url="http://www.ncbi.nlm.nih.gov/pubmed/37235721" } @Article{info:doi/10.2196/44606, author="Chung, Ping-Chen and Chen, J. Kevin and Chang, Hui-Mei and Chan, Ta-Chien", title="Evaluating the Effectiveness of School Closure in COVID-19--Related Syndromes From Community-Based Syndromic Surveillance: Longitudinal Observational Study", journal="Interact J Med Res", year="2023", month="Dec", day="15", volume="12", pages="e44606", keywords="school closure", keywords="COVID-19", keywords="syndromic surveillance", keywords="outpatient", keywords="mobility", abstract="Background: During the COVID-19 pandemic, a school closure policy was adopted to prevent cluster transmission in schools and subsequent household transmission. However, the effectiveness of school closure is not consistent in studies conducted in different countries. Objective: This study aimed to explore the association between school closure and the daily standardized incidence of COVID-19--related syndromes in an outpatient syndromic surveillance system. Methods: We calculated the incidence of COVID-19--related syndromes derived from a community-based syndromic surveillance system between the first week of January and the second or fourth weeks after school closure in 2021 and 2022 in Taipei City, Taiwan. The effect of school closure on the standardized incidence of COVID-19--related syndromes was evaluated by interrupted time series analysis using an autoregressive integrated moving average with a distributed lag function. The exogenous variables were changes in human mobility measured by Google COVID-19 community mobility reports. Furthermore, the models quantified the influence of different age groups and the hierarchy of medical facilities, such as clinics or community hospitals. Results: School closure was only negatively and significantly associated with the overall standardized incidence of COVID-19--related syndromes in 2021 for 2 weeks after the intervention (coefficient ?1.24, 95\% CI ?2.40 to ?0.08). However, in different age groups, school closure had a significantly negative association with the standardized incidence among people aged 13-18 years and ?65 years for 2 weeks after the intervention in clinics in 2021. In community hospitals, school closure was significantly positively associated with the standardized incidence among people aged 19-24 years in 2021. In 2022, 2 weeks after the intervention, school closure had a significantly negative association with the standardized incidence among people aged 0-6, 7-12, and 19-24 years in community hospitals and aged >45 years in clinics. Furthermore, the standardized incidence was positively associated with movement change toward grocery and pharmacy stores in all age groups in 2022. In addition, movement changes toward residences were significantly positively associated with the standardized incidence among all age groups. Conclusions: Overall, school closure effectively suppresses COVID-19--related syndromes in students owing to the reduction of physical contact. In addition, school closure has a spillover effect on elderly people who stay at home. ", doi="10.2196/44606", url="https://www.i-jmr.org/2023/1/e44606", url="http://www.ncbi.nlm.nih.gov/pubmed/38100192" } @Article{info:doi/10.2196/49771, author="Wang, Guoyong and Gao, Kai and Liu, Qianyang and Wu, Yuxin and Zhang, Kaijun and Zhou, Wei and Guo, Chunbao", title="Potential and Limitations of ChatGPT 3.5 and 4.0 as a Source of COVID-19 Information: Comprehensive Comparative Analysis of Generative and Authoritative Information", journal="J Med Internet Res", year="2023", month="Dec", day="14", volume="25", pages="e49771", keywords="ChatGPT 3.5", keywords="ChatGPT 4.0", keywords="artificial intelligence", keywords="AI", keywords="COVID-19", keywords="pandemic", keywords="public health", keywords="information retrieval", abstract="Background: The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has necessitated reliable and authoritative information for public guidance. The World Health Organization (WHO) has been a primary source of such information, disseminating it through a question and answer format on its official website. Concurrently, ChatGPT 3.5 and 4.0, a deep learning-based natural language generation system, has shown potential in generating diverse text types based on user input. Objective: This study evaluates the accuracy of COVID-19 information generated by ChatGPT 3.5 and 4.0, assessing its potential as a supplementary public information source during the pandemic. Methods: We extracted 487 COVID-19--related questions from the WHO's official website and used ChatGPT 3.5 and 4.0 to generate corresponding answers. These generated answers were then compared against the official WHO responses for evaluation. Two clinical experts scored the generated answers on a scale of 0-5 across 4 dimensions---accuracy, comprehensiveness, relevance, and clarity---with higher scores indicating better performance in each dimension. The WHO responses served as the reference for this assessment. Additionally, we used the BERT (Bidirectional Encoder Representations from Transformers) model to generate similarity scores (0-1) between the generated and official answers, providing a dual validation mechanism. Results: The mean (SD) scores for ChatGPT 3.5--generated answers were 3.47 (0.725) for accuracy, 3.89 (0.719) for comprehensiveness, 4.09 (0.787) for relevance, and 3.49 (0.809) for clarity. For ChatGPT 4.0, the mean (SD) scores were 4.15 (0.780), 4.47 (0.641), 4.56 (0.600), and 4.09 (0.698), respectively. All differences were statistically significant (P<.001), with ChatGPT 4.0 outperforming ChatGPT 3.5. The BERT model verification showed mean (SD) similarity scores of 0.83 (0.07) for ChatGPT 3.5 and 0.85 (0.07) for ChatGPT 4.0 compared with the official WHO answers. Conclusions: ChatGPT 3.5 and 4.0 can generate accurate and relevant COVID-19 information to a certain extent. However, compared with official WHO responses, gaps and deficiencies exist. Thus, users of ChatGPT 3.5 and 4.0 should also reference other reliable information sources to mitigate potential misinformation risks. Notably, ChatGPT 4.0 outperformed ChatGPT 3.5 across all evaluated dimensions, a finding corroborated by BERT model validation. ", doi="10.2196/49771", url="https://www.jmir.org/2023/1/e49771", url="http://www.ncbi.nlm.nih.gov/pubmed/38096014" } @Article{info:doi/10.2196/43105, author="Singh, Akanksha and Schooley, Benjamin and Patel, Nitin", title="Effects of User-Reported Risk Factors and Follow-Up Care Activities on Satisfaction With a COVID-19 Chatbot: Cross-Sectional Study", journal="JMIR Mhealth Uhealth", year="2023", month="Dec", day="14", volume="11", pages="e43105", keywords="patient engagement", keywords="chatbot", keywords="population health", keywords="health recommender systems", keywords="conversational recommender systems", keywords="design factors", keywords="COVID-19", abstract="Background: The COVID-19 pandemic influenced many to consider methods to reduce human contact and ease the burden placed on health care workers. Conversational agents or chatbots are a set of technologies that may aid with these challenges. They may provide useful interactions for users, potentially reducing the health care worker burden while increasing user satisfaction. Research aims to understand these potential impacts of chatbots and conversational recommender systems and their associated design features. Objective: The objective of this study was to evaluate user perceptions of the helpfulness of an artificial intelligence chatbot that was offered free to the public in response to COVID-19. The chatbot engaged patients and provided educational information and the opportunity to report symptoms, understand personal risks, and receive referrals for care. Methods: A cross-sectional study design was used to analyze 82,222 chats collected from patients in South Carolina seeking services from the Prisma Health system. Chi-square tests and multinomial logistic regression analyses were conducted to assess the relationship between reported risk factors and perceived chat helpfulness using chats started between April 24, 2020, and April 21, 2022. Results: A total of 82,222 chat series were started with at least one question or response on record; 53,805 symptom checker questions with at least one COVID-19--related activity series were completed, with 5191 individuals clicking further to receive a virtual video visit and 2215 clicking further to make an appointment with a local physician. Patients who were aged >65 years (P<.001), reported comorbidities (P<.001), had been in contact with a person with COVID-19 in the last 14 days (P<.001), and responded to symptom checker questions that placed them at a higher risk of COVID-19 (P<.001) were 1.8 times more likely to report the chat as helpful than those who reported lower risk factors. Users who engaged with the chatbot to conduct a series of activities were more likely to find the chat helpful (P<.001), including seeking COVID-19 information (3.97-4.07 times), in-person appointments (2.46-1.99 times), telehealth appointments with a nearby provider (2.48-1.9 times), or vaccination (2.9-3.85 times) compared with those who did not perform any of these activities. Conclusions: Chatbots that are designed to target high-risk user groups and provide relevant actionable items may be perceived as a helpful approach to early contact with the health system for assessing communicable disease symptoms and follow-up care options at home before virtual or in-person contact with health care providers. The results identified and validated significant design factors for conversational recommender systems, including triangulating a high-risk target user population and providing relevant actionable items for users to choose from as part of user engagement. ", doi="10.2196/43105", url="https://mhealth.jmir.org/2023/1/e43105", url="http://www.ncbi.nlm.nih.gov/pubmed/38096007" } @Article{info:doi/10.2196/45204, author="Delabre, M. Rosemary and Di Ciaccio, Marion and Lorente, Nicolas and Villes, Virginie and Castro Avila, Juliana and Yattassaye, Adam and Bonifaz, C{\'e}sar and Ben Moussa, Amal and Sikitu, Ingrid-Za{\"i}re and Khodabocus, Niloufer and Freitas, Rosa and Spire, Bruno and Veras, Am{\'e}lia Maria and Sagaon-Teyssier, Luis and Girard, Gabriel and Roux, Perrine and Velter, Annie and Delpech, Val{\'e}rie and Ghosn, Jade and Riegel, Lucas and Rojas Castro, Daniela", title="Impact of the COVID-19 Health Crisis on Key Populations at Higher Risk for, or Living With, HIV or Hepatitis C Virus and People Working With These Populations: Multicountry Community-Based Research Study Protocol (EPIC Program)", journal="JMIR Res Protoc", year="2023", month="Dec", day="14", volume="12", pages="e45204", keywords="COVID-19", keywords="key populations", keywords="health", keywords="crisis", keywords="HIV", keywords="mobile phone", abstract="Background: Information concerning the impact of the COVID-19 health crisis on populations most affected by HIV and hepatitis C virus (HCV; or key populations [KP]), and those working with these populations in community settings, is limited. Community-based organizations working in the field of HIV and viral hepatitis are well placed to identify and meet the new needs of KP owing to the health crisis. Objective: This study aims to describe the development and implementation of an exploratory and descriptive multicountry, community-based research program, EPIC (Enqu{\^e}tes Pour {\'e}valuer l'Impact de la crise sanitaire covid en milieu Communautaire), within an international network of community-based organizations involved in the response to HIV and viral hepatitis. The EPIC program aimed to study the impact of the COVID-19 health crisis on KP or people living with HIV or HCV and people working with these populations at the community level (community health workers [CHWs]) and to identify the key innovations and adaptations in HIV and HCV services. Methods: A general protocol and study documents were developed and shared within the Coalition PLUS network. The protocol had a built-in flexibility that allowed participating organizations to adapt the study to local needs in terms of the target population and specific themes of interest. Data were collected using surveys or interviews. Results: From July 2020 to May 2022, a total of 79 organizations participated in the EPIC program. Across 32 countries, 118 studies were conducted: 66 quantitative (n=12,060 among KP or people living with HIV or people living with HCV and n=811 among CHWs) and 52 qualitative (n=766 among KP or people living with HIV or people living with HCV and n=136 among CHWs). Conclusions: The results of the EPIC program will provide data to describe the impact of the health crisis on KP and CHWs and identify their emerging needs. Documentation of innovative solutions that were put into place in this context may help improve the provision of services after COVID-19 and for future health crises. International Registered Report Identifier (IRRID): DERR1-10.2196/45204 ", doi="10.2196/45204", url="https://www.researchprotocols.org/2023/1/e45204", url="http://www.ncbi.nlm.nih.gov/pubmed/38096016" } @Article{info:doi/10.2196/50682, author="Berthelot, Simon and Longtin, Yves and Margni, Manuele and Guertin, Robert Jason and LeBlanc, Annie and Marx, Tania and Mangou, Khadidiatou and Bluteau, Ariane and Mantovani, Diego and Mikhaylin, Sergey and Bergeron, Fr{\'e}d{\'e}ric and Dancause, Val{\'e}rie and Desjardins, Anne and Lahrichi, Nadia and Martin, Danielle and Sossa, J{\'e}r{\^o}me Charles and Lachapelle, Philippe and Genest, Isabelle and Schaal, St{\'e}phane and Gignac, Anne and Tremblay, St{\'e}phane and Hufty, {\'E}ric and B{\'e}langer, Lynda and Beatty, Erica", title="Postpandemic Evaluation of the Eco-Efficiency of Personal Protective Equipment Against COVID-19 in Emergency Departments: Proposal for a Mixed Methods Study", journal="JMIR Res Protoc", year="2023", month="Dec", day="7", volume="12", pages="e50682", keywords="COVID-19", keywords="SARS-CoV-2", keywords="personal protective equipment", keywords="emergency department", keywords="health care workers", keywords="systematic review", keywords="cost-consequence analysis", keywords="time-driven activity-based costing", keywords="life cycle assessment", keywords="ecological footprint", abstract="Background: The COVID-19 pandemic has had a profound impact on emergency department (ED) care in Canada and around the world. To prevent transmission of COVID-19, personal protective equipment (PPE) was required for all ED care providers in contact with suspected cases. With mass vaccination and improvements in several infection prevention components, our hypothesis is that the risks of transmission of COVID-19 will be significantly reduced and that current PPE use will have economic and ecological consequences that exceed its anticipated benefits. Evidence is needed to evaluate PPE use so that recommendations can ensure the clinical, economic, and environmental efficiency (ie, eco-efficiency) of its use. Objective: To support the development of recommendations for the eco-efficient use of PPE, our research objectives are to (1) estimate the clinical effectiveness (reduced transmission, hospitalizations, mortality, and work absenteeism) of PPE against COVID-19 for health care workers; (2) estimate the financial cost of using PPE in the ED for the management of suspected or confirmed COVID-19 patients; and (3) estimate the ecological footprint of PPE use against COVID-19 in the ED. Methods: We will conduct a mixed method study to evaluate the eco-efficiency of PPE use in the 5 EDs of the CHU de Qu{\'e}bec-Universit{\'e} Laval (Qu{\'e}bec, Canada). To achieve our goals, the project will include four phases: systematic review of the literature to assess the clinical effectiveness of PPE (objective?1; phase 1); cost estimation of PPE use in the ED using a time-driven activity-based costing method (objective?2; phase 2); ecological footprint estimation of PPE use using a life cycle assessment approach (objective?3; phase 3); and cost-consequence analysis and focus groups (integration of objectives?1?to?3; phase 4). Results: The first 3 phases have started. The results of these phases will be available in 2023. Phase 4 will begin in 2023 and results will be available in 2024. Conclusions: While the benefits of PPE use are likely to diminish as health care workers' immunity increases, it is important to assess its economic and ecological impacts to develop recommendations to guide its eco-efficient use. Trial Registration: PROSPERO CRD42022302598; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=302598 International Registered Report Identifier (IRRID): DERR1-10.2196/50682 ", doi="10.2196/50682", url="https://www.researchprotocols.org/2023/1/e50682", url="http://www.ncbi.nlm.nih.gov/pubmed/38060296" } @Article{info:doi/10.2196/50367, author="Tin, Jason and Stevens, Hannah and Rasul, Ehab Muhammad and Taylor, D. Laramie", title="Incivility in COVID-19 Vaccine Mandate Discourse and Moral Foundations: Natural Language Processing Approach", journal="JMIR Form Res", year="2023", month="Nov", day="29", volume="7", pages="e50367", keywords="incivility", keywords="vaccine hesitancy", keywords="moral foundations", keywords="COVID-19", keywords="vaccines", keywords="morality", keywords="social media", keywords="natural language processing", keywords="machine learning", abstract="Background: Vaccine hesitancy poses a substantial threat to efforts to mitigate the harmful effects of the COVID-19 pandemic. To combat vaccine hesitancy, officials in the United States issued vaccine mandates, which were met with strong antivaccine discourse on social media platforms such as Reddit. The politicized and polarized nature of COVID-19 on social media has fueled uncivil discourse related to vaccine mandates, which is known to decrease confidence in COVID-19 vaccines. Objective: This study examines the moral foundations underlying uncivil COVID-19 vaccine discourse. Moral foundations theory poses that individuals make decisions to express approval or disapproval (ie, uncivil discourse) based on innate moral values. We examine whether moral foundations are associated with dimensions of incivility. Further, we explore whether there are any differences in the presence of incivility between the r/coronaviruscirclejerk and r/lockdownskepticism subreddits. Methods: Natural language processing methodologies were leveraged to analyze the moral foundations underlying uncivil discourse in 2 prominent antivaccine subreddits, r/coronaviruscirclejerk and r/lockdownskepticism. All posts and comments from both of the subreddits were collected since their inception in March 2022. This was followed by filtering the data set for key terms associated with the COVID-19 vaccine (eg, ``vaccinate'' and ``Pfizer'') and mandates (eg, ``forced'' and ``mandating''). These key terms were selected based on a review of existing literature and because of their salience in both of the subreddits. A 10\% sample of the filtered key terms was used for the final analysis. Results: Findings suggested that moral foundations play a role in the psychological processes underlying uncivil vaccine mandate discourse. Specifically, we found substantial associations between all moral foundations (ie, care and harm, fairness and cheating, loyalty and betrayal, authority and subversion, and sanctity and degradation) and dimensions of incivility (ie, toxicity, insults, profanity, threat, and identity attack) except for the authority foundation. We also found statistically significant differences between r/coronaviruscirclejerk and r/lockdownskepticism for the presence of the dimensions of incivility. Specifically, the mean of identity attack, insult, toxicity, profanity, and threat in the r/lockdownskepticism subreddit was significantly lower than that in the r/coronaviruscirclejerk subreddit (P<.001). Conclusions: This study shows that moral foundations may play a substantial role in the presence of incivility in vaccine discourse. On the basis of the findings of the study, public health practitioners should tailor messaging by addressing the moral values underlying the concerns people may have about vaccines, which could manifest as uncivil discourse. Another way to tailor public health messaging could be to direct it to parts of social media platforms with increased uncivil discourse. By integrating moral foundations, public health messaging may increase compliance and promote civil discourse surrounding COVID-19. ", doi="10.2196/50367", url="https://formative.jmir.org/2023/1/e50367", url="http://www.ncbi.nlm.nih.gov/pubmed/38019581" } @Article{info:doi/10.2196/41811, author="Candelo, Estephania and Arias-Valderrama, Oriana and Trivi{\~n}o-Arias, Jacobo and Quiroz, Felipe and Isaza-Pierotti, Francisco Daniel and Victoria, William and Tintinago, F. Luis", title="Airway Sequelae After Mechanical Ventilation for COVID-19: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2023", month="Nov", day="29", volume="12", pages="e41811", keywords="airway", keywords="sequelae", keywords="COVID-19", keywords="mechanical ventilation", keywords="SARS-CoV-2", keywords="scoping review", keywords="pulmonary", keywords="mortality", keywords="voice production", keywords="health care cost", keywords="health intervention", abstract="Background: The epidemiology, morbidity, and burden of disease related to airway sequelae associated with invasive mechanical ventilation in the context of the COVID-19 pandemic remain unclear. Objective: This scoping review aims to summarize the current knowledge regarding airway sequelae after severe SARS-CoV-2 infection. This knowledge will help guide research endeavors and decision-making in clinical practice. Methods: This scoping review will include participants of all genders, and no particular age group who developed post--COVID-19 airway-related complication will be excluded. No exclusion criteria will be applied from country, language, or document type. The information source will include analytical observational studies. Unpublished data will not be completely covered as gray literature will be covered. A total of 2 independent reviewers will participate in the process of screening, selection, and data extraction, and the whole process will be performed blindly. Conflict between the reviewers will be solved through discussion and an additional reviewer. The results will be reported by using descriptive statistics, and information will be displayed on RedCap (Research Electronic Data Capture). Results: The literature search was conducted in May 2022 in the following databases: PubMed, Embase, SCOPUS, Cochrane Library, as well as LILACS and gray literature to identify observational studies; a total of 738 results were retrieved. The scoping review will be finished by March 2023. Conclusions: This scoping review will describe current knowledge on the most frequently encountered laryngeal or tracheal sequelae in patients exposed to mechanical ventilation due to SARS-CoV-2 infection. This scoping review will find the incidence of airway sequelae post COVID-19 and the most common sequelae such as airway granuloma, vocal fold paralysis, and airway stenoses. Future studies should evaluate the incidence of these disorders. International Registered Report Identifier (IRRID): DERR1-10.2196/41811 ", doi="10.2196/41811", url="https://www.researchprotocols.org/2023/1/e41811", url="http://www.ncbi.nlm.nih.gov/pubmed/37191952" } @Article{info:doi/10.2196/32848, author="Soto, Raymond and Paul, Litty and Porucznik, A. Christina and Xie, Heng and Stinnett, Czako Rita and Briggs, Benjamin and Biggerstaff, Matthew and Stanford, Joseph and Schlaberg, Robert", title="Effectiveness of Self-Collected, Ambient Temperature--Preserved Nasal Swabs Compared to Samples Collected by Trained Staff for Genotyping of Respiratory Viruses by Shotgun RNA Sequencing: Comparative Study", journal="JMIR Form Res", year="2023", month="Nov", day="24", volume="7", pages="e32848", keywords="genotyping", keywords="self-collected nasal swabs", keywords="RNA sequencing", keywords="respiratory virus surveillance", keywords="surveillance", keywords="respiratory virus", keywords="influenza virus", keywords="pandemic", keywords="preparedness", keywords="testing capacity", keywords="self-test", keywords="viral genome analysis", keywords="swabs", keywords="barriers", keywords="early detection", keywords="nasal swab", keywords="temperature", keywords="public health", keywords="specimen", keywords="collection", keywords="diagnosis", keywords="laboratory", keywords="respiratory", keywords="virus", keywords="COVID-19", abstract="Background: The SARS-CoV-2 pandemic has underscored the need for field specimen collection and transport to diagnostic and public health laboratories. Self-collected nasal swabs transported without dependency on a cold chain have the potential to remove critical barriers to testing, expand testing capacity, and reduce opportunities for exposure of health professionals in the context of a pandemic. Objective: We compared nasal swab collection by study participants from themselves and their children at home to collection by trained research staff. Methods: Each adult participant collected 1 nasal swab, sampling both nares with the single swab, after which they collected 1 nasal swab from 1 child. After all the participant samples were collected for the household, the research staff member collected a separate single duplicate sample from each individual. Immediately after the sample collection, the adult participants completed a questionnaire about the acceptability of the sampling procedures. Swabs were placed in temperature-stable preservative and respiratory viruses were detected by shotgun RNA sequencing, enabling viral genome analysis. Results: In total, 21 households participated in the study, each with 1 adult and 1 child, yielding 42 individuals with paired samples. Study participants reported that self-collection was acceptable. Agreement between identified respiratory viruses in both swabs by RNA sequencing demonstrated that adequate collection technique was achieved by brief instructions. Conclusions: Our results support the feasibility of a scalable and convenient means for the identification of respiratory viruses and implementation in pandemic preparedness for novel respiratory pathogens. ", doi="10.2196/32848", url="https://formative.jmir.org/2023/1/e32848", url="http://www.ncbi.nlm.nih.gov/pubmed/37999952" } @Article{info:doi/10.2196/49435, author="Gable, M. Jessica S. and Sauvayre, Romy and Chauvi{\`e}re, C{\'e}dric", title="Fight Against the Mandatory COVID-19 Immunity Passport on Twitter: Natural Language Processing Study", journal="J Med Internet Res", year="2023", month="Nov", day="23", volume="25", pages="e49435", keywords="mandatory vaccination", keywords="public policy", keywords="public health measures", keywords="COVID-19", keywords="vaccine", keywords="social media analysis", keywords="Twitter", keywords="natural language processing", keywords="deep learning", keywords="social media", keywords="public health", keywords="vaccination", keywords="immunity", keywords="social distancing", keywords="neural network", keywords="effectiveness", abstract="Background: To contain and curb the spread of COVID-19, the governments of countries around the world have used different strategies (lockdown, mandatory vaccination, immunity passports, voluntary social distancing, etc). Objective: This study aims to examine the reactions produced by the public announcement of a binding political decision presented by the president of the French Republic, Emmanuel Macron, on July 12, 2021, which imposed vaccination on caregivers and an immunity passport on all French people to access restaurants, cinemas, bars, and so forth. Methods: To measure these announcement reactions, 901,908 unique tweets posted on Twitter (Twitter Inc) between July 12 and August 11, 2021, were extracted. A neural network was constructed to examine the arguments of the tweets and to identify the types of arguments used by Twitter users. Results: This study shows that in the debate about mandatory vaccination and immunity passports, mostly ``con'' arguments (399,803/847,725, 47\%; $\chi$26=952.8; P<.001) and ``scientific'' arguments (317,156/803,583, 39\%; $\chi$26=5006.8; P<.001) were used. Conclusions: This study shows that during July and August 2021, social events permeating the public sphere and discussions about mandatory vaccination and immunity passports collided on Twitter. Moreover, a political decision based on scientific arguments led citizens to challenge it using pseudoscientific arguments contesting the effectiveness of vaccination and the validity of these political decisions. ", doi="10.2196/49435", url="https://www.jmir.org/2023/1/e49435", url="http://www.ncbi.nlm.nih.gov/pubmed/37850906" } @Article{info:doi/10.2196/52114, author="Mart{\'i}nez-Baz, Iv{\'a}n and Bull{\'o}n-Vela, Vanessa and Soldevila, N{\'u}ria and Torner, N{\'u}ria and Palma, David and Garc{\'i}a Cenoz, Manuel and P{\'e}rez, Gl{\`o}ria and Burgui, Cristina and Castilla, Jes{\'u}s and Godoy, Pere and Dom{\'i}nguez, Angela and Toledo, Diana", title="Assessment of Knowledge and Attitudes Over Time in Postacute COVID-19 Environments: Protocol for an Epidemiological Study", journal="JMIR Res Protoc", year="2023", month="Nov", day="23", volume="12", pages="e52114", keywords="COVID-19", keywords="knowledge", keywords="attitudes", keywords="household contact", keywords="vaccination", keywords="preventive measures", keywords="survey", abstract="Background: Globally, COVID-19 is in transition from the acute pandemic phase into a postacute phase, and special attention should be paid at this time to COVID-19 control strategies. Understanding public knowledge and attitudes plays a pivotal role in controlling COVID-19's spread and provides information about the public's adherence to preventive and control measures. Objective: This study protocol describes the planning and management of a survey to investigate the persistent or changing trends in knowledge and attitudes regarding COVID-19, vaccination, and nonpharmaceutical preventive measures among COVID-19 cases' household contacts aged 18 years and older, after the acute phase of the pandemic in Catalonia and Navarre in Spain. The secondary objectives include investigating the rate of secondary transmission in households, taking into account the demographic characteristics, clinical manifestations, and preventive measures toward COVID-19. Methods: A telephone questionnaire was designed to assess the changing trends in knowledge, preventive measures, and attitudes toward COVID-19 in 3 rounds (after identification as a household contact, 3 months later, and 6 months later). The questionnaire was developed following an extensive literature review and through discussions with a panel of experts who designed and assessed the validity of the questionnaire in terms of relevance, consistency, completeness, and clarity. The questionnaire consists of the following 7 sections: social and demographic characteristics (ie, gender, age, educational level, and workplace), comorbidities and risk factors (according to the recommendations from the COVID-19 vaccination strategy), epidemiological data (ie, exposure time, relationship with index cases, and frequency of use of nonpharmaceutical preventive measures), COVID-19 vaccination status (ie, the number and date of doses received), knowledge and attitudes toward COVID-19 (assessed using a 5-point Likert scale---totally agree, agree, neither agree nor disagree, disagree, and totally disagree), and sources of information (including traditional mass media, social media, and official sources). Results: A pilot study was performed in May 2022 to evaluate the questionnaire with 22 household contacts. Preliminary findings indicated that the questionnaire was feasible and acceptable in the general population. The average response time was 15 minutes, with greater variations in responses by older participants. After the pilot study, recruitment of participants began and is expected to be completed at the end of the year 2023, after which the final results will be available in 2024. Conclusions: Despite the low transmission levels of SARS-CoV-2 and the relaxation of containment measures, the implementation of the survey during the postacute phase will provide valuable insight to assist public health decision-making and control the transmission of SARS-CoV-2 and other respiratory viruses, thereby attenuating the negative effects of COVID-19 at individual and population level. International Registered Report Identifier (IRRID): DERR1-10.2196/52114 ", doi="10.2196/52114", url="https://www.researchprotocols.org/2023/1/e52114", url="http://www.ncbi.nlm.nih.gov/pubmed/37995118" } @Article{info:doi/10.2196/34128, author="Cordoba, Raul and Lopez-Garcia, Alberto and Morillo, Daniel and Perez-Saenz, Maria-Angeles and Askari, Elham and Prieto, Elena Rosa and Castillo Bazan, Eva and Llamas Sillero, Pilar and Herrero Gonzalez, Antonio and Short Apellaniz, Jorge and del Olmo, Marta and Arcos, Javier", title="Feasibility of Telemedicine in the Management Strategy of Patients With Lymphoma Amid the COVID-19 Pandemic in Spain: Prospective Observational Study", journal="JMIR Form Res", year="2023", month="Nov", day="17", volume="7", pages="e34128", keywords="telemedicine", keywords="lymphoma", keywords="COVID-19", keywords="cancer", keywords="telehealth", keywords="risk factor", keywords="patient portal", keywords="electronic health record", keywords="EHR", abstract="Background: On March 14, 2020, a state of alarm was declared in Spain due to the spread of SARS-CoV-2. Beyond this date, COVID-19 in the country changed the practice of oncologic care. Objective: Since recurrent hospital visits were a potential risk factor for contagion, the aim of this prospective observational study was to analyze the consequences of the COVID-19 pandemic in the health care of patients with lymphoma. Methods: All data were obtained from the electronic medical record. Variables such as age, sex, reason of the visit, use of the patient portal, changes in management, enrollment in clinical trials, and COVID-19 infection were recorded. Results: In all, 290 patients visited the lymphoma clinic, totaling 437 appointments. The median age was 66 (range 18-94) years, and 157 (54.1\%) patients were male. Of them, 214 (73.8\%) patients had only 1 visit to the clinic. Only 23 (7.9\%) patients did not have access to the patient portal. Amid the COVID-19 pandemic, 78 (26.9\%) patients remained in active treatment, 35 (12.1\%) experienced delays in their treatments, and 6 (2.1\%) experienced treatment discontinuation. During the follow-up, only 7 (2.4\%) patients had a COVID-19 infection (6 cases with confirmed polymerase chain reaction test and 1 case with clinical suspicion). Despite the implementation of telemedicine strategies to avoid visits to the hospital, 66 (22.8\%) patients had in-person visits at the lymphoma clinic. Patients who attended in-person consultations were younger than those who preferred telemedicine consultations (62 vs 66 years; P=.10) and had less use of the patient portal (17/224, 7.6\% vs 6/66, 9\%; P=.10), although these differences did not reach statistical significance. Patients who attended in-person visits were more likely to have had only 1 visit to the hospital (29/66, 43.9\% vs 185/224, 82.6\%; P<.001). Regarding the reason of in-person consultations, more patients were on active treatment in comparison to those using telemedicine resources (37/66, 56.1\% vs 42/224, 18.3\%; P<.001). Patients with a preference for telemedicine strategies had more surveillance visits (147/224, 65.6\% vs 24/66, 36.4\%; P<.001). Regarding treatment modifications, more treatment delays (29/224, 12.9\% vs 6/66, 9.1\%; P=.10) and more definite treatment discontinuations (6/224, 2.7\% vs 0/66, 0\%; P=.10) were seen in patients using telemedicine resources when compared to patients attending in-person visits, although these differences did not reach statistical significance. Regarding the type of therapy, patients attending in-person visits were more likely to receive an intravenous treatment rather than those using telemedicine (23/66, 62.2\% vs 17/224, 40.5\%; P<.001). Conclusions: Telemedicine such as patient portals are feasible strategies in the management of patients with lymphoma during the COVID-19 pandemic, with a reduction of in-person visits to the hospital and a very low contagion rate. ", doi="10.2196/34128", url="https://formative.jmir.org/2023/1/e34128", url="http://www.ncbi.nlm.nih.gov/pubmed/36645838" } @Article{info:doi/10.2196/49753, author="Zhou, Xinyu and Song, Suhang and Zhang, Ying and Hou, Zhiyuan", title="Deep Learning Analysis of COVID-19 Vaccine Hesitancy and Confidence Expressed on Twitter in 6 High-Income Countries: Longitudinal Observational Study", journal="J Med Internet Res", year="2023", month="Nov", day="6", volume="25", pages="e49753", keywords="COVID-19 vaccine", keywords="hesitancy", keywords="confidence", keywords="social media", keywords="machine learning", abstract="Background: An ongoing monitoring of national and subnational trajectory of COVID-19 vaccine hesitancy could offer support in designing tailored policies on improving vaccine uptake. Objective: We aim to track the temporal and spatial distribution of COVID-19 vaccine hesitancy and confidence expressed on Twitter during the entire pandemic period in major English-speaking countries. Methods: We collected 5,257,385 English-language tweets regarding COVID-19 vaccination between January 1, 2020, and June 30, 2022, in 6 countries---the United States, the United Kingdom, Australia, New Zealand, Canada, and Ireland. Transformer-based deep learning models were developed to classify each tweet as intent to accept or reject COVID-19 vaccination and the belief that COVID-19 vaccine is effective or unsafe. Sociodemographic factors associated with COVID-19 vaccine hesitancy and confidence in the United States were analyzed using bivariate and multivariable linear regressions. Results: The 6 countries experienced similar evolving trends of COVID-19 vaccine hesitancy and confidence. On average, the prevalence of intent to accept COVID-19 vaccination decreased from 71.38\% of 44,944 tweets in March 2020 to 34.85\% of 48,167 tweets in June 2022 with fluctuations. The prevalence of believing COVID-19 vaccines to be unsafe continuously rose by 7.49 times from March 2020 (2.84\% of 44,944 tweets) to June 2022 (21.27\% of 48,167 tweets). COVID-19 vaccine hesitancy and confidence varied by country, vaccine manufacturer, and states within a country. The democrat party and higher vaccine confidence were significantly associated with lower vaccine hesitancy across US states. Conclusions: COVID-19 vaccine hesitancy and confidence evolved and were influenced by the development of vaccines and viruses during the pandemic. Large-scale self-generated discourses on social media and deep learning models provide a cost-efficient approach to monitoring routine vaccine hesitancy. ", doi="10.2196/49753", url="https://www.jmir.org/2023/1/e49753", url="http://www.ncbi.nlm.nih.gov/pubmed/37930788" } @Article{info:doi/10.2196/40264, author="Akhras, Aya and ElSaban, Mariam and Tamil?Selvan, Varshini and Alzaabi, Zain Shaika and Senok, Abiola? and Zary, Nabil and Ho, B. Samuel", title="An Inquiry-Based Distance Learning Tool for Medical Students Under Lockdown (``COVID-19 Rounds''): Cross-Sectional Study", journal="JMIR Med Educ", year="2023", month="Nov", day="6", volume="9", pages="e40264", keywords="medical education", keywords="COVID-19", keywords="technology-enhanced learning", keywords="distance learning", keywords="student engagement", keywords="5E instructional model", abstract="Background: The?COVID-19 pandemic?presented significant challenges to both?clinical practice and the?delivery of medical education. Educators and learners implemented novel techniques, including distance learning and web-based rounds, while trying to stay updated with the surge of information regarding COVID-19 epidemiology, pathogenesis, and treatment. Hence, we designed and implemented a technologically enhanced course called ``COVID-19 Rounds'' to educate students about the rapidly evolving pandemic. Objective: The objectives of this study are to describe a technologically enhanced course called ``COVID-19 Rounds'' and evaluate the following: (1) student satisfaction and program usefulness in achieving preset objectives, (2) perceived improvement in literacy regarding the pandemic, and (3) the impact of student engagement by designing infographics and initiating COVID-19--related research projects. Methods: This is a cross-sectional study measuring the impact of the implementation of the web-based ``COVID-19 Rounds'' course. This program included?web-based clinical experiences with physicians?on?actual?rounds?in COVID-19 wards in the hospital, weekly updates on evolving data and new research, and engagement in student-led projects. The study population included 47 fourth-year medical students at the Mohamed Bin Rashid University of Medicine and Health Sciences in Dubai, the United Arab Emirates, who attended the course.?We designed and administered a 47-item survey to assess student satisfaction, program usefulness, impact on knowledge, and student engagement. Data were collected at the end of program delivery via Microsoft Forms. Results: In total, 38 (81\%)?out of 47 fourth-year medical students?participated in?this study. The final course evaluation revealed an overall high satisfaction rate, with a mean rating of 3.9 (SD 0.94) on the 5-point Likert scale.?Most students were satisfied with the course format (27/38, 71\%), organization (31/38, 82\%), and the learning experience (28/38, 74\%) that the course offered.?The course was particularly appreciated for offering evidence-based talks about aspects of the pandemic (34/38, 90\%), providing weekly updates regarding emerging evidence (32/38, 84\%),?and enhancing understanding of the challenges of the pandemic (34/38, 90\%). Satisfaction with distance learning was moderate (23/37, 62\%), and a minority of students would have preferred an in-person version of the course (10/37, 27\%). Student engagement in the course was high. All students participated in small group presentations of infographics of pandemic-related topics. Perceived advantages included conciseness and visual appeal, and disadvantages included the lack of detail and the time-consuming nature of infographic design, especially for students with no prior design experience. After the course ended, 27 (57\%) students began research projects. This resulted in 6 abstracts presented at local meetings and 8 scientific papers published or submitted for publication. Conclusions: This inquiry-based adaptive approach to educating medical students about updates on COVID-19 via web-based learning was successful in achieving objectives and encouraging engagement in research. However, shortcomings of the course related to the lack of in-person teaching and clinical activities were?also highlighted. ", doi="10.2196/40264", url="https://mededu.jmir.org/2023/1/e40264", url="http://www.ncbi.nlm.nih.gov/pubmed/37856734" } @Article{info:doi/10.2196/44299, author="Nazarov, Anthony and Fikretoglu, Deniz and Liu, Aihua and Born, Jennifer and Michaud, Kathy and Hendriks, Tonya and B{\'e}langer, AH St{\'e}phanie and Do, T. Minh and Lam, Quan and Brooks, Brenda and King, Kristen and Sudom, Kerry and Jetly, Rakesh and Garber, Bryan and Thompson, Megan", title="Moral Distress, Mental Health, and Risk and Resilience Factors Among Military Personnel Deployed to Long-Term Care Facilities During the COVID-19 Pandemic: Research Protocol and Participation Metrics", journal="JMIR Res Protoc", year="2023", month="Nov", day="6", volume="12", pages="e44299", keywords="mental health", keywords="military", keywords="Canadian Armed Forces", keywords="operational organization", keywords="logistics support", keywords="health care", keywords="moral distress", keywords="moral injury", keywords="deployment", keywords="risk factors", keywords="COVID-19", keywords="quarantine", keywords="readiness", keywords="well-being", keywords="resilience", keywords="long-term care facility", keywords="centre de soins de longue dur{\'e}e", keywords="survey", keywords="older adult", keywords="qualitative interviews", keywords="quantitative", abstract="Background: The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID-19 cases and COVID-19--related deaths among residents of long-term care facilities (LTCFs). As part of Canada's response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (ie, related to core values, eg, witnessing human suffering). Emerging data from health care workers exposed to the unprecedented medical challenges and dilemmas of the early pandemic stages also indicated that such experiences were associated with increased risk of adverse mental health outcomes. Objective: This study aims to identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury, and traditional mental health and well-being outcomes of Operation LASER LTCF CAF personnel. This paper aimed to document the methodology, implementation procedures, and participation metrics. Methods: A multimethod research initiative was conducted consisting of 2 primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with web-based, self-report questionnaires administered at 3 time points (3, 6, and 12 mo after deployment). The qualitative arm consisted of individual, web-based interviews with a focus on understanding the nuanced lived experiences of individuals participating in the Operation LASER LTCF deployment. Results: CAF personnel deployed to Operation LASER LTCF (N=2595) were invited to participate in the study. Data collection is now complete. Overall, of the 2595 deployed personnel, 1088 (41.93\%), 582 (22.43\%), and 497 (19.15\%) responded to the survey at time point 1 (3 mo), time point 2 (6 mo), and time point 3 (12 mo) after deployment, respectively. The target sample size for the qualitative interviews was set at approximately 50 considering resourcing and data saturation. Interest in participating in qualitative interviews surpassed expectations, with >200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Operation LASER LTCF role, and province. In total, 53 interviews were conducted. Conclusions: The data generated through this research have the potential to inform and promote better understanding of the well-being and mental health of Operation LASER LTCF personnel over time; identify general and Operation LASER LTCF--specific risk and protective factors; provide necessary support to the military personnel who served in this mission; and inform preparation and interventions for future missions, especially those more domestic and humanitarian in nature. International Registered Report Identifier (IRRID): DERR1-10.2196/44299 ", doi="10.2196/44299", url="https://www.researchprotocols.org/2023/1/e44299", url="http://www.ncbi.nlm.nih.gov/pubmed/37676877" } @Article{info:doi/10.2196/45830, author="Muroi, Kei and Ishitsuka, Mami and Hachisuka, Tomoko and Shibata, Itsuka and Ikeda, Tomohiko and Hori, Daisuke and Doki, Shotaro and Takahashi, Tsukasa and Sasahara, Shin-ichiro and Matsuzaki, Ichiyo", title="Factors Associated With Work Engagement of Nurses During the Fifth Wave of the COVID-19 Pandemic in Japan: Web-Based Cross-Sectional Study", journal="JMIR Form Res", year="2023", month="Nov", day="3", volume="7", pages="e45830", keywords="age", keywords="COVID-19", keywords="cross-sectional study", keywords="engagement", keywords="experience", keywords="gender", keywords="intensive care", keywords="Japan", keywords="JD-R model", keywords="job demands-resources", keywords="mental health", keywords="nurses", keywords="psychiatric", keywords="psychological", keywords="survey", keywords="work engagement", abstract="Background: The COVID-19 pandemic has brought to light the prevalence of mental health issues among nurses. Work engagement (WE) is a concept that describes work-related positive psychological states and is of importance within mental health measures. There is, however, a lack of research on factors associated with the WE of nurses during the COVID-19 pandemic. Objective: We aimed to determine which factors are associated with WE among nurses during the COVID-19 pandemic using the job demands-resources (JD-R) model as a framework. Methods: A web-based cross-sectional survey was conducted among nurses working in acute care and psychiatric institutions in the prefectures of Chiba and Tokyo in Japan. The survey period occurred between August 8 and September 30, 2021, during a time when the number of patients with a positive COVID-19 infection increased. The 3-item version of the Utrecht Work Engagement Scale (UWES-3) was used to measure WE. Factors such as age, gender, years of experience, affiliated ward, COVID-19--related stress, financial rewards from the government and hospital, encouragement from the government and patients, and workplace social capital were assessed. A total of 187 participants were included in the final analysis. Multiple regression analysis was performed to examine the factors related to WE. Partial regression coefficients (B), 95\% CI, and P values were calculated. Results: The mean overall score for the UWES-3 was 3.19 (SD 1.21). Factors negatively associated with UWES-3 were COVID-19--related stress on work motivation and escape behavior ($\Beta$ --0.16, 95\% CI --0.24 to --0.090; P<.001), and factors positively associated with UWES-3 were affiliation of intensive care units ($\Beta$ 0.76, 95\% CI 0.020-1.50; P=.045) and financial rewards from the government and hospital ($\Beta$ 0.40, 95\% CI 0.040-0.76; P=.03). Conclusions: This study examined factors related to WE among nurses during the COVID-19 pandemic using the JD-R model. When compared with findings from previous studies, our results suggest that nurses' WE was lower than before the COVID-19 pandemic. Negative motivation and escape behaviors related to COVID-19 were negatively associated with WE, while there were positive associations with financial rewards from the government and hospital and affiliation with an intensive care unit. Further research into larger populations is needed to confirm these findings. ", doi="10.2196/45830", url="https://formative.jmir.org/2023/1/e45830", url="http://www.ncbi.nlm.nih.gov/pubmed/37921864" } @Article{info:doi/10.2196/49300, author="Dai, Jing and Lyu, Fang and Yu, Lin and He, Yunyu", title="Temporal and Emotional Variations in People's Perceptions of Mass Epidemic Infectious Disease After the COVID-19 Pandemic Using Influenza A as an Example: Topic Modeling and Sentiment Analysis Based on Weibo Data", journal="J Med Internet Res", year="2023", month="Nov", day="2", volume="25", pages="e49300", keywords="mass epidemic infections", keywords="sentiment analysis", keywords="text mining", keywords="spatial differences", keywords="temporal differences", keywords="influenza A", keywords="COVID-19", abstract="Background: The COVID-19 pandemic has had profound impacts on society, including public health, the economy, daily life, and social interactions. Social distancing measures, travel restrictions, and the influx of pandemic-related information on social media have all led to a significant shift in how individuals perceive and respond to health crises. In this context, there is a growing awareness of the role that social media platforms such as Weibo, among the largest and most influential social media sites in China, play in shaping public sentiment and influencing people's behavior during public health emergencies. Objective: This study aims to gain a comprehensive understanding of the sociospatial impact of mass epidemic infectious disease by analyzing the spatiotemporal variations and emotional orientations of the public after the COVID-19 pandemic. We use the outbreak of influenza A after the COVID-19 pandemic as a case study. Through temporal and spatial analyses, we aim to uncover specific variations in the attention and emotional orientations of people living in different provinces in China regarding influenza A. We sought to understand the societal impact of large-scale infectious diseases and the public's stance after the COVID-19 pandemic to improve public health policies and communication strategies. Methods: We selected Weibo as the data source and collected all influenza A--related Weibo posts from November 1, 2022, to March 31, 2023. These data included user names, geographic locations, posting times, content, repost counts, comments, likes, user types, and more. Subsequently, we used latent Dirichlet allocation topic modeling to analyze the public's focus as well as the bidirectional long short-term memory model to conduct emotional analysis. We further classified the focus areas and emotional orientations of different regions. Results: The research findings indicate that, compared with China's western provinces, the eastern provinces exhibited a higher volume of Weibo posts, demonstrating a greater interest in influenza A. Moreover, inland provinces displayed elevated levels of concern compared with coastal regions. In addition, female users of Weibo exhibited a higher level of engagement than male users, with regular users comprising the majority of user types. The public's focus was categorized into 23 main themes, with the overall emotional sentiment predominantly leaning toward negativity (making up 7562 out of 9111 [83\%] sentiments). Conclusions: The results of this study underscore the profound societal impact of the COVID-19 pandemic. People tend to be pessimistic toward new large-scale infectious diseases, and disparities exist in the levels of concern and emotional sentiments across different regions. This reflects diverse societal responses to health crises. By gaining an in-depth understanding of the public's attitudes and focal points regarding these infectious diseases, governments and decision makers can better formulate policies and action plans to cater to the specific needs of different regions and enhance public health awareness. ", doi="10.2196/49300", url="https://www.jmir.org/2023/1/e49300", url="http://www.ncbi.nlm.nih.gov/pubmed/37917144" } @Article{info:doi/10.2196/45549, author="Kr{\"a}mer, Dennis and Brachem, Elisabeth and Schneider-Reuter, Lydia and D'Angelo, Isabella and Vollmann, Jochen and Haltaufderheide, Joschka", title="Smartphone Apps for Containing the COVID-19 Pandemic in Germany: Qualitative Interview Study With Experts Based on Grounded Theory", journal="J Med Internet Res", year="2023", month="Oct", day="20", volume="25", pages="e45549", keywords="Corona-Warn-App", keywords="COVID-19 pandemic", keywords="eHealth", keywords="Germany", keywords="health technology", keywords="mobile phone", keywords="qualitative research", keywords="sovereignty", keywords="transparency", abstract="Background: Smartphone apps, including those for digital contact tracing (DCT), played a crucial role in containing infections during the COVID-19 pandemic. Their primary function is to generate and disseminate information to disrupt transmissions based on various events, such as encounters, vaccinations, locations, or infections. Although the functionality of these apps has been extensively studied, there is still a lack of qualitative research addressing critical issues. Objective: We will demonstrate that the use of DCT presents a challenge due to the tension between continuous health monitoring and uncertainties related to transparency and user sovereignty. On one hand, DCT enables the monitoring of various risk factors, including data-based calculations of infection probabilities. On the other hand, continuous risk management is intertwined with several uncertainties, including the unclear storage of personal data, who has access to it, and how it will be used in the future. Methods: We focus on the German ``Corona-Warn-App'' and support our argument with empirical data from 19 expert interviews conducted between 2020 and 2021. The interviews were conducted using a semistructured questionnaire and analyzed according to the principles of grounded theory. Results: Our data underscores 3 dimensions: transparency, data sovereignty, and the east-west divide. While transparency is considered an essential foundation for establishing trust in the use of DCT by providing a sense of security, data sovereignty is seen as a high value during the pandemic, protecting users from an undesired loss of control. The aspect of the east-west divide highlights the idea of incorporating sociocultural values and standards into technology, emphasizing that algorithms and data-driven elements, such as distance indicators, encounters, and isolations, are also influenced by sociocultural factors. Conclusions: The effective use of DCT for pandemic containment relies on achieving a balance between individual control and technological prevention. Maximizing the technological benefits of these tools is crucial. However, users must also be mindful of the information they share and maintain control over their shared data. ", doi="10.2196/45549", url="https://www.jmir.org/2023/1/e45549", url="http://www.ncbi.nlm.nih.gov/pubmed/37862068" } @Article{info:doi/10.2196/47677, author="Koskan, M. Alexis and Sivanandam, Shalini and Roschke, Kristy and Irby, Jonathan and Helitzer, L. Deborah and Doebbeling, Bradley", title="Sharing Reliable COVID-19 Information and Countering Misinformation: In-Depth Interviews With Information Advocates", journal="JMIR Infodemiology", year="2023", month="Oct", day="20", volume="3", pages="e47677", keywords="COVID-19", keywords="coronavirus", keywords="pandemic", keywords="infodemic", keywords="misinformation", keywords="social media", keywords="qualitative research", keywords="public health", keywords="health communication", abstract="Background: The rampant spread of misinformation about COVID-19 has been linked to a lower uptake of preventive behaviors such as vaccination. Some individuals, however, have been able to resist believing in COVID-19 misinformation. Further, some have acted as information advocates, spreading accurate information and combating misinformation about the pandemic. Objective: This work explores highly knowledgeable information advocates' perspectives, behaviors, and information-related practices. Methods: To identify participants for this study, we used outcomes of survey research of a national sample of 1498 adults to find individuals who scored a perfect or near-perfect score on COVID-19 knowledge questions and who also self-reported actively sharing or responding to news information within the past week. Among this subsample, we selected a diverse sample of 25 individuals to participate in a 1-time, phone-based, semistructured interview. Interviews were recorded and transcribed, and the team conducted an inductive thematic analysis. Results: Participants reported trusting in science, data-driven sources, public health, medical experts, and organizations. They had mixed levels of trust in various social media sites to find reliable health information, noting distrust in particular sites such as Facebook (Meta Platforms) and more trust in specific accounts on Twitter (X Corp) and Reddit (Advance Publications). They reported relying on multiple sources of information to find facts instead of depending on their intuition and emotions to inform their perspectives about COVID-19. Participants determined the credibility of information by cross-referencing it, identifying information sources and their potential biases, clarifying information they were unclear about with health care providers, and using fact-checking sites to verify information. Most participants reported ignoring misinformation. Others, however, responded to misinformation by flagging, reporting, and responding to it on social media sites. Some described feeling more comfortable responding to misinformation in person than online. Participants' responses to misinformation posted on the internet depended on various factors, including their relationship to the individual posting the misinformation, their level of outrage in response to it, and how dangerous they perceived it could be if others acted on such information. Conclusions: This research illustrates how well-informed US adults assess the credibility of COVID-19 information, how they share it, and how they respond to misinformation. It illustrates web-based and offline information practices and describes how the role of interpersonal relationships contributes to their preferences for acting on such information. Implications of our findings could help inform future training in health information literacy, interpersonal information advocacy, and organizational information advocacy. It is critical to continue working to share reliable health information and debunk misinformation, particularly since this information informs health behaviors. ", doi="10.2196/47677", url="https://infodemiology.jmir.org/2023/1/e47677", url="http://www.ncbi.nlm.nih.gov/pubmed/37862066" } @Article{info:doi/10.2196/48641, author="Chau, Brian and Taba, Melody and Dodd, Rachael and McCaffery, Kirsten and Bonner, Carissa", title="Twitch Data in Health Promotion Research: Protocol for a Case Study Exploring COVID-19 Vaccination Views Among Young People", journal="JMIR Res Protoc", year="2023", month="Oct", day="18", volume="12", pages="e48641", keywords="twitch", keywords="social media", keywords="COVID-19", keywords="vaccination communication", keywords="video gaming", keywords="gaming", keywords="health promotion", keywords="streaming", abstract="Background: Social media platforms have emerged as a useful channel for health promotion communication, offering different channels to reach targeted populations. For example, social media has recently been used to disseminate information about COVID-19 vaccination across various demographics. Traditional modes of health communication such as television, health events, and newsletters may not reach all groups within a community. Health communications for younger generations are increasingly disseminated through social media to reflect key information sources. This paper explores a social media gaming platform as an alternative way to reach young people in health promotion research. Objective: This protocol study aimed to pilot-test the potential of Twitch, a live streaming platform initially designed for video gaming, to conduct health promotion research with young people. We used COVID-19 vaccination as a topical case study that was recommended by Australian health authorities at the time of the research. Methods: The research team worked with a Twitch Account Manager to design and test a case study within the guidelines and ethics protocols required by Twitch, identify suitable streamers to approach and establish a protocol for conducting research on the platform. This involved conducting a poll to initiate discussion about COVID-19 vaccination, monitoring the chat in 3 live Twitch sessions with 2 streamers to pilot the protocol, and briefly analyze Twitch chat logs to observe the range of response types that may be acquired from this methodology. Results: The Twitch streams provided logs and videos on demand that were derived from the live session. These included demographics of viewers, chat logs, and polling results. The results of the poll showed a range of engagement in health promotion for the case study topic: the majority of participants had received their vaccination by the time of the poll; however, there was still a proportion that had not received their vaccination yet or had decided to not be vaccinated. Analysis of the Twitch chat logs demonstrated a range of both positive and negative themes regarding health promotion for the case study topic. This included irrelevant comments, misinformation (compared to health authority information at the time of this study), comedic and conspiracy responses, as well as vaccine status, provaccine comments, and vaccine-hesitant comments. Conclusions: This study developed and tested a protocol for using Twitch data for health promotion research with young people. With live polling, open text discussion between participants and immediate responses to questions, Twitch can be used to collect both quantitative and qualitative research data from demographics that use social media. The platform also presents some challenges when engaging with independent streamers and sensitive health topics. This study provides an initial protocol for future researchers to use and build on. International Registered Report Identifier (IRRID): RR1-10.2196/48641 ", doi="10.2196/48641", url="https://www.researchprotocols.org/2023/1/e48641", url="http://www.ncbi.nlm.nih.gov/pubmed/37851494" } @Article{info:doi/10.2196/46190, author="Wong, W. Kirstie H. T. and Lau, Y. Wallis C. and Man, C. Kenneth K. and Bilbow, Andrea and Ip, Patrick and Wei, Li", title="Effectiveness of Facebook Groups and Pages on Participant Recruitment Into a Randomized Controlled Trial During the COVID-19 Pandemic: Descriptive Study", journal="J Med Internet Res", year="2023", month="Oct", day="17", volume="25", pages="e46190", keywords="1-2-3 Magic, ADHD", keywords="attention deficit/hyperactivity disorder", keywords="behavioral parenting training", keywords="BPT", keywords="clinical trial", keywords="COVID-19", keywords="Facebook group", keywords="Facebook page", keywords="Facebook", keywords="pediatric", keywords="randomized controlled trial", keywords="recruitment", keywords="social media", keywords="youth", keywords="Zoom", abstract="Background: In response to the unprecedented challenges posed by the COVID-19 pandemic, conventional recruitment approaches were halted, causing the suspension of numerous clinical trials. Previously, Facebook (Meta Platforms, Inc) has emerged as a promising tool for augmenting participant recruitment. While previous research has explored the use of Facebook for surveys and qualitative studies, its potential for recruiting participants into randomized controlled trials (RCTs) remains underexplored. Objective: This study aimed to comprehensively examine the effectiveness of using Facebook groups and pages to facilitate participant recruitment during the COVID-19 pandemic for an RCT on the effectiveness of a remote parenting program, 1-2-3 Magic, in families who have children with attention-deficit/hyperactivity disorder (ADHD) in the United Kingdom. Methods: We disseminated 5 Facebook posts with an attached digital flyer across 4 prominent ADHD UK support groups and pages run by the National Attention Deficit Disorder Information and Support Services, reaching an audience of around 16,000 individuals over 2 months (January 7 to March 4, 2022). Eligibility criteria mandated participants to be parents or caregivers of a child with diagnosed ADHD aged 12 years or younger, be residing in the United Kingdom, have access to stable internet, and have a device with the Zoom (Zoom Video Communications) app. Participants were required to have never attended 1-2-3 Magic training previously. Prospective participants expressed their interest through Microsoft Forms (Microsoft Corporation). The trial aimed to recruit 84 parents. It is important to note that the term ``parent'' or ``caregiver'' in the RCT and in this study within a trial refers to anybody who has legal responsibility for the child. Results: Overall, 478 individuals registered their interest through Microsoft Forms within the stipulated 2-month window. After the eligibility check, 135 participants were contacted for a baseline meeting through Zoom. The first 84 participants who attended a baseline meeting and returned a completed consent form were enrolled. Subsequently, another 16 participants were added, resulting in a final sample of 100 participants. This recruitment strategy incurred negligible expenses and demanded minimal human resources. The approach yielded favorable outcomes by efficiently attracting eligible participants in a condensed time frame, transcending geographical barriers throughout the United Kingdom, which would have been tedious to achieve through traditional recruitment methods. Conclusions: Our experience demonstrated that digital flyers posted in the targeted Facebook groups were a cost-effective and quick method for recruiting for an RCT, which opened during the COVID-19 pandemic when lockdown restrictions were in place in the United Kingdom. Trialists should consider this low-cost recruitment intervention for trials going forward, and in the case of a global pandemic, this novel recruitment method enabled the trial to continue where many have failed. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 15281572; https://www.isrctn.com/ISRCTN15281572 ", doi="10.2196/46190", url="https://www.jmir.org/2023/1/e46190", url="http://www.ncbi.nlm.nih.gov/pubmed/37847536" } @Article{info:doi/10.2196/44887, author="Prado, Silva Aneliana da and Kohls, Elisabeth and Baldofski, Sabrina and Rummel-Kluge, Christine and Freitas, Lucas Joanneliese de", title="Acceptability and Feasibility of Online Support Groups for Mental Health Promotion in Brazilian Graduate Students During the COVID-19 Pandemic: Longitudinal Observational Study", journal="JMIR Form Res", year="2023", month="Oct", day="13", volume="7", pages="e44887", keywords="support group", keywords="online group", keywords="COVID-19 pandemic", keywords="higher education", keywords="graduate students", keywords="university students", keywords="mental health", keywords="online intervention", keywords="internet intervention", keywords="e--mental health", keywords="mental health promotion", keywords="feasibility", keywords="students", keywords="acceptability", abstract="Background: The outbreak of the COVID-19 pandemic in 2020 aggravated already existing difficulties and added new challenges for students. Owing to the gap between needed and available psychological services, group interventions may offer a helpful strategy for student mental health promotion. Objective: This study aimed to investigate the acceptability and feasibility of a 4-week online support group program designed for mental health promotion tailored to graduate students at a Brazilian public university in the context of the COVID-19 pandemic (May 2022 to June 2022). Methods: Participants in the program took part in online support groups based on a pilot group facilitated by a trained clinical psychologist. Self-administered, standardized web-based questionnaires were assessed at the baseline (T0; before the intervention), postintervention (T2), and follow-up (T3; after 4-6 weeks) time points. We measured sociodemographic variables, treatment credibility and expectancy (Credibility and Expectancy Questionnaire), satisfaction (Client Satisfaction Questionnaire), negative effects of the intervention (Negative Effects Questionnaire), depressive symptoms (Patient Health Questionnaire--9 [PHQ-9]), and participants' quality of life (abbreviated World Health Organization Quality of Life assessment). A 9--answer option questionnaire and open-ended questions also assessed the group's perceived positive and negative outcomes. Results: The total sample comprised 32 participants. Most (23/32, 72\%) were doctoral students. Credibility and expectancy scores were high. Participants' satisfaction (Client Satisfaction Questionnaire) with the program was high at the postintervention (T2) and follow-up (T3) evaluations (T2: mean 28.66, SD 3.02; T3: mean 27.91, SD 3.02). Most participants reported that they could learn from other participants' experiences (T2: 29/32, 91\%; T3: 27/32, 84\%) and felt encouraged to take better care of themselves (T2: 22/32, 69\%; T3: 24/32, 75\%). None of the participants reported that they had no benefits from the program. The PHQ-9 scores showed mild to moderate depressive symptoms (mean 9.59, SD 6.34), whereas the answers of 9\% (3/32) of the participants to the PHQ-9 item 9 indicated suicidality at baseline (T0). Finally, the 4 domains of quality of life (physical: P=.01; psychological: P=.004; social: P=.02; and environmental: P<.001) showed a slight and statistically significant improvement at the postintervention evaluation (T0: mean 57.03, SD 15.39 to 59.64, SD 17.21; T2: mean 64.32, SD 11.97 to 68.75, SD 8.87). Conclusions: Online support groups for the mental health promotion of graduate students are feasible and can be especially useful for universities with students allocated to different cities. They are also satisfactory and may positively influence participants' quality of life. Therefore, they can be considered a helpful mental health promotion strategy in the educational context. Further studies could evaluate these (or similar) programs under nonpandemic circumstances. ", doi="10.2196/44887", url="https://formative.jmir.org/2023/1/e44887", url="http://www.ncbi.nlm.nih.gov/pubmed/37831483" } @Article{info:doi/10.2196/44556, author="Kang, Annie and Hetrick, Sarah and Cargo, Tania and Hopkins, Sarah and Ludin, Nicola and Bodmer, Sarah and Stevenson, Kiani and Holt-Quick, Chester and Stasiak, Karolina", title="Exploring Young Adults' Views About Aroha, a Chatbot for Stress Associated With the COVID-19 Pandemic: Interview Study Among Students", journal="JMIR Form Res", year="2023", month="Oct", day="12", volume="7", pages="e44556", keywords="chatbot", keywords="mental health", keywords="COVID-19", keywords="young adults", keywords="acceptability", keywords="qualitative methods", abstract="Background: In March 2020, New Zealand was plunged into its first nationwide lockdown to halt the spread of COVID-19. Our team rapidly adapted our existing chatbot platform to create Aroha, a well-being chatbot intended to address the stress experienced by young people aged 13 to 24 years in the early phase of the pandemic. Aroha was made available nationally within 2 weeks of the lockdown and continued to be available throughout 2020. Objective: In this study, we aimed to evaluate the acceptability and relevance of the chatbot format and Aroha's content in young adults and to identify areas for improvement. Methods: We conducted qualitative in-depth and semistructured interviews with young adults as well as in situ demonstrations of Aroha to elicit immediate feedback. Interviews were recorded, transcribed, and analyzed using thematic analysis assisted by NVivo (version 12; QSR International). Results: A total of 15 young adults (age in years: median 20; mean 20.07, SD 3.17; female students: n=13, 87\%; male students: n=2, 13\%; all tertiary students) were interviewed in person. Participants spoke of the challenges of living during the lockdown, including social isolation, loss of motivation, and the demands of remote work or study, although some were able to find silver linings. Aroha was well liked for sounding like a ``real person'' and peer with its friendly local ``Kiwi'' communication style, rather than an authoritative adult or counselor. The chatbot was praised for including content that went beyond traditional mental health advice. Participants particularly enjoyed the modules on gratitude, being active, anger management, job seeking, and how to deal with alcohol and drugs. Aroha was described as being more accessible than traditional mental health counseling and resources. It was an appealing option for those who did not want to talk to someone in person for fear of the stigma associated with mental health. However, participants disliked the software bugs. They also wanted a more sophisticated conversational interface where they could express themselves and ``vent'' in free text. There were several suggestions for making Aroha more relevant to a diverse range of users, including developing content on navigating relationships and diverse chatbot avatars. Conclusions: Chatbots are an acceptable format for scaling up the delivery of public mental health and well-being--enhancing strategies. We make the following recommendations for others interested in designing and rolling out mental health chatbots to better support young people: make the chatbot relatable to its target audience by working with them to develop an authentic and relevant communication style; consider including holistic health and lifestyle content beyond traditional ``mental health'' support; and focus on developing features that make users feel heard, understood, and empowered. ", doi="10.2196/44556", url="https://formative.jmir.org/2023/1/e44556", url="http://www.ncbi.nlm.nih.gov/pubmed/37527545" } @Article{info:doi/10.2196/47239, author="Tran, Xuan Bach and Dam, Trong Vu Anh and Auquier, Pascal and Boyer, Laurent and Fond, Guillaume and Nguyen, Manh Hung and Nguyen, Tuan Hung and Le, Thi Huong and Tran, Thi Ha Nhi and Vu, Thu Giang and Nguyen, Duc Manh and Nguyen, Thi Duong Anh and Ly, Viet Bang and Latkin, A. Carl and Zhang, WB Melvyn and Ho, CM Roger and Ho, SH Cyrus", title="Structural Equation Model for Social Support and Quality of Life Among Individuals With Mental Health Disorders During the COVID-19 Pandemic", journal="JMIR Public Health Surveill", year="2023", month="Oct", day="11", volume="9", pages="e47239", keywords="contextual", keywords="social support", keywords="quality of life", keywords="mental health disorders", keywords="Vietnam", keywords="mental health", keywords="mental illness", keywords="cross-sectional", keywords="association", abstract="Background: In light of the COVID-19 pandemic, the distribution of social support for mental health problems has likely become unequal. Family- and community-based social support has been recognized as a promising approach for mental disorders; however, limited global frameworks have been applied to developing countries such as Vietnam. Objective: The aim of this study was to evaluate the quality of life and social support among patients with mental health disorders in Vietnam and to investigate the factors associated with quality of life among these patients. Methods: A cross-sectional study was conducted on 222 psychiatric patients in Hanoi from 2020 to 2022. A structured questionnaire was developed based on four standardized scales: Mental Well-Being-5 scale, Multidimensional Scale of Perceived Social Support, EuroQoL-visual analog scale (EQ-VAS), and EuroQoL-5 dimensions-5 levels (EQ-5D-5L) scale. Tobit regression was used to identify factors associated with the EQ-5D-5L and EQ-VAS scores. Structural equation modeling was applied to verify the relationship between quality of life and social support. Results: The results showed that perceived support from family scored the highest compared to support from friends and significant others. Patients with depression reported the lowest quality of life and perceived social support. Structural equation modeling showed a root mean square error of approximation of 0.055 (90\% CI 0.006-0.090), comparative fit index of 0.954, Tucker-Lewis index of 0.892, and standardized root mean squared error of 0.036 (P<.001). The hypothetical model indicated statistically significant correlations between EQ-VAS score and social support (P=.004), EQ-5D-5L and mental well-being (P<.001), and social support and mental well-being (P<.001). Critical deterioration of quality of life and inconsistency in social support for patients with mental illness were also recorded. Conclusions: There is a need to enhance social support and service delivery in Vietnam, focusing on occupation and quality of life. The correlations between social support, quality of life, and mental health issues suggest the potential of a clinical-social integrated intervention model of care. ", doi="10.2196/47239", url="https://publichealth.jmir.org/2023/1/e47239", url="http://www.ncbi.nlm.nih.gov/pubmed/37819706" } @Article{info:doi/10.2196/42960, author="Rambaud, Kimberly and van Woerden, Simon and Palumbo, Leonardo and Salvi, Cristiana and Smallwood, Catherine and Rockenschaub, Gerald and Okoliyski, Michail and Marinova, Lora and Fomaidi, Galina and Djalalova, Malika and Faruqui, Nabiha and Melo Bianco, Viviane and Mosquera, Mario and Spasov, Ivaylo and Totskaya, Yekaterina", title="Building a Chatbot in a Pandemic", journal="J Med Internet Res", year="2023", month="Oct", day="10", volume="25", pages="e42960", keywords="COVID-19", keywords="chatbots", keywords="evidence-based communication channels", keywords="conversational agent", keywords="user-centered", keywords="health promotion", keywords="digital health intervention", keywords="online health information", keywords="digital health tool", keywords="health communication", doi="10.2196/42960", url="https://www.jmir.org/2023/1/e42960", url="http://www.ncbi.nlm.nih.gov/pubmed/37074958" } @Article{info:doi/10.2196/46807, author="Velez, Tom and Wang, Tony and Garibaldi, Brian and Singman, Eric and Koutroulis, Ioannis", title="Identification and Prediction of Clinical Phenotypes in Hospitalized Patients With COVID-19: Machine Learning From Medical Records", journal="JMIR Form Res", year="2023", month="Oct", day="6", volume="7", pages="e46807", keywords="big data", keywords="COVID", keywords="respiratory distress", keywords="critical care", keywords="early warning", keywords="electronic medical record", keywords="machine learning", keywords="clinical phenotypes", keywords="pathogenesis", keywords="infection", keywords="immune response", keywords="treatment", keywords="biomarkers", keywords="training", keywords="sepsis", keywords="mortality", keywords="utility", keywords="phenotype", keywords="support tool", abstract="Background: There is significant heterogeneity in disease progression among hospitalized patients with COVID-19. The pathogenesis of SARS-CoV-2 infection is attributed to a complex interplay between virus and host immune response that in some patients unpredictably and rapidly leads to ``hyperinflammation'' associated with increased risk of mortality. The early identification of patients at risk of progression to hyperinflammation may help inform timely therapeutic decisions and lead to improved outcomes. Objective: The primary objective of this study was to use machine learning to reproducibly identify specific risk-stratifying clinical phenotypes across hospitalized patients with COVID-19 and compare treatment response characteristics and outcomes. A secondary objective was to derive a predictive phenotype classification model using routinely available early encounter data that may be useful in informing optimal COVID-19 bedside clinical management. Methods: This was a retrospective analysis of electronic health record data of adult patients (N=4379) who were admitted to a Johns Hopkins Health System hospital for COVID-19 treatment from 2020 to 2021. Phenotypes were identified by clustering 38 routine clinical observations recorded during inpatient care. To examine the reproducibility and validity of the derived phenotypes, patient data were randomly divided into 2 cohorts, and clustering analysis was performed independently for each cohort. A predictive phenotype classifier using the gradient-boosting machine method was derived using routine clinical observations recorded during the first 6 hours following admission. Results: A total of 2 phenotypes (designated as phenotype 1 and phenotype 2) were identified in patients admitted for COVID-19 in both the training and validation cohorts with similar distributions of features, correlations with biomarkers, treatments, comorbidities, and outcomes. In both the training and validation cohorts, phenotype-2 patients were older; had elevated markers of inflammation; and were at an increased risk of requiring intensive care unit--level care, developing sepsis, and mortality compared with phenotype-1 patients. The gradient-boosting machine phenotype prediction model yielded an area under the curve of 0.89 and a positive predictive value of 0.83. Conclusions: Using machine learning clustering, we identified and internally validated 2 clinical COVID-19 phenotypes with distinct treatment or response characteristics consistent with similar 2-phenotype models derived from other hospitalized populations with COVID-19, supporting the reliability and generalizability of these findings. COVID-19 phenotypes can be accurately identified using machine learning models based on readily available early encounter clinical data. A phenotype prediction model based on early encounter data may be clinically useful for timely bedside risk stratification and treatment personalization. ", doi="10.2196/46807", url="https://formative.jmir.org/2023/1/e46807", url="http://www.ncbi.nlm.nih.gov/pubmed/37642512" } @Article{info:doi/10.2196/46318, author="Xu, Stanley and Hong, Vennis and Sy, S. Lina and Bruxvoort, J. Katia and Lewin, Bruno and Han, Bing and Holmquist, J. Kimberly and Qian, Lei", title="Risk Factors for Not Completing a 2-Dose Primary Series of Messenger RNA COVID-19 Vaccination in a Large Health Care System in Southern California: Retrospective Cohort Study", journal="JMIR Public Health Surveill", year="2023", month="Oct", day="4", volume="9", pages="e46318", keywords="mRNA COVID-19 vaccines", keywords="2-dose primary series", keywords="vaccines", keywords="SARS-CoV-2", keywords="coronavirus", keywords="respiratory", keywords="infectious", keywords="communicable", keywords="immunization", keywords="immunize", keywords="noncompletion", keywords="risk factors", keywords="multiple Poisson regression model", keywords="COVID-19", keywords="vaccination", keywords="vaccine", keywords="dose", keywords="dosing", keywords="regression", keywords="risk", keywords="risks", keywords="health outcome", keywords="health outcomes", keywords="retrospective", keywords="cohort", keywords="dosage", keywords="United States", keywords="community", keywords="inoculation", abstract="Background: COVID-19 vaccination is crucial in combating the COVID-19 pandemic. Messenger RNA COVID-19 vaccines were initially authorized as a 2-dose primary series and have been widely used in the United States; completing the 2-dose primary series offers protection against infection, severe illness, and death. Understanding the risk factors for not completing the 2-dose primary series is critical to evaluate COVID-19 vaccination programs and promote completion of the 2-dose primary series. Objective: This study examined potential risk factors for not completing a 2-dose primary series of mRNA COVID-19 vaccination. Methods: We conducted a retrospective cohort study among members aged ?18 years from a large integrated health care system, Kaiser Permanente Southern California, from December 14, 2020, to June 30, 2022. Noncompletion of the 2-dose primary series was defined as not completing the second dose within 6 months after receipt of the first dose. Crude noncompletion rates were estimated overall and by demographic characteristics, health care use patterns, comorbidity, and community-level socioeconomic factors. A Poisson regression model was fit to examine associations of individual-level and community-level risk factors with noncompletion of the 2-dose primary series. Results: Among 2.5 million recipients of ?1 dose of mRNA COVID-19 vaccines, 3.3\% (n=81,202) did not complete the second dose within 6 months. Members aged 25-44 years, 65-74 years, and ?75 years were less likely to not complete the 2-dose primary series than those aged 18-24 years, while members aged 45-64 years were more likely to not complete the 2-dose primary series (adjusted risk ratio [aRR] 1.13, 95\% CI 1.10-1.15). Male sex was associated with a higher risk of noncompletion (aRR 1.17, 95\% CI 1.15-1.19). Hispanic and non-Hispanic Black race/ethnicity were associated with a lower risk of noncompletion (range aRR 0.78-0.91). Having Medicaid and prior influenza vaccination were associated with a higher risk of noncompletion. Having SARS-CoV-2 infection, experiencing an adverse event, or having an inpatient and emergency department visit during the minimum recommended dose intervals were associated with a higher risk of not completing the 2-dose primary series (aRR 1.98, 95\% CI 1.85-2.12; 1.99, 95\% CI 1.43-2.76; and 1.85, 95\% CI 1.77-1.93, respectively). Those who received the first dose after June 30, 2021, were more likely to not complete the 2-dose primary series within 6 months of receipt of the first dose. Conclusions: Despite limitations such as being a single-site study and the inability to consider social factors such as employment and vaccine attitudes, our study identified several risk factors for not completing a 2-dose primary series of mRNA vaccination, including being male; having Medicaid coverage; and experiencing SARS-CoV-2 infection, adverse events, or inpatient and emergency department visits during the minimum recommended dose intervals. These findings can inform future efforts in developing effective strategies to enhance vaccination coverage and improve the completion rate of necessary doses. ", doi="10.2196/46318", url="https://publichealth.jmir.org/2023/1/e46318", url="http://www.ncbi.nlm.nih.gov/pubmed/37792452" } @Article{info:doi/10.2196/45980, author="Bacon, Elizabeth and An, Lawrence and Yang, Penny and Hawley, Sarah and Van Horn, Lee M. and Resnicow, Ken", title="Novel Psychosocial Correlates of COVID-19 Vaccine Hesitancy: Cross-Sectional Survey", journal="JMIR Form Res", year="2023", month="Sep", day="27", volume="7", pages="e45980", keywords="COVID-19 vaccination", keywords="health communication", keywords="psychological predictors", keywords="psychology", keywords="public health", keywords="conspiracy beliefs", keywords="vaccine misinformation", keywords="religious beliefs", keywords="anti-vaccination beliefs", keywords="reactance", keywords="dogmatism", keywords="political beliefs", keywords="health care system distrust", keywords="gender roles", keywords="gender", keywords="online survey", keywords="USA", keywords="adults", keywords="death", keywords="illness", keywords="virus", keywords="psychosocial", abstract="Background: Effective COVID-19 vaccines have been available since early 2021 yet many Americans refuse or delayed uptake. As of mid-2022, still around 30\% of US adults remain unvaccinated against COVID-19. The majority (81\%) of these unvaccinated adults say they will ``definitely not'' be getting the COVID-19 vaccine. Understanding the determinants of COVID-19 vaccine uptake is critical to reducing death and illness from the virus, as well as to inform future vaccine efforts, such as the more recent bivalent (omicron) booster. Objective: This study aimed to expand our understanding of psychosocial determinants of COVID-19 vaccine uptake. We focus on both COVID-19--specific factors, such as COVID-19 conspiracy beliefs, as well as more global personality attributes such as dogmatism, reactance, gender roles, political beliefs, and religiosity. Methods: We conducted a web-based survey in mid-2021 of a representative sample of 1376 adults measuring both COVID-19--specific beliefs and attitudes, as well as global personality attributes. COVID-19 vaccination status is reported at 3 levels: vaccinated; unvaccinated-may-get-it; unvaccinated-hard-no. Results: Our analyses focused on the correlation of COVID-19 vaccination status with 10 psychosocial attributes: COVID-19-specific conspiracy theory beliefs; COVID-19 vaccine misinformation; COVID-19--related Rapture beliefs; general antivaccination beliefs; trait reactance; trait dogmatism; belief in 2020 election fraud; belief in a QAnon conspiracy; health care system distrust; and identification with traditional gender roles. We used a multivariate analysis of covariance to examine mean differences across vaccine status groups for each of the correlates while holding constant the effects of age, gender, race, income, education, political party, and Evangelicalism. Across the 10 psychosocial correlates, several different response scales were used. To allow for comparison of effects across correlates, measures of effect size were computed by converting correlates to z scores and then examining adjusted mean differences in z scores between the groups. We found that all 10 psychosocial variables were significantly associated with vaccination status. After general antivaccination beliefs, COVID-19 misinformation beliefs and COVID-19 conspiracy beliefs had the largest effect on vaccine uptake. Conclusions: The association of these psychosocial factors with COVID-19 vaccine hesitancy may help explain why vaccine uptake has not shifted much among the unvaccinated-hard-no group since vaccines became available. These findings deepen our understanding of those who remain resistant to getting vaccinated and can guide more effective tailored communications to reach them. Health communication professionals may apply lessons learned from countering related beliefs and personality attributes around issues such as climate change and other forms of vaccine hesitancy. For example, using motivational interviewing strategies that are equipped to handle resistance and provide correct information in a delicate manner that avoids reactance. ", doi="10.2196/45980", url="https://formative.jmir.org/2023/1/e45980", url="http://www.ncbi.nlm.nih.gov/pubmed/37756115" } @Article{info:doi/10.2196/41863, author="Faviez, Carole and Talmatkadi, Manissa and Foulqui{\'e}, Pierre and Mebarki, Adel and Sch{\"u}ck, St{\'e}phane and Burgun, Anita and Chen, Xiaoyi", title="Assessment of the Early Detection of Anosmia and Ageusia Symptoms in COVID-19 on Twitter: Retrospective Study", journal="JMIR Infodemiology", year="2023", month="Sep", day="25", volume="3", pages="e41863", keywords="social media", keywords="COVID-19", keywords="anosmia", keywords="ageusia", keywords="infodemiology", keywords="symptom", keywords="Twitter", keywords="psychological", keywords="tweets", keywords="pandemic", keywords="rapid stage", keywords="epidemic", keywords="information", keywords="knowledge", keywords="online health", keywords="misinformation", keywords="education", keywords="online education", keywords="ehealth", keywords="qualitative", abstract="Background: During the unprecedented COVID-19 pandemic, social media has been extensively used to amplify the spread of information and to express personal health-related experiences regarding symptoms, including anosmia and ageusia, 2 symptoms that have been reported later than other symptoms. Objective: Our objective is to investigate to what extent Twitter users reported anosmia and ageusia symptoms in their tweets and if they connected them to COVID-19, to evaluate whether these symptoms could have been identified as COVID-19 symptoms earlier using Twitter rather than the official notice. Methods: We collected French tweets posted between January 1, 2020, and March 31, 2020, containing anosmia- or ageusia-related keywords. Symptoms were detected using fuzzy matching. The analysis consisted of 3 parts. First, we compared the coverage of anosmia and ageusia symptoms in Twitter and in traditional media to determine if the association between COVID-19 and anosmia or ageusia could have been identified earlier through Twitter. Second, we conducted a manual analysis of anosmia- and ageusia-related tweets to obtain quantitative and qualitative insights regarding their nature and to assess when the first associations between COVID-19 and these symptoms were established. We randomly annotated tweets from 2 periods: the early stage and the rapid spread stage of the epidemic. For each tweet, each symptom was annotated regarding 3 modalities: symptom (yes or no), associated with COVID-19 (yes, no, or unknown), and whether it was experienced by someone (yes, no, or unknown). Third, to evaluate if there was a global increase of tweets mentioning anosmia or ageusia in early 2020, corresponding to the beginning of the COVID-19 epidemic, we compared the tweets reporting experienced anosmia or ageusia between the first periods of 2019 and 2020. Results: In total, 832 (respectively 12,544) tweets containing anosmia (respectively ageusia) related keywords were extracted over the analysis period in 2020. The comparison to traditional media showed a strong correlation without any lag, which suggests an important reactivity of Twitter but no earlier detection on Twitter. The annotation of tweets from 2020 showed that tweets correlating anosmia or ageusia with COVID-19 could be found a few days before the official announcement. However, no association could be found during the first stage of the pandemic. Information about the temporality of symptoms and the psychological impact of these symptoms could be found in the tweets. The comparison between early 2020 and early 2019 showed no difference regarding the volumes of tweets. Conclusions: Based on our analysis of French tweets, associations between COVID-19 and anosmia or ageusia by web users could have been found on Twitter just a few days before the official announcement but not during the early stage of the pandemic. Patients share qualitative information on Twitter regarding anosmia or ageusia symptoms that could be of interest for future analyses. ", doi="10.2196/41863", url="https://infodemiology.jmir.org/2023/1/e41863", url="http://www.ncbi.nlm.nih.gov/pubmed/37643302" } @Article{info:doi/10.2196/48398, author="Lumini, Jos{\'e} Maria and Sousa, Rui Maria and Salazar, Berta and Martins, Teresa", title="Assessing the Effectiveness of a Massive Open Online Course for Caregivers Amid the COVID-19 Pandemic: Methodological Study", journal="JMIR Form Res", year="2023", month="Sep", day="25", volume="7", pages="e48398", keywords="caregivers", keywords="education", keywords="COVID-19", keywords="distance", keywords="effectiveness", keywords="skill", keywords="safe care", keywords="health system", keywords="older people", keywords="family", keywords="social isolation", keywords="massive open online courses", keywords="care challenges", abstract="Background: The COVID-19 pandemic has presented significant challenges to health care systems, particularly impacting the older population due to their vulnerability and increased susceptibility to severe complications. Many of the most vulnerable individuals rely on informal caregivers, who play a vital role in enabling them to continue living in their homes. However, social isolation and limited access to health services during the pandemic have made caregiving more difficult. In response, massive open online courses (MOOCs) have emerged as a training and support solution for caregivers. This study focuses on a MOOC developed to assist caregivers during the pandemic, aiming to enhance their knowledge of COVID-19 and prevention measures and promote effective self-care practices. Objective: The study's aim is to develop and validate a MOOC integrating personal and housing hygiene measures to be adopted in self-care--related activities, surveillance, and monitoring by caregivers of the most vulnerable home-dwelling--dependent people, to provide safe care and prevent SARS-CoV-2 infection. Methods: A methodological study was developed. The content of the MOOC was developed based on scientific evidence and a Delphi study. The course was organized into 9 modules, addressing aspects related to safe self-care assistance and minimizing the risk of contagion. A convenience sample of 33 informal caregivers was recruited through a caregivers' association to verify the adequacy of the course. Knowledge questionnaires were administered before and after the course to assess the impact on caregivers` knowledge. The Family Caregiving Factors Inventory was used to evaluate caregiver resources, knowledge, expectations, and difficulties. Additionally, the technology acceptance model was applied to assess participants' satisfaction with the MOOC. Results: Prior to attending the MOOC, participants demonstrated an average knowledge level score of mean 14.94 (SD 2.72). After completing the course, this score significantly increased to mean 16.52 (SD 2.28), indicating an improvement in knowledge. Caregivers found the course accessible, valuable, and applicable to their caregiving roles. Feedback regarding the MOOC's structure, illustrative videos, and language was overwhelmingly positive. Participants perceived the course as a valuable resource for decision-making in care delivery, leading to enhanced self-esteem and confidence. Conclusions: The MOOC has proven to be an effective tool for increasing caregivers' knowledge and empowering them in their roles. Remarkably, even low-literacy caregivers found the course valuable for its clear and understandable information. The MOOC demonstrated its adaptability to challenges faced during the pandemic, ensuring access to relevant information. This empowering strategy for caregivers has yielded positive outcomes. The MOOC represents a tool to support and empower informal caregivers, enabling them to provide optimal care during difficult times. ", doi="10.2196/48398", url="https://formative.jmir.org/2023/1/e48398", url="http://www.ncbi.nlm.nih.gov/pubmed/37747772" } @Article{info:doi/10.2196/42857, author="Kang-Auger, Sarit and Lewin, Antoine and Ayoub, Aimina and Bilodeau-Bertrand, Marianne and Marcoux, Sophie and Auger, Nathalie", title="Social Media and Selfie-Related Mortality Amid COVID-19: Interrupted Time Series Analysis", journal="JMIR Form Res", year="2023", month="Sep", day="25", volume="7", pages="e42857", keywords="COVID-19", keywords="injury", keywords="mortality", keywords="mortality rate", keywords="web-based news", keywords="selfie", keywords="social media", keywords="time series regression", abstract="Background: COVID-19 had a considerable impact on mortality, but its effect on behaviors associated with social media remains unclear. As travel decreased due to lockdowns during the pandemic, selfie-related mortality may have decreased, as fewer individuals were taking smartphone photographs in risky locations. Objective: In this study, we examined the effect of the COVID-19 pandemic on trends in selfie-related mortality. Methods: We identified fatal selfie-related injuries reported in web-based news reports worldwide between March 2014 and April 2021, including the deaths of individuals attempting a selfie photograph or anyone else present during the incident. The main outcome measure was the total number of selfie-related deaths per month. We used interrupted time series regression to estimate the monthly change in the number of selfie-related deaths over time, comparing the period before the pandemic (March 2014 to February 2020) with the period during the pandemic (March 2020 to April 2021). Results: The study included a total of 332 selfie-related deaths occurring between March 2014 and April 2021, with 18 (5.4\%) deaths during the pandemic. Most selfie-related deaths occurred in India (n=153, 46.1\%) and involved men (n=221, 66.6\%) and young individuals (n=296, 89.2\%). During the pandemic, two-thirds of selfie-related deaths were due to falls, whereas a greater proportion of selfie-related deaths before the pandemic were due to drowning. Based on interrupted time series regression, there was an average of 1.3 selfie-related deaths per month during the pandemic, compared with 4.3 deaths per month before the pandemic. The number of selfie-related deaths decreased by 2.6 in the first month of the pandemic alone and continued to decrease thereafter. Conclusions: Our findings indicate that the COVID-19 pandemic led to a marked decrease in selfie-related mortality, suggesting that lockdowns and travel restrictions likely prevented hazardous selfie-taking. The decrease in selfie-related mortality occurred despite a potential increase in social media use during the pandemic. ", doi="10.2196/42857", url="https://formative.jmir.org/2023/1/e42857", url="http://www.ncbi.nlm.nih.gov/pubmed/37747765" } @Article{info:doi/10.2196/50486, author="Werkmeister, Benjamin and Haase, M. Anne and Fleming, Theresa and Officer, N. Tara", title="Global Implications From the Rise and Recession of Telehealth in Aotearoa New Zealand Mental Health Services During the COVID-19 Pandemic: Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Sep", day="22", volume="7", pages="e50486", keywords="telehealth", keywords="mental health services", keywords="Aotearoa New Zealand", keywords="mixed methods research", keywords="clinician", keywords="COVID-19", abstract="Background: The COVID-19 pandemic accelerated the adoption of telehealth services for remote mental health care provision. Although studies indicate that telehealth can enhance the efficiency of service delivery and might be favored or even preferred by certain clients, its use varied after the pandemic. Once the pandemic-related restrictions eased, some regions curtailed their telehealth offerings, whereas others sustained them. Understanding the factors that influenced these decisions can offer valuable insights for evidence-based decision-making concerning the future of telehealth in mental health services. Objective: This study explored the factors associated with the uptake of and retreat from telehealth across a multiregional outpatient mental health service in Aotearoa New Zealand. We aimed to contribute to the understanding of the factors influencing clinicians' use of telehealth services to inform policy and practice. Methods: Applying an interpretive description methodology, this sequential mixed methods study involved semistructured interviews with 33 mental health clinicians, followed by a time-series analysis of population-level quantitative data on clinician appointment activities before and throughout the COVID-19 pandemic. The interviews were thematically analyzed, and select themes were reframed for quantitative testing. The time-series analysis was conducted using administrative data to explore the extent to which these data supported the themes. In total, 4,117,035 observations were analyzed between September 2, 2019, and August 1, 2022. The findings were then synthesized through the rereview of qualitative themes. Results: The rise and recession of telehealth in the study regions were related to 3 overarching themes: clinician preparedness and role suitability, population determinants, and service capability. Participants spoke about the importance of familiarity and training but noted differences between specialist roles. Quantitative data further suggested differences based on the form of telehealth services offered (eg, audiovisual or telephone). In addition, differences were noted based on age, gender, and ethnicity; however, clinicians recognized that effective telehealth use enabled clinicians' flexibility and client choice. In turn, clinicians spoke about system factors such as telehealth usability and digital exclusion that underpinned the daily functionality of telehealth. Conclusions: For telehealth services to thrive when they are not required by circumstances such as pandemic, investment is needed in telehealth training for clinicians, digital infrastructure, and resources for mental health teams. The strength of this study lies in its use of population-level data and consideration of a telehealth service operating across a range of teams. In turn, these findings reflect the voice of a variety of mental health clinicians, including teams operating from within specific cultural perspectives. ", doi="10.2196/50486", url="https://formative.jmir.org/2023/1/e50486", url="http://www.ncbi.nlm.nih.gov/pubmed/37738075" } @Article{info:doi/10.2196/49061, author="Ng, Margaret Yee Man and Hoffmann Pham, Katherine and Luengo-Oroz, Miguel", title="Exploring YouTube's Recommendation System in the Context of COVID-19 Vaccines: Computational and Comparative Analysis of Video Trajectories", journal="J Med Internet Res", year="2023", month="Sep", day="15", volume="25", pages="e49061", keywords="algorithmic auditing", keywords="antivaccine sentiment", keywords="crowdsourcing", keywords="recommendation systems", keywords="watch history", keywords="YouTube", abstract="Background: Throughout the COVID-19 pandemic, there has been a concern that social media may contribute to vaccine hesitancy due to the wide availability of antivaccine content on social media platforms. YouTube has stated its commitment to removing content that contains misinformation on vaccination. Nevertheless, such claims are difficult to audit. There is a need for more empirical research to evaluate the actual prevalence of antivaccine sentiment on the internet. Objective: This study examines recommendations made by YouTube's algorithms in order to investigate whether the platform may facilitate the spread of antivaccine sentiment on the internet. We assess the prevalence of antivaccine sentiment in recommended videos and evaluate how real-world users' experiences are different from the personalized recommendations obtained by using synthetic data collection methods, which are often used to study YouTube's recommendation systems. Methods: We trace trajectories from a credible seed video posted by the World Health Organization to antivaccine videos, following only video links suggested by YouTube's recommendation system. First, we gamify the process by asking real-world participants to intentionally find an antivaccine video with as few clicks as possible. Having collected crowdsourced trajectory data from respondents from (1) the World Health Organization and United Nations system (nWHO/UN=33) and (2) Amazon Mechanical Turk (nAMT=80), we next compare the recommendations seen by these users to recommended videos that are obtained from (3) the YouTube application programming interface's RelatedToVideoID parameter (nRTV=40) and (4) from clean browsers without any identifying cookies (nCB=40), which serve as reference points. We develop machine learning methods to classify antivaccine content at scale, enabling us to automatically evaluate 27,074 video recommendations made by YouTube. Results: We found no evidence that YouTube promotes antivaccine content; the average share of antivaccine videos remained well below 6\% at all steps in users' recommendation trajectories. However, the watch histories of users significantly affect video recommendations, suggesting that data from the application programming interface or from a clean browser do not offer an accurate picture of the recommendations that real users are seeing. Real users saw slightly more provaccine content as they advanced through their recommendation trajectories, whereas synthetic users were drawn toward irrelevant recommendations as they advanced. Rather than antivaccine content, videos recommended by YouTube are likely to contain health-related content that is not specifically related to vaccination. These videos are usually longer and contain more popular content. Conclusions: Our findings suggest that the common perception that YouTube's recommendation system acts as a ``rabbit hole'' may be inaccurate and that YouTube may instead be following a ``blockbuster'' strategy that attempts to engage users by promoting other content that has been reliably successful across the platform. ", doi="10.2196/49061", url="https://www.jmir.org/2023/1/e49061", url="http://www.ncbi.nlm.nih.gov/pubmed/37713243" } @Article{info:doi/10.2196/41364, author="Lin, Li-Yin and Lin, Chun-Ji and Kuan, Chen-I and Chiou, Hung-Yi", title="Potential Determinants Contributing to COVID-19 Vaccine Acceptance and Hesitancy in Taiwan: Rapid Qualitative Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Sep", day="12", volume="7", pages="e41364", keywords="COVID-19", keywords="vaccine acceptance", keywords="vaccine hesitancy", keywords="google trends", keywords="public health", keywords="vaccination", keywords="health promotion", keywords="thematic analysis", keywords="infoveillance", abstract="Background: Although vaccination has been shown to be one of the most important interventions, COVID-19 vaccine hesitancy remains one of the top 10 global public health challenges worldwide. Objective: The objective of this study is to investigate (1) major determinants of vaccine hesitancy, (2) changes in the determinants of vaccine hesitancy at different time periods, and (3) the potential factors affecting vaccine acceptance. Methods: This study applied a mixed methods approach to explore the potential determinants contributing to vaccine hesitancy among the Taiwanese population. The quantitative design of this study involved using Google Trends search query data. We chose the search term ``??`` (vaccine), selected ''??'' (Taiwan) as the location, and selected the period between December 18, 2020, and July 31, 2021. The rising keywords related to vaccine acceptance and hesitancy were collected. Based on the responses obtained from the qualitative study and the rising keywords obtained in Google Trends, the 3 most popular keywords related to vaccine hesitancy were identified and used as search queries in Google Trends between December 18, 2020, and July 31, 2021, to generate relative search volumes (RSVs). Lastly, autoregressive integrated moving average modeling was used to forecast the RSVs for the 3 keywords between May 29 and July 31, 2021. The estimated RSVs were compared to the observed RSVs in Google Trends within the same time frame. Results: The 4 prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy were doubts about the government and manufacturers, side effects, deaths associated with vaccination, and efficacy of vaccination. During the vaccine observation period, ``political role'' was the overarching consideration leading to vaccine hesitancy. During the peak of the pandemic, side effects, death, and vaccine protection were the main factors contributing to vaccine hesitancy. The popularity of the 3 frequently searched keywords ``side effects,'' ``vaccine associated deaths,'' and ``vaccine protection'' continued to rise throughout the pandemic outbreak. Lastly, the highest Google search queries related to COVID-19 vaccines emerged as ``side effects'' prior to vaccination, deaths associated with vaccines during the period when single vaccines were available, and ``side effects'' and ``vaccine protection'' during the period when multiple vaccines were available. Conclusions: Investigating the key factors influencing COVID-19 vaccine hesitancy appears to be a fundamental task that needs to be undertaken to ensure effective implementation of COVID-19 vaccination. Google Trends may be used as a complementary infoveillance tool by government agencies for future vaccine policy implementation and communication. ", doi="10.2196/41364", url="https://formative.jmir.org/2023/1/e41364", url="http://www.ncbi.nlm.nih.gov/pubmed/37698904" } @Article{info:doi/10.2196/46002, author="Tewary, Sweta and Cook, Nicole and Dezine, Marie and Shnayder, Oksana and Pandya, Naushira", title="Supporting Vulnerable Older Adults With Telehealth Through Wellness Calls and Tablet Distribution During COVID-19: Quality Improvement Project", journal="JMIR Form Res", year="2023", month="Sep", day="11", volume="7", pages="e46002", keywords="COVID-19", keywords="telehealth", keywords="older adults", keywords="isolation", keywords="health education", keywords="mental wellness", keywords="telemedicine", keywords="health literacy", keywords="digital health", keywords="mental health", keywords="social isolation", abstract="Background: Loneliness, social isolation, and lack of technical literacy are associated with poorer health outcomes. To help improve social connection during the COVID-19 pandemic, Nova Southeastern University's South Florida Geriatric Workforce Enhancement Program partnered with a community-based organization to provide educational resources to promote telehealth services. Objective: This study aimed to provide educational resources to older adults with limited resources and promote the use of telehealth services in this population. Methods: Through this pilot project, we contacted 66 vulnerable older adults who expressed interest in telehealth support through wellness calls, with 44 participants moving on to participate in tablet usage. All tablets were preloaded with educational information on using the device, COVID-19 resources, and accessing telehealth services for patients, caregivers, and families. Results: Feedback from wellness assessments suggested a significant need for telehealth support. Participants used the tablets mainly for telehealth (n=6, 15\%), to connect with friends and family (n=10, 26\%), and to connect with faith communities (n=3, 8\%). Conclusions: The findings from the pilot project suggest that wellness calls and telehealth education are beneficial to support telehealth usage among older adults. ", doi="10.2196/46002", url="https://formative.jmir.org/2023/1/e46002", url="http://www.ncbi.nlm.nih.gov/pubmed/37695647" } @Article{info:doi/10.2196/42217, author="Shoemaker, E. Holly and Thorpe, Alistair and Stevens, Vanessa and Butler, M. Jorie and Drews, A. Frank and Burpo, Nicole and Scherer, D. Laura and Fagerlin, Angela", title="Telehealth Use During the COVID-19 Pandemic Among Veterans and Nonveterans: Web-Based Survey Study", journal="JMIR Form Res", year="2023", month="Sep", day="8", volume="7", pages="e42217", keywords="telehealth", keywords="telemedicine", keywords="veterans", keywords="COVID-19", keywords="health care", keywords="nationwide web-based survey", keywords="underserved population", keywords="accessible health care", keywords="health inequality", keywords="health care disparity", abstract="Background: In the first year of the COVID-19 pandemic, studies reported delays in health care usage due to safety concerns. Delays in care may result in increased morbidity and mortality from otherwise treatable conditions. Telehealth provides a safe alternative for patients to receive care when other circumstances make in-person care unavailable or unsafe, but information on patient experiences is limited. Understanding which people are more or less likely to use telehealth and their experiences can help tailor outreach efforts to maximize the impact of telehealth. Objective: This study aims to examine the characteristics of telehealth users and nonusers and their reported experiences among veteran and nonveteran respondents. Methods: A nationwide web-based survey of current behaviors and health care experiences was conducted in December 2020-March 2021. The survey consisted of 3 waves, and the first wave is assessed here. Respondents included US adults participating in Qualtrics web-based panels. Primary outcomes were self-reported telehealth use and number of telehealth visits. The analysis used a 2-part regression model examining the association between telehealth use and the number of visits with respondent characteristics. Results: There were 2085 participants in the first wave, and 898 (43.1\%) reported using telehealth since the pandemic began. Most veterans who used telehealth reported much or somewhat preferring an in-person visit (336/474, 70.9\%), while slightly less than half of nonveterans (189/424, 44.6\%) reported this preference. While there was no significant difference between veteran and nonveteran likelihood of using telehealth (odds ratio [OR] 1.33, 95\% CI 0.97-1.82), veterans were likely to have more visits when they did use it (incidence rate ratio [IRR] 1.49, 95\% CI 1.07-2.07). Individuals were less likely to use telehealth and reported fewer visits if they were 55 years and older (OR 0.39, 95\% CI 0.25-0.62 for ages 55-64 years; IRR 0.43, 95\% CI 0.28-0.66) or lived in a small city (OR 0.63, 95\% CI 0.43-0.92; IRR 0.71, 95\% CI 0.51-0.99). Receiving health care partly or primarily at the Veterans Health Administration (VA) was associated with telehealth use (primarily VA: OR 3.25, 95\% CI 2.20-4.81; equal mix: OR 2.18, 95\% CI 1.40-3.39) and more telehealth visits (primarily VA: IRR 1.5, 95\% CI 1.10-2.04; equal mix: IRR 1.57, 95\% CI 1.11-2.24). Conclusions: Telehealth will likely continue to be an important source of health care for patients, especially following situations like the COVID-19 pandemic. Some groups who may benefit from telehealth are still underserved. Telehealth services and outreach should be improved to provide accessible care for all. ", doi="10.2196/42217", url="https://formative.jmir.org/2023/1/e42217", url="http://www.ncbi.nlm.nih.gov/pubmed/37527547" } @Article{info:doi/10.2196/42446, author="Chu, MY Amanda and Chong, Y. Andy C. and Lai, T. Nick H. and Tiwari, Agnes and So, P. Mike K.", title="Enhancing the Predictive Power of Google Trends Data Through Network Analysis: Infodemiology Study of COVID-19", journal="JMIR Public Health Surveill", year="2023", month="Sep", day="7", volume="9", pages="e42446", keywords="internet search volumes", keywords="network analysis", keywords="pandemic risk", keywords="health care analytics", keywords="network connectedness", keywords="infodemiology", keywords="infoveillance", keywords="mobile phone", keywords="COVID-19", abstract="Background: The COVID-19 outbreak has revealed a high demand for timely surveillance of pandemic developments. Google Trends (GT), which provides freely available search volume data, has been proven to be a reliable forecast and nowcast measure for public health issues. Previous studies have tended to use relative search volumes from GT directly to analyze associations and predict the progression of pandemic. However, GT's normalization of the search volumes data and data retrieval restrictions affect the data resolution in reflecting the actual search behaviors, thus limiting the potential for using GT data to predict disease outbreaks. Objective: This study aimed to introduce a merged algorithm that helps recover the resolution and accuracy of the search volume data extracted from GT over long observation periods. In addition, this study also aimed to demonstrate the extended application of merged search volumes (MSVs) in combination of network analysis, via tracking the COVID-19 pandemic risk. Methods: We collected relative search volumes from GT and transformed them into MSVs using our proposed merged algorithm. The MSVs of the selected coronavirus-related keywords were compiled using the rolling window method. The correlations between the MSVs were calculated to form a dynamic network. The network statistics, including network density and the global clustering coefficients between the MSVs, were also calculated. Results: Our research findings suggested that although GT restricts the search data retrieval into weekly data points over a long period, our proposed approach could recover the daily search volume over the same investigation period to facilitate subsequent research analyses. In addition, the dynamic time warping diagrams show that the dynamic networks were capable of predicting the COVID-19 pandemic trends, in terms of the number of COVID-19 confirmed cases and severity risk scores. Conclusions: The innovative method for handling GT search data and the application of MSVs and network analysis to broaden the potential for GT data are useful for predicting the pandemic risk. Further investigation of the GT dynamic network can focus on noncommunicable diseases, health-related behaviors, and misinformation on the internet. ", doi="10.2196/42446", url="https://publichealth.jmir.org/2023/1/e42446", url="http://www.ncbi.nlm.nih.gov/pubmed/37676701" } @Article{info:doi/10.2196/48299, author="Benton, Mark", title="Experience and Impact of COVID-19 on a Newly Formed Rural University Medical Office: Survey Study", journal="JMIR Form Res", year="2023", month="Sep", day="7", volume="7", pages="e48299", keywords="remote", keywords="access", keywords="COVID-19", keywords="learning", keywords="survey", keywords="office", keywords="HOPE", keywords="administration", keywords="administrative", keywords="medical education", keywords="education system", keywords="education systems", abstract="Background: The COVID-19 pandemic had large social effects, particularly in the fields of medicine and medical education. Medical organizations in the United States operate in overlapping contexts with interrelated goals inside multiple organizations, and the context of work strongly influenced how organizations were able to respond to COVID-19 restrictions. Objective: This research examines the experience and impact of COVID-19 on the implementation of a Health Resources and Services Administration grant in a newly formed university medical office with the interrelated goals of health policy, health outreach, and medical education. The goal is to understand how COVID-19 created different experiences and challenges for leaders and their collaborators working in medical education compared to those working in public health outreach or health policy. Methods: A survey about COVID-19 opportunities and challenges was administered to work unit leaders and their project collaborators. The most common experiences and challenges are shown, direct educational and other respondents' experiences and challenges are compared, and open-ended comment segments are analyzed. Results: Helping others adjust to digital work, remoteness, and coordination were common experiences during COVID-19. Common challenges include coordination and an inability to make comparisons to previous program years. On average, respondents had 11.3 (SD 7.8) experiences and 8.3 (SD 6.9) challenges considered in the survey. While all units were influenced by COVID-19 restrictions, medical education units had more experiences and challenges. Those involved directly in medical education experienced 69\% (18.6/27) of their possible experiences and 54\% (14.7/27) of their possible challenges on average compared to 35\% (7/20) and 21\% (4.2/20) among other respondents (P<.001). COVID-19 restrictions increased the complexity of project work and presented challenges, especially in terms of coordinating responses and access to locations. Conclusions: The findings suggest that COVID-19 made the overall administration of programs more complex and drew attention from other medical and public health programs. While remoteness is appropriate for some medical education tasks, it is less appropriate for clinical learning. Remoteness presents an especially large challenge to clinical education. Employees now have expectations for remoteness to be built into programs and workplaces. Program administrators will have to integrate remoteness' benefits and drawbacks into their organization for the foreseeable future. ", doi="10.2196/48299", url="https://formative.jmir.org/2023/1/e48299", url="http://www.ncbi.nlm.nih.gov/pubmed/37676708" } @Article{info:doi/10.2196/48581, author="Neely, Stephen and Hao, Feng", title="Diagnosis Disclosure and Peer-to-Peer Information Seeking Among COVID-19--Infected Social Media Users: Survey of US-Based Adults", journal="JMIR Form Res", year="2023", month="Sep", day="5", volume="7", pages="e48581", keywords="chronic health condition", keywords="COVID-19", keywords="diagnosis disclosure", keywords="information seeking", keywords="information sharing", keywords="online health communities", keywords="peer support", keywords="social media", keywords="social support", keywords="survey sample", abstract="Background: Research examining online health communities suggests that individuals affected by chronic health conditions can obtain valuable information and social support through participation in peer-to-peer web-based information exchanges, including information sharing and seeking behaviors. The risks and rewards of these same behaviors in the case of acute illnesses, such as COVID-19, are less well understood, though there is reason to believe that individuals with COVID-19 and other acute illnesses may accrue similar benefits. Objective: This study examines the propensity of American adults to disclose and discuss their COVID-19 diagnosis and symptoms on social media while actively infected with the SARS-CoV-2 virus, as well as to engage in peer-to-peer information seeking in order to better understand the illness that they are experiencing. Additionally, this study seeks to identify the motivations for these behaviors as well as their subsequent impacts on perceived social connectedness and health anxiety in patients with COVID-19. Methods: We conducted a representative survey of 2500 US-based adults using a sample purchased through an industry-leading market research provider. Participants were selected through a stratified quota sampling approach to ensure a representative sample of the US population. Balanced quotas were determined (by region of the country) for gender, age, race, ethnicity, and political affiliation. Responses were analyzed from 946 participants who reported having an active social media account and testing positive for COVID-19 at least once since the start of the pandemic. Results: The results show that only a small portion of social media users (166/946, 18\%) chose to disclose and discuss their COVID-19 diagnosis while infected with the virus. However, among those who did, an overwhelming majority (206/251, 82\%) said that doing so helped them feel more connected and supported while infected with the virus. A larger percentage of the 946 respondents (n=319, 34\%) engaged in peer-to-peer information seeking while infected with COVID-19. Among those who did, a large majority (301/319, 94\%) said that doing so was ``helpful,'' but more than one-third (115/319, 36\%) said that reading about other people's experiences made them ``more worried'' about having COVID-19, while 33\% (108/319) said that it made them ``less worried.'' Illness severity and political affiliation were significant predictors of both information sharing and seeking. Conclusions: The findings suggest that the benefits (and risks) associated with online health communities are germane to patients with acute illnesses such as COVID-19. It is recommended that public health officials and health care providers take a proactive approach to cultivating professionally moderated forums supporting peer-to-peer engagement during future outbreaks of COVID-19 and other acute illnesses in order to improve patient outcomes and promote social support and connectedness among infected patients. ", doi="10.2196/48581", url="https://formative.jmir.org/2023/1/e48581", url="http://www.ncbi.nlm.nih.gov/pubmed/37669087" } @Article{info:doi/10.2196/45867, author="Hirabayashi, Mai and Shibata, Daisaku and Shinohara, Emiko and Kawazoe, Yoshimasa", title="Influence of Tweets Indicating False Rumors on COVID-19 Vaccination: Case Study", journal="JMIR Form Res", year="2023", month="Sep", day="5", volume="7", pages="e45867", keywords="coronavirus", keywords="correlation", keywords="COVID-19", keywords="disinformation", keywords="false information", keywords="infodemiology", keywords="misinformation", keywords="rumor", keywords="rumor-indication", keywords="SARS-CoV-2", keywords="social media", keywords="tweet", keywords="Twitter", keywords="vaccination", keywords="vaccine", abstract="Background: As of December 2022, the outbreak of COVID-19 showed no sign of abating, continuing to impact people's lives, livelihoods, economies, and more. Vaccination is an effective way to achieve mass immunity. However, in places such as Japan, where vaccination is voluntary, there are people who choose not to receive the vaccine, even if an effective vaccine is offered. To promote vaccination, it is necessary to clarify what kind of information on social media can influence attitudes toward vaccines. Objective: False rumors and counterrumors are often posted and spread in large numbers on social media, especially during emergencies. In this paper, we regard tweets that contain questions or point out errors in information as counterrumors. We analyze counterrumors tweets related to the COVID-19 vaccine on Twitter. We aimed to answer the following questions: (1) what kinds of COVID-19 vaccine--related counterrumors were posted on Twitter, and (2) are the posted counterrumors related to social conditions such as vaccination status? Methods: We use the following data sets: (1) counterrumors automatically collected by the ``rumor cloud'' (18,593 tweets); and (2) the number of COVID-19 vaccine inoculators from September 27, 2021, to August 15, 2022, published on the Prime Minister's Office's website. First, we classified the contents contained in counterrumors. Second, we counted the number of COVID-19 vaccine--related counterrumors from data set 1. Then, we examined the cross-correlation coefficients between the numbers of data sets 1 and 2. Through this verification, we examined the correlation coefficients for the following three periods: (1) the same period of data; (2) the case where the occurrence of the suggestion of counterrumors precedes the vaccination (negative time lag); and (3) the case where the vaccination precedes the occurrence of counterrumors (positive time lag). The data period used for the validation was from October 4, 2021, to April 18, 2022. Results: Our classification results showed that most counterrumors about the COVID-19 vaccine were negative. Moreover, the correlation coefficients between the number of counterrumors and vaccine inoculators showed significant and strong positive correlations. The correlation coefficient was over 0.7 at ?8, ?7, and ?1 weeks of lag. Results suggest that the number of vaccine inoculators tended to increase with an increase in the number of counterrumors. Significant correlation coefficients of 0.5 to 0.6 were observed for lags of 1 week or more and 2 weeks or more. This implies that an increase in vaccine inoculators increases the number of counterrumors. These results suggest that the increase in the number of counterrumors may have been a factor in inducing vaccination behavior. Conclusions: Using quantitative data, we were able to reveal how counterrumors influence the vaccination status of the COVID-19 vaccine. We think that our findings would be a foundation for considering countermeasures of vaccination. ", doi="10.2196/45867", url="https://formative.jmir.org/2023/1/e45867", url="http://www.ncbi.nlm.nih.gov/pubmed/37669092" } @Article{info:doi/10.2196/46343, author="Esener, Yildiz and McCall, Terika and Lakdawala, Adnan and Kim, Heejun", title="Seeking and Providing Social Support on Twitter for Trauma and Distress During the COVID-19 Pandemic: Content and Sentiment Analysis", journal="J Med Internet Res", year="2023", month="Aug", day="31", volume="25", pages="e46343", keywords="COVID-19", keywords="social support", keywords="trauma", keywords="distress", keywords="posttraumatic stress disorder", keywords="PTSD", keywords="Twitter", keywords="social media", keywords="mental health", abstract="Background: The COVID-19 pandemic can be recognized as a traumatic event that led to stressors, resulting in trauma or distress among the general population. Social support is vital in the management of these stressors, especially during a traumatic event, such as the COVID-19 pandemic. Because of the limited face-to-face interactions enforced by physical distancing regulations during the pandemic, people sought solace on social media platforms to connect with, and receive support from, one another. Hence, it is crucial to investigate the ways in which people seek and offer support on social media for mental health management. Objective: The research aimed to examine the types of social support (eg, emotional, informational, instrumental, and appraisal) sought and provided for trauma or distress on Twitter during the COVID-19 pandemic. In addition, this study aimed to gain insight into the difficulties and concerns of people during the pandemic by identifying the associations between terms representing the topics of interest related to trauma or distress and their corresponding sentiments. Methods: The study methods included content analysis to investigate the type of social support people sought for trauma or distress during the pandemic. Sentiment analysis was also performed to track the negative and positive sentiment tweets posted between January 1, 2020, and March 15, 2021. Association rule mining was used to uncover associations between terms and sentiments in tweets. In addition, the research used Kruskal-Wallis and Mann-Whitney U tests to determine whether the retweet count and like count varied based on the social support type. Results: Most Twitter users who indicated trauma or distress sought emotional support. Regarding sentiment, Twitter users mostly posted negative sentiment tweets, particularly in January 2021. An intriguing observation was that wearing masks could trigger and exacerbate trauma or distress. The results revealed that people mostly sought and provided emotional support on Twitter regarding difficulties with wearing masks, mental health status, financial hardships, and treatment methods for trauma or distress. In addition, tweets regarding emotional support received the most endorsements from other users, highlighting the critical role of social support in fostering a sense of community and reducing the feelings of isolation during the pandemic. Conclusions: This study demonstrates the potential of social media as a platform to exchange social support during challenging times and to identify the specific concerns (eg, wearing masks and exacerbated symptoms) of individuals with self-reported trauma or distress. The findings provide insights into the types of support that were most beneficial for those struggling with trauma or distress during the pandemic and may inform policy makers and health organizations regarding better practices for pandemic response and special considerations for groups with a history of trauma or distress. ", doi="10.2196/46343", url="https://www.jmir.org/2023/1/e46343", url="http://www.ncbi.nlm.nih.gov/pubmed/37651178" } @Article{info:doi/10.2196/42669, author="Vargas Meza, Xanat and Park, Woo Han", title="Information Circulation Among Spanish-Speaking and Caribbean Communities Related to COVID-19: Social Media--Based Multidimensional Analysis", journal="J Med Internet Res", year="2023", month="Aug", day="23", volume="25", pages="e42669", keywords="COVID-19", keywords="social media", keywords="Spanish", keywords="multidimensional analysis", keywords="Caribbean", keywords="accessibility", abstract="Background: Scienti?c studies from North America and Europe tend to predominate the internet and bene?t English-speaking users. Meanwhile, the COVID-19 death rate was high at the onset of the pandemic in Spanish-speaking countries, and information about nearby Caribbean countries was rarely highlighted. Given the rise in social media use in these regions, the web-based dissemination of scientific information related to COVID-19 must be thoroughly examined. Objective: This study aimed to provide a multidimensional analysis of peer-reviewed information circulation related to COVID-19 in Spanish-speaking and Caribbean regions. Methods: COVID-19--related, peer-reviewed resources shared by web-based accounts located in Spanish-speaking and Caribbean regions were identified through the Altmetric website, and their information was collected. A multidimensional model was used to examine these resources, considering time, individuality, place, activity, and relations. Time was operationalized as the 6 dates of data collection, individuality as the knowledge area and accessibility level, place as the publication venue and affiliation countries, activity as the Altmetric score and number of mentions in the selected regions, and relations as coauthorship between countries and types of social media users who disseminated COVID-19--related information. Results: The highest information circulation peaks in Spanish-speaking countries were from April 2020 to August 2020 and from December 2020 to April 2021, whereas the highest peaks in Caribbean regions were from December 2019 to April 2020. Regarding Spanish-speaking regions, at the onset of the pandemic, scientific expertise was concentrated on a few peer-reviewed sources written in English. The top scienti?c journals mentioned were from English-speaking, westernized regions, whereas the top scienti?c authorships were from China. The most mentioned scientific resources were about breakthrough findings in the medical and health sciences area, written in highly technical language. The top relationships were self-loops in China, whereas international collaborations were between China and the United States. Argentina had high closeness and betweenness, and Spain had high closeness. On the basis of social media data, a combination of media outlets; educational institutions; and expert associations, particularly from Panama, influenced the diffusion of peer-reviewed information. Conclusions: We determined the diffusion patterns of peer-reviewed resources in Spanish-speaking countries and Caribbean territories. This study aimed to advance the management and analysis of web-based public data from non-white people to improve public health communication in their regions. ", doi="10.2196/42669", url="https://www.jmir.org/2023/1/e42669", url="http://www.ncbi.nlm.nih.gov/pubmed/37402284" } @Article{info:doi/10.2196/45146, author="Shin, Hocheol and Yuniar, Tri Cindra and Oh, SuA and Purja, Sujata and Park, Sera and Lee, Haeun and Kim, Eunyoung", title="The Adverse Effects and Nonmedical Use of Methylphenidate Before and After the Outbreak of COVID-19: Machine Learning Analysis", journal="J Med Internet Res", year="2023", month="Aug", day="16", volume="25", pages="e45146", keywords="methylphenidate", keywords="attention-deficit/hyperactivity disorder (ADHD)", keywords="social network services", keywords="adverse effect", keywords="nonmedical use", keywords="machine learning", keywords="deep learning", keywords="child", keywords="adolescent", keywords="psychiatric disorder", abstract="Background: Methylphenidate is an effective first-line treatment for attention-deficit/hyperactivity disorder (ADHD). However, many adverse effects of methylphenidate have been recorded from randomized clinical trials and patient-reported outcomes, but it is difficult to determine abuse from them. In the context of COVID-19, it is important to determine how drug use evaluation, as well as misuse of drugs, have been affected by the pandemic. As people share their reasons for using medication, patient sentiments, and the effects of medicine on social networking services (SNSs), the application of machine learning and SNS data can be a method to overcome the limitations. Proper machine learning models could be evaluated to validate the effects of the COVID-19 pandemic on drug use. Objective: To analyze the effect of the COVID-19 pandemic on the use of methylphenidate, this study analyzed the adverse effects and nonmedical use of methylphenidate and evaluated the change in frequency of nonmedical use based on SNS data before and after the outbreak of COVID-19. Moreover, the performance of 4 machine learning models for classifying methylphenidate use based on SNS data was compared. Methods: In this cross-sectional study, SNS data on methylphenidate from Twitter, Facebook, and Instagram from January 2019 to December 2020 were collected. The frequency of adverse effects, nonmedical use, and drug use before and after the COVID-19 pandemic were compared and analyzed. Interrupted time series analysis about the frequency and trends of nonmedical use of methylphenidate was conducted for 24 months from January 2019 to December 2020. Using the labeled training data set and features, the following 4 machine learning models were built using the data, and their performance was evaluated using F-1 scores: na{\"i}ve Bayes classifier, random forest, support vector machine, and long short-term memory. Results: This study collected 146,352 data points and detected that 4.3\% (6340/146,352) were firsthand experience data. Psychiatric problems (521/1683, 31\%) had the highest frequency among the adverse effects. The highest frequency of nonmedical use was for studies or work (741/2016, 36.8\%). While the frequency of nonmedical use before and after the outbreak of COVID-19 has been similar (odds ratio [OR] 1.02 95\% CI 0.91-1.15), its trend has changed significantly due to the pandemic (95\% CI 2.36-22.20). Among the machine learning models, RF had the highest performance of 0.75. Conclusions: The trend of nonmedical use of methylphenidate has changed significantly due to the COVID-19 pandemic. Among the machine learning models using SNS data to analyze the adverse effects and nonmedical use of methylphenidate, the random forest model had the highest performance. ", doi="10.2196/45146", url="https://www.jmir.org/2023/1/e45146", url="http://www.ncbi.nlm.nih.gov/pubmed/37585250" } @Article{info:doi/10.2196/46819, author="Livesay, Karen and Petersen, Sacha and Walter, Ruby and Zhao, Lin and Butler-Henderson, Kerryn and Abdolkhani, Robab", title="Sociotechnical Challenges of Digital Health in Nursing Practice During the COVID-19 Pandemic: National Study", journal="JMIR Nursing", year="2023", month="Aug", day="16", volume="6", pages="e46819", keywords="nursing informatics", keywords="digital health", keywords="COVID-19 pandemic", keywords="workforce", keywords="sociotechnical approach", abstract="Background: The COVID-19 pandemic has accelerated the use of digital health innovations, which has greatly impacted nursing practice. However, little is known about the use of digital health services by nurses and how this has changed during the pandemic. Objective: This study explored the sociotechnical challenges that nurses encountered in using digital health services implemented during the pandemic and, accordingly, what digital health capabilities they expect from the emerging workforce. Methods: Five groups of nurses, including chief nursing information officers, nurses, clinical educators, nurse representatives at digital health vendor companies, and nurse representatives in government bodies across Australia were interviewed. They were asked about their experience of digital health during the pandemic, their sociotechnical challenges, and their expectations of the digital health capabilities of emerging nurses to overcome these challenges. Interviews were deductively analyzed based on 8 sociotechnical themes, including technical challenges, nurse-technology interaction, clinical content management, training and human resources, communication and workflow, internal policies and guidelines, external factors, and effectiveness assessment of digital health for postpandemic use. Results: Sixteen participants were interviewed. Human factors and clinical workflow challenges were highly mentioned. Nurses' lack of knowledge and involvement in digital health implementation and evaluation led to inefficient use of these technologies during the pandemic. They expected the emerging workforce to be digitally literate and actively engaged in digital health interventions beyond documentation, such as data analytics and decision-making. Conclusions: Nurses should be involved in digital health interventions to efficiently use these technologies and provide safe and quality care. Collaborative efforts among policy makers, vendors, and clinical and academic industries can leverage digital health capabilities in the nursing workforce. ", doi="10.2196/46819", url="https://nursing.jmir.org/2023/1/e46819", url="http://www.ncbi.nlm.nih.gov/pubmed/37585256" } @Article{info:doi/10.2196/38965, author="Campos-Castillo, Celeste", title="Impact of Beliefs About Local Physician Supply and Self-Rated Health on Willingness to See a Nurse Practitioner During the COVID-19 Pandemic: Web-Based Survey and Experiment", journal="JMIR Form Res", year="2023", month="Aug", day="16", volume="7", pages="e38965", keywords="primary care shortage", keywords="workforce", keywords="health care seeking", keywords="public opinion", keywords="consumers", keywords="online studies", keywords="COVID-19", keywords="pandemic", keywords="primary care", keywords="nurse practitioners", keywords="nurse", keywords="healthcare", keywords="resources", keywords="advocacy", abstract="Background: The COVID-19 pandemic overburdened primary care clinicians. For nurse practitioners (NPs) to alleviate the burden, the public must be willing to see an NP over a physician. Those with poor health tended to continue seeking care during the pandemic, suggesting that they may be willing to see an NP. Objective: The aim of this study is to evaluate the public's willingness to see an NP for primary care and how this may be associated with their beliefs about the local supply of physicians and self-rated health. Two studies were conducted: (1) a survey to identify correlations and (2) an experiment to assess how willingness is dependent on information about the local supply of physicians. Methods: The survey and experiment were conducted digitally in April and December 2020, respectively. Participants were US adults recruited from Amazon's Mechanical Turk platform. The key independent variables were self-rated health, which was a dichotomized 5-point scale (excellent, very good, good vs fair, and poor), and beliefs about local physician supply. The survey measured beliefs about local physician supply, while the experiment manipulated beliefs by altering information the participants read about the local supply of physicians. Willingness to see an NP was assessed in 2 ways. First as an overall preference over a physician and the second as a preference given 2 clinically significant scenarios in which participants imagined they were experiencing either coughing or a headache (presentation order randomized). Multiple regressions and ANOVAs were used to assess how beliefs about the local physician supply and self-rated health were associated with overall willingness to see an NP. Bivariate probits simultaneously estimated willingness to see an NP in the 2 clinically significant scenarios. Results: The survey showed that concerns about physician supply were associated with lower willingness to see an NP among respondents with comparatively better health but a greater willingness among respondents with comparatively worse health. The experiment suggests that only the latter is causal. For the 2 clinically significant scenarios, these patterns appeared for the coughing scenario in the survey and the headache scenario in the experiment. Conclusions: US adults with comparatively worse self-rated health become more willing to see an NP for primary care when they hear information that raises their concerns about the local physician supply. The differences between the survey and experiment results may be useful for interpreting findings from future studies. Findings may aid in managing finite health care resources during public health crises and crafting successful messaging by NP advocacy groups. Efforts to address nursing shortages will also be needed. ", doi="10.2196/38965", url="https://formative.jmir.org/2023/1/e38965", url="http://www.ncbi.nlm.nih.gov/pubmed/37347928" } @Article{info:doi/10.2196/45069, author="Zaidi, Zainab and Ye, Mengbin and Samon, Fergus and Jama, Abdisalan and Gopalakrishnan, Binduja and Gu, Chenhao and Karunasekera, Shanika and Evans, Jamie and Kashima, Yoshihisa", title="Topics in Antivax and Provax Discourse: Yearlong Synoptic Study of COVID-19 Vaccine Tweets", journal="J Med Internet Res", year="2023", month="Aug", day="8", volume="25", pages="e45069", keywords="COVID-19 vaccine", keywords="vaccine hesitancy", keywords="antivax", keywords="stance detection", keywords="topic modeling", keywords="misinformation", keywords="disinformation", abstract="Background: Developing an understanding of the public discourse on COVID-19 vaccination on social media is important not only for addressing the ongoing COVID-19 pandemic but also for future pathogen outbreaks. There are various research efforts in this domain, although, a need still exists for a comprehensive topic-wise analysis of tweets in favor of and against COVID-19 vaccines. Objective: This study characterizes the discussion points in favor of and against COVID-19 vaccines posted on Twitter during the first year of the pandemic. The aim of this study was primarily to contrast the views expressed by both camps, their respective activity patterns, and their correlation with vaccine-related events. A further aim was to gauge the genuineness of the concerns expressed in antivax tweets. Methods: We examined a Twitter data set containing 75 million English tweets discussing the COVID-19 vaccination from March 2020 to March 2021. We trained a stance detection algorithm using natural language processing techniques to classify tweets as antivax or provax and examined the main topics of discourse using topic modeling techniques. Results: Provax tweets (37 million) far outnumbered antivax tweets (10 million) and focused mostly on vaccine development, whereas antivax tweets covered a wide range of topics, including opposition to vaccine mandate and concerns about safety. Although some antivax tweets included genuine concerns, there was a large amount of falsehood. Both stances discussed many of the same topics from opposite viewpoints. Memes and jokes were among the most retweeted messages. Most tweets from both stances (9,007,481/10,566,679, 85.24\% antivax and 24,463,708/37,044,507, 66.03\% provax tweets) came from dual-stance users who posted both provax and antivax tweets during the observation period. Conclusions: This study is a comprehensive account of COVID-19 vaccine discourse in the English language on Twitter from March 2020 to March 2021. The broad range of discussion points covered almost the entire conversation, and their temporal dynamics revealed a significant correlation with COVID-19 vaccine--related events. We did not find any evidence of polarization and prevalence of antivax discourse over Twitter. However, targeted countering of falsehoods is important because only a small fraction of antivax discourse touched on a genuine issue. Future research should examine the role of memes and humor in driving web-based social media activity. ", doi="10.2196/45069", url="https://www.jmir.org/2023/1/e45069", url="http://www.ncbi.nlm.nih.gov/pubmed/37552535" } @Article{info:doi/10.2196/44774, author="Wang, Yijun and Chukwusa, Emeka and Koffman, Jonathan and Curcin, Vasa", title="Public Opinions About Palliative and End-of-Life Care During the COVID-19 Pandemic: Twitter-Based Content Analysis", journal="JMIR Form Res", year="2023", month="Aug", day="7", volume="7", pages="e44774", keywords="palliative care", keywords="end-of-life care", keywords="COVID-19", keywords="Twitter", keywords="public opinions", abstract="Background: Palliative and end-of-life care (PEoLC) played a critical role in relieving distress and providing grief support in response to the heavy toll caused by the COVID-19 pandemic. However, little is known about public opinions concerning PEoLC during the pandemic. Given that social media have the potential to collect real-time public opinions, an analysis of this evidence is vital to guide future policy-making. Objective: This study aimed to use social media data to investigate real-time public opinions regarding PEoLC during the COVID-19 crisis and explore the impact of vaccination programs on public opinions about PEoLC. Methods: This Twitter-based study explored tweets across 3 English-speaking countries: the United States, the United Kingdom, and Canada. From October 2020 to March 2021, a total of 7951 PEoLC-related tweets with geographic tags were retrieved and identified from a large-scale COVID-19 Twitter data set through the Twitter application programming interface. Topic modeling realized through a pointwise mutual information--based co-occurrence network and Louvain modularity was used to examine latent topics across the 3 countries and across 2 time periods (pre- and postvaccination program periods). Results: Commonalities and regional differences among PEoLC topics in the United States, the United Kingdom, and Canada were identified specifically: cancer care and care facilities were of common interest to the public across the 3 countries during the pandemic; the public expressed positive attitudes toward the COVID-19 vaccine and highlighted the protection it affords to PEoLC professionals; and although Twitter users shared their personal experiences about PEoLC in the web-based community during the pandemic, this was more prominent in the United States and Canada. The implementation of the vaccination programs raised the profile of the vaccine discussion; however, this did not influence public opinions about PEoLC. Conclusions: Public opinions on Twitter reflected a need for enhanced PEoLC services during the COVID-19 pandemic. The insignificant impact of the vaccination program on public discussion on social media indicated that public concerns regarding PEoLC continued to persist even after the vaccination efforts. Insights gleaned from public opinions regarding PEoLC could provide some clues for policy makers on how to ensure high-quality PEoLC during public health emergencies. In this post--COVID-19 era, PEoLC professionals may wish to continue to examine social media and learn from web-based public discussion how to ease the long-lasting trauma caused by this crisis and prepare for public health emergencies in the future. Besides, our results showed social media's potential in acting as an effective tool to reflect public opinions in the context of PEoLC. ", doi="10.2196/44774", url="https://formative.jmir.org/2023/1/e44774", url="http://www.ncbi.nlm.nih.gov/pubmed/37368840" } @Article{info:doi/10.2196/41959, author="Scharnetzki, Elizabeth and Waterston, Leo and Scherer, M. Aaron and Thorpe, Alistair and Fagerlin, Angela and Han, J. Paul K.", title="Effects of Prosocial and Hope-Promoting Communication Strategies on COVID-19 Worry and Intentions for Risk-Reducing Behaviors and Vaccination: Experimental Study", journal="JMIR Form Res", year="2023", month="Aug", day="1", volume="7", pages="e41959", keywords="COVID-19", keywords="communication", keywords="hope", keywords="prosocial", keywords="vaccination", keywords="risk", keywords="behavior", keywords="vaccine", keywords="effect", keywords="effectiveness", keywords="social", keywords="messages", keywords="public", keywords="web-based", keywords="survey", abstract="Background: The COVID-19 pandemic has engendered widespread fear and skepticism about recommended risk-reducing behaviors including vaccination. Health agencies are faced with the need to communicate to the public in ways that both provide reassurance and promote risk-reducing behaviors. Communication strategies that promote prosocial (PS) values and hope are being widely used; however, the existing research on the persuasiveness of these strategies has offered mixed evidence. There is also very little research examining the comparative effectiveness of PS and hope-promoting (HP) strategies. Objective: The aim of this study is to evaluate the comparative effectiveness of PS and HP messages in reassuring the public and motivating COVID-19 risk--reducing behaviors. Methods: A web-based factorial experiment was conducted in which a diverse sample of the US public was randomized to read messages which adapted existing COVID-19 information from a public website produced by a state government public health department to include alternative framing language: PS, HP, or no additional framing (control). Participants then completed surveys measuring COVID-19 worry and intentions for COVID-19 risk--reducing behaviors and vaccination. Results: COVID-19 worry was unexpectedly higher in the HP than in the control and PS conditions. Intentions for COVID-19 risk--reducing behaviors did not differ between groups; however, intentions for COVID-19 vaccination were higher in the HP than in the control condition, and this effect was mediated by COVID-19 worry. Conclusions: It appears that HP communication strategies may be more effective than PS strategies in motivating risk-reducing behaviors in some contexts but with the paradoxical cost of promoting worry. ", doi="10.2196/41959", url="https://formative.jmir.org/2023/1/e41959", url="http://www.ncbi.nlm.nih.gov/pubmed/37379364" } @Article{info:doi/10.2196/45349, author="Patel, S. Khushi and Corbett, F. Cynthia and Combs, M. Elizabeth and Donevant, B. Sara and Selph, J. Margaret and Gibson, M. Lynette and Dawson, M. Robin and Sheth, P. Amit and Hughes, G. Ronda", title="Perceptions of COVID-19 and the Use of Health Information Technology Among People Who Are Uninsured: Multimethod Survey Study", journal="JMIR Form Res", year="2023", month="Jul", day="28", volume="7", pages="e45349", keywords="COVID-19", keywords="medically uninsured", keywords="medical informatics", keywords="telemedicine", keywords="mobile apps", keywords="health literacy", keywords="mobile phone", abstract="Background: As of May 2023, the novel SARS-CoV-2 has claimed nearly 7 million lives globally and >1.1 million lives in the United States. Low-income populations are often disproportionately affected by risk factors such as lifestyle, employment, and limited health literacy. These populations may lack the knowledge of appropriate infection precautions or have reduced access to care during illness, particularly in countries without universal health care. Objective: We aimed to explore the perceptions and experiences of COVID-19, including symptoms and risk factors among uninsured individuals seeking care at a free medical clinic, and to obtain respondents' perceptions of and suggestions for adapting a mobile health (mHealth) app to an uninsured population known to have low health literacy. Methods: We conducted a prospective multimethod survey study with a convenience sample of uninsured adults seeking care at 3 free clinics in the United States. Respondents were questioned about their risk for and awareness of COVID-19 symptoms, COVID-19 testing, current technology use, and the use of technology to facilitate their health regarding COVID-19. Data were analyzed using descriptive statistics (eg, frequencies and mean differences). In addition, a small subset of respondents from one of the clinics (n=10) participated in interviews to provide feedback about the design of a COVID-19 web-based smartphone (mHealth) app. Results: The survey respondents (N=240) were 53.8\% (n=129) female, were primarily White (n=113, 47.1\%), and had a mean age of 50.0 (SD 11.67; range 19-72) years. Most respondents (162/222, 73\%) did not think that they were at risk for COVID-19. Although respondents reported only moderate confidence in their knowledge of the short- and long-term symptoms of COVID-19, their knowledge of the symptoms aligned well with reports published by the Centers for Disease Control and Prevention of the most common acute (590/610, 96.7\%) and long-term (217/271, 80.1\%) symptoms. Most respondents (159/224, 71\%) reported an interest in using the mHealth app to gain additional information regarding COVID-19 and available community resources. Respondents who were interviewed provided suggestions to improve the mHealth app but had overall positive perceptions about the potential usefulness and usability of the app. Conclusions: It was encouraging that the knowledge of COVID-19 symptoms aligned well with the reports published by the Centers for Disease Control and Prevention and that respondents were enthusiastic about using an mHealth app to monitor symptoms. However, it was concerning that most respondents did not think they were at a risk of contracting COVID-19. ", doi="10.2196/45349", url="https://formative.jmir.org/2023/1/e45349", url="http://www.ncbi.nlm.nih.gov/pubmed/37505792" } @Article{info:doi/10.2196/43628, author="Jin, Qiang and Raza, Hassan Syed and Yousaf, Muhammad and Zaman, Umer and Ogadimma, C. Emenyeonu and Shah, Ali Amjad and Core, Rachel and Malik, Aqdas", title="Assessing How Risk Communication Surveillance Prompts COVID-19 Vaccine Acceptance Among Internet Users by Applying the Situational Theory of Problem Solving: Cross-Sectional Study", journal="JMIR Form Res", year="2023", month="Jul", day="26", volume="7", pages="e43628", keywords="COVID-19", keywords="vaccine safety", keywords="risk communication", keywords="digital interventions", keywords="health communication", keywords="Situational Theory of Problem Solving", abstract="Background: The World Health Organization has recently raised concerns regarding the low number of people fully vaccinated against COVID-19. The low ratio of fully vaccinated people and the emergence of renewed infectious variants correspond to worsening public health. Global health managers have highlighted COVID-19 vaccine--related infodemics as a significant risk perception factor hindering mass vaccination campaigns. Objective: Given the ambiguous digital communication environment that has fostered infodemics, resource-limited nations struggle to boost public willingness to encourage people to fully vaccinate. Authorities have launched some risk communication--laden digital interventions in response to infodemics. However, the value of the risk communication strategies used to tackle infodemics needs to be evaluated. The current research using the tenets of the Situational Theory of Problem Solving is novel, as it explores the impending effects of risk communication strategies. The relationship between infodemic-induced risk perception of COVID-19 vaccine safety and risk communication actions to intensify willingness to be fully vaccinated was examined. Methods: This study used a cross-sectional research design vis-{\`a}-vis a nationally representative web-based survey. We collected data from 1946 internet users across Pakistan. Participants voluntarily participated in this research after completing the consent form and reading ethical permissions. Responses were received over 3 months, from May 2022 to July 2022. Results: The results delineated that infodemics positively affected risk perception. This realization pushed the public to engage in risky communicative actions through reliance on and searches for accurate information. Therefore, the prospect of managing infodemics through risk information exposure (eg, digital interventions) using the situational context could predict robust willingness to be fully vaccinated against COVID-19. Conclusions: These pioneering results offer strategic considerations for health authorities to effectively manage the descending spiral of optimal protection against COVID-19. This research concludes that the likelihood of managing infodemics using situational context through exposure to relevant information could improve one's knowledge of forfending and selection, which can lead to robust protection against COVID-19. Hence, more situation-specific information about the underlying problem (ie, the selection of an appropriate vaccine) can be made accessible through several official digital sources to achieve a more active public health response. ", doi="10.2196/43628", url="https://formative.jmir.org/2023/1/e43628", url="http://www.ncbi.nlm.nih.gov/pubmed/37315198" } @Article{info:doi/10.2196/41376, author="Abuauf, Mawahib and Raboe, Hassan Enaam and Alshareef, Muneera and Rabie, Nada and Zailaie, Roaa and Alharbi, Abdullah and Felemban, Walaa and Alnasser, Ibrahim and Shalaby, Hanin", title="COVID-19 Conceptual Modeling: Single-Center Cross-Sectional Study", journal="JMIR Form Res", year="2023", month="Jul", day="11", volume="7", pages="e41376", keywords="conceptual model", keywords="conceptual framework", keywords="modeling", keywords="Saudi Arabia", keywords="COVID-19", keywords="SARS-CoV-2", keywords="mortality", keywords="morbidity", keywords="CURB-65", keywords="socioeconomic", keywords="health care", keywords="hospital database", keywords="electronic record", keywords="medical decision-making", keywords="hospital admission", keywords="hospitalization", keywords="cross-sectional", keywords="death", keywords="intensive care", abstract="Background: Conceptual models are abstract representations of the real world. They are used to refine medical and nonmedical health care scopes of service. During the COVID-19 pandemic, numerous analytic predictive models were generated aiming to evaluate the impact of implemented policies on mitigating the spread of the virus. The models also aimed to examine the psychosocial factors that might govern the general population's adherence to these policies and to identify factors that could affect COVID-19 vaccine uptake and allocation. The outcomes of these analytic models helped set priorities when vaccines were available and predicted readiness to resume non--COVID-19 health care services. Objective: The objective of our research was to implement a descriptive-analytical conceptual model that analyzes the data of all COVID-19--positive cases admitted to our hospital from March 1 to May 31, 2020, the initial wave of the pandemic, the time interval during which local policies and clinical guidelines were constantly updated to mitigate the local effects of COVID-19, minimize mortality, reduce intensive care unit (ICU) admission, and ensure the safety of health care providers. The primary outcome of interest was to identify factors that might affect mortality and ICU admission rates and the impact of the implemented policy on COVID-19 positivity among health care providers. The secondary outcome of interest was to evaluate the sensitivity of the COVID-19 visual score, implemented by the Saudi Arabia Ministry of Health for COVID-19 risk assessment, and CURB-65 (confusion, urea, respiratory rate, blood pressure, and age >65 years) scores in predicting ICU admission or mortality among the study population. Methods: This was a cross-sectional study. The relevant attributes were constructed based on research findings from the first wave of the pandemic and were electronically retrieved from the hospital database. Analysis of the conceptual model was based on the International Society for Pharmacoeconomics and Outcomes Research guidelines and the Society for Medical Decision-Making. Results: A total of 275 individuals tested positive for COVID-19 within the study design interval. The conceptualization model revealed a low-risk population based on the following attributes: a mean age of 42 (SD 19.2) years; 19\% (51/275) of the study population being older adults ?60 years of age; 80\% (220/275) having a CURB-65 score <4; 53\% (147/275) having no comorbidities; 5\% (13/275) having extreme obesity; and 20\% (55/275) having a significant hematological abnormality. The overall rate of ICU admission for the study population was 5\% (13/275), and the overall mortality rate was 1.5\% (4/275). The multivariate correlation analysis revealed that a high-selectivity approach was adopted, resulting in patients with complex medical problems not being sent to MOH isolation facilities. Furthermore, 5\% of health care providers tested positive for COVID-19, none of whom were health care providers allocated to the COVID-19 screening areas, indicating the effectiveness of the policy implemented to ensure the safety of health care providers. Conclusions: Based on the conceptual model outcome, the selectivity applied in retaining high-risk populations within the hospital might have contributed to the observed low mortality rate, without increasing the risk to attending health care providers. ", doi="10.2196/41376", url="https://formative.jmir.org/2023/1/e41376", url="http://www.ncbi.nlm.nih.gov/pubmed/37256829" } @Article{info:doi/10.2196/44603, author="Cummins, A. Jack and Lipworth, D. Adam", title="Reddit and Google Activity Related to Non-COVID Epidemic Diseases Surged at Start of COVID-19 Pandemic: Retrospective Study", journal="JMIR Form Res", year="2023", month="Jul", day="6", volume="7", pages="e44603", keywords="COVID-19", keywords="Reddit", keywords="Google Trends", keywords="chikungunya", keywords="Ebola", keywords="H1N1", keywords="Middle Eastern respiratory syndrome", keywords="MERS", keywords="severe acute respiratory syndrome", keywords="SARS", keywords="Zika", keywords="infectious disease", keywords="social media", keywords="search data", keywords="search query", keywords="web-based search", keywords="information behavior", keywords="information seeking", keywords="public interest", abstract="Background: Resources such as Google Trends and Reddit provide opportunities to gauge real-time popular interest in public health issues. Despite the potential for these publicly available and free resources to help optimize public health campaigns, use for this purpose has been limited. Objective: The purpose of this study is to determine whether early public awareness of COVID-19 correlated with elevated public interest in other infectious diseases of public health importance. Methods: Google Trends search data and Reddit comment data were analyzed from 2018 through 2020 for the frequency of keywords ``chikungunya,'' ``Ebola,'' ``H1N1,'' ``MERS,'' ``SARS,'' and ``Zika,'' 6 highly publicized epidemic diseases in recent decades. After collecting Google Trends relative popularity scores for each of these 6 terms, unpaired 2-tailed t tests were used to compare the 2020 weekly scores for each term to their average level over the 3-year study period. The number of Reddit comments per month with each of these 6 terms was collected and then adjusted for the total estimated Reddit monthly comment volume to derive a measure of relative use, analogous to the Google Trends popularity score. The relative monthly incidence of comments with each search term was then compared to the corresponding search term's pre-COVID monthly comment data, again using unpaired 2-tailed t tests. P value cutoffs for statistical significance were determined a priori with a Bonferroni correction. Results: Google Trends and Reddit data both demonstrate large and statistically significant increases in the usage of each evaluated disease term through at least the initial months of the pandemic. Google searches and Reddit comments that included any of the evaluated infectious disease search terms rose significantly in the first months of 2020 above their baseline usage, peaking in March 2020. Google searches for ``SARS'' and ``MERS'' remained elevated for the entirety of the 2020 calendar year, as did Reddit comments with the words ``Ebola,'' ``H1N1,'' ``MERS,'' and ``SARS'' (P<.001, for each weekly or monthly comparison, respectively). Conclusions: Google Trends and Reddit can readily be used to evaluate real-time general interest levels in public health--related topics, providing a tool to better time and direct public health initiatives that require a receptive target audience. The start of the COVID-19 pandemic correlated with increased public interest in other epidemic infectious diseases. We have demonstrated that for 6 distinct infectious causes of epidemics over the last 2 decades, public interest rose substantially and rapidly with the outbreak of COVID-19. Our data suggests that for at least several months after the initial outbreak, the public may have been particularly receptive to dialogue on these topics. Public health officials should consider using Google Trends and social media data to identify patterns of engagement with public health topics in real time and to optimize the timing of public health campaigns. ", doi="10.2196/44603", url="https://formative.jmir.org/2023/1/e44603", url="http://www.ncbi.nlm.nih.gov/pubmed/37256832" } @Article{info:doi/10.2196/34598, author="Mabuka, Thabo and Naidoo, Natalie and Ncube, Nesisa and Yiga, Thabo and Ross, Michael and Kurehwa, Kuzivakwashe and Nare Nyathi, Mothabisi and Silaji, Andrea and Ndemera, Tinashe and Lemeke, Tlaleng and Taiwo, Ridwan and Macharia, Willie and Sithole, Mthokozisi", title="The Impact of SARS-CoV-2 Lineages (Variants) and COVID-19 Vaccination on the COVID-19 Epidemic in South Africa: Regression Study", journal="JMIRx Med", year="2023", month="Jul", day="3", volume="4", pages="e34598", keywords="COVID-19", keywords="SARS-CoV-2", keywords="vaccines", keywords="variants", keywords="lineages", keywords="South Africa", keywords="epidemiology", keywords="statistics", abstract="Background: Emerging SARS-CoV-2 variants have been attributed to the occurrence of secondary, tertiary, quaternary, and quinary COVID-19 epidemic waves threatening vaccine efforts owing to their immune invasiveness. Since the importation of SARS-CoV-2 in South Africa, with the first reported COVID-19 case on March 5, 2020, South Africa has observed 5 consecutive COVID-19 epidemic waves. The evolution of SARS-CoV-2 has played a major role in the resurgence of COVID-19 epidemic waves in South Africa and across the globe. Objective: We aimed to conduct descriptive and inferential statistical analysis on South African COVID-19 epidemiological data to investigate the impact of SARS-CoV-2 lineages and COVID-19 vaccinations in South African COVID-19 epidemiology. Methods: The general methodology involved the collation and stratification, covariance, regression analysis, normalization, and comparative inferential statistical analysis through null hypothesis testing (paired 2-tailed t tests) of South African COVID-19 epidemiological data. Results: The mean daily positive COVID-19 tests in South Africa's first, second, third, fourth, and fifth COVID-19 epidemic wave periods were 11.5\% (SD 8.58\%), 11.5\% (SD 8.45\%), 13.3\% (SD 9.72\%), 13.1\% (SD 9.91\%), and 14.3\% (SD 8.49\%), respectively. The COVID-19 transmission rate in the first and second COVID-19 epidemic waves in South Africa was similar, while the COVID-19 transmission rate was higher in the third, fourth, and fifth COVID-19 epidemic waves than in the aforementioned waves. Most COVID-19 hospitalized cases in South Africa were in the general ward (60\%-79.1\%). Patients with COVID-19 on oxygen were the second-largest admission status (11.2\%-16.8\%), followed by patients with COVID-19 in the intensive care unit (8.07\%-16.7\%). Most patients hospitalized owing to COVID-19 in South Africa's first, second, third, and fourth COVID-19 epidemic waves were aged between 40 and 49 years (16.8\%-20.4\%) and 50 and 59 years (19.8\%-25.3\%). Patients admitted to the hospital owing to COVID-19 in the age groups of 0 to 19 years were relatively low (1.98\%-4.59\%). In general, COVID-19 hospital admissions in South Africa for the age groups between 0 and 29 years increased after each consecutive COVID-19 epidemic wave, while for age groups between 30 and 79 years, hospital admissions decreased. Most COVID-19 hospitalization deaths in South Africa in the first, second, third, fourth, and fifth COVID-19 epidemic waves were in the ages of 50 to 59 years (15.8\%-24.8\%), 60 to 69 years (15.9\%-29.5\%), and 70 to 79 years (16.6\%-20.7\%). Conclusions: The relaxation of COVID-19 nonpharmaceutical intervention health policies in South Africa and the evolution of SARS-CoV-2 were associated with increased COVID-19 transmission and severity in the South African population. COVID-19 vaccination in South Africa was strongly associated with a decrease in COVID-19 hospitalization and severity in South Africa. ", doi="10.2196/34598", url="https://med.jmirx.org/2023/1/e34598", url="http://www.ncbi.nlm.nih.gov/pubmed/37463043" } @Article{info:doi/10.2196/48913, author="Shania, Mila and Handayani, Wuri Putu and Asih, Sali", title="Designing High-Fidelity Mobile Health for Depression in Indonesian Adolescents Using Design Science Research: Mixed Method Approaches", journal="JMIR Form Res", year="2023", month="Jul", day="3", volume="7", pages="e48913", keywords="mobile health", keywords="mental health", keywords="user interface", keywords="design science research", keywords="Indonesia", keywords="digital app", keywords="mHealth", keywords="depression", keywords="pandemic", keywords="adolescents", abstract="Background: COVID-19 mitigation protocols, enacted to control the pandemic, have also been shown to have a negative impact on mental health, including the mental health of adolescents. The threat of being infected by SARS-CoV-2 and substantial changes in lifestyle, including limited social interaction due to stay-at-home orders, led to loneliness as well as depressive symptoms. However, offline psychological assistance is restricted, as psychologists are bounded by mitigation protocols. Further, not all adolescents' guardians are open to their children attending or have the means to pay for psychological service; thus, adolescents remain untreated. Having a mobile health (mHealth) app for mental health that uses monitoring, provides social networks, and delivers psychoeducation may provide a solution, especially in countries that have limited health facilities and mental health workers. Objective: This study aimed to design an mHealth app to help prevent and monitor depression in adolescents. The design of this mHealth app was carried out as a high-fidelity prototype. Methods: We used a design science research (DSR) methodology with 3 iterations and 8 golden rule guidelines. The first iteration used interviews, and the second and third iterations used mixed method approaches. The DSR stages include the following: (1) identify the problem; (2) define the solution; (3) define the solution objective; (4) develop, demonstrate, and evaluate the solution; and (5) communicate the solution. This study involved students and medical experts. Results: The first iteration resulted in a wireframe and prototype for the next iteration. The second iteration resulted in a System Usability Scale score of 67.27, indicating a good fit. In the third iteration, the system usefulness, information quality, interface quality, and overall values were 2.416, 2.341, 2.597, and 2.261, respectively, indicating a good design. Key features of this mHealth app include a mood tracker, community, activity target, and meditation, and supporting features that complement the design include education articles and early detection features. Conclusions: Our findings provide guidance for health facilities and to design and implement future mHealth apps to help treat adolescent depression. ", doi="10.2196/48913", url="https://formative.jmir.org/2023/1/e48913", url="http://www.ncbi.nlm.nih.gov/pubmed/37399059" } @Article{info:doi/10.2196/41134, author="Isip Tan, Thiele Iris and Cleofas, Jerome and Solano, Geoffrey and Pillejera, Genevive Jeanne and Catapang, Kyle Jasper", title="Interdisciplinary Approach to Identify and Characterize COVID-19 Misinformation on Twitter: Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Jun", day="28", volume="7", pages="e41134", keywords="COVID-19", keywords="misinformation", keywords="natural language processing", keywords="Twitter", keywords="biterm topic modeling", abstract="Background: Studying COVID-19 misinformation on Twitter presents methodological challenges. A computational approach can analyze large data sets, but it is limited when interpreting context. A qualitative approach allows for a deeper analysis of content, but it is labor-intensive and feasible only for smaller data sets. Objective: We aimed to identify and characterize tweets containing COVID-19 misinformation. Methods: Tweets geolocated to the Philippines (January 1 to March 21, 2020) containing the words coronavirus, covid, and ncov were mined using the GetOldTweets3 Python library. This primary corpus (N=12,631) was subjected to biterm topic modeling. Key informant interviews were conducted to elicit examples of COVID-19 misinformation and determine keywords. Using NVivo (QSR International) and a combination of word frequency and text search using key informant interview keywords, subcorpus A (n=5881) was constituted and manually coded to identify misinformation. Constant comparative, iterative, and consensual analyses were used to further characterize these tweets. Tweets containing key informant interview keywords were extracted from the primary corpus and processed to constitute subcorpus B (n=4634), of which 506 tweets were manually labeled as misinformation. This training set was subjected to natural language processing to identify tweets with misinformation in the primary corpus. These tweets were further manually coded to confirm labeling. Results: Biterm topic modeling of the primary corpus revealed the following topics: uncertainty, lawmaker's response, safety measures, testing, loved ones, health standards, panic buying, tragedies other than COVID-19, economy, COVID-19 statistics, precautions, health measures, international issues, adherence to guidelines, and frontliners. These were categorized into 4 major topics: nature of COVID-19, contexts and consequences, people and agents of COVID-19, and COVID-19 prevention and management. Manual coding of subcorpus A identified 398 tweets with misinformation in the following formats: misleading content (n=179), satire and/or parody (n=77), false connection (n=53), conspiracy (n=47), and false context (n=42). The discursive strategies identified were humor (n=109), fear mongering (n=67), anger and disgust (n=59), political commentary (n=59), performing credibility (n=45), overpositivity (n=32), and marketing (n=27). Natural language processing identified 165 tweets with misinformation. However, a manual review showed that 69.7\% (115/165) of tweets did not contain misinformation. Conclusions: An interdisciplinary approach was used to identify tweets with COVID-19 misinformation. Natural language processing mislabeled tweets, likely due to tweets written in Filipino or a combination of the Filipino and English languages. Identifying the formats and discursive strategies of tweets with misinformation required iterative, manual, and emergent coding by human coders with experiential and cultural knowledge of Twitter. An interdisciplinary team composed of experts in health, health informatics, social science, and computer science combined computational and qualitative methods to gain a better understanding of COVID-19 misinformation on Twitter. ", doi="10.2196/41134", url="https://formative.jmir.org/2023/1/e41134", url="http://www.ncbi.nlm.nih.gov/pubmed/37220196" } @Article{info:doi/10.2196/37857, author="Rodr{\'i}guez-Blanque, Raquel and S{\'a}nchez-Garc{\'i}a, Carlos Juan and Cobos Vargas, Angel and Leyva Mart{\'i}nez, Socorro M. and Mart{\'i}nez Diz, Silvia and Cort{\'e}s-Mart{\'i}n, Jonathan and Tovar-G{\'a}lvez, Isabel Mar{\'i}a", title="Evaluation of Lactobacillus Coryniformis K8 Consumption by Health Care Workers Exposed to COVID-19 (LactoCor2 Project): Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Jun", day="28", volume="12", pages="e37857", keywords="COVID-19", keywords="coronavirus", keywords="Lactobacillus", keywords="health care workers", keywords="Lactobacilo", keywords="trabajadores de la salud", keywords="SARS-CoV-2", keywords="probi{\'o}tico", abstract="Background: Lactobacillus coryniformis K8 CECT5711 has immune-modulating properties, enhances the immune response to viral antigens leading to the production of specific antibodies, and has anti-inflammatory activity, which may help to prevent uncontrolled inflammatory processes leading to respiratory and other organ failures. Objective: The purpose of this study is to evaluate the effect of the consumption of a probiotic strain on the incidence and severity of COVID-19 in health personnel who carry out their professional work among patients with infection or suspected infection by SARS-CoV-2. Methods: This is a double-blind randomized clinical trial in which the experimental group will receive a capsule of L coryniformis K8 per day (3{\texttimes}109 colony former units/day), and the control group will receive a daily placebo capsule consisting of maltodextrin. A sample size of 314 volunteers was calculated. Volunteers must meet the following inclusion criteria: older than 20 years and active health personnel caring for patients with COVID-19, including all professionals such as medical doctors, nurses, and caretakers at the 2 referral hospitals that treat patients with COVID-19. The main outcome of the clinical trial will be the incidence of symptomatic infection by SARS-CoV-2 in personnel who care for patients with suspected or confirmed COVID-19. Results: The study had to be extended to the 2 referral hospitals that treat patients with COVID-19 in the province of Granada (Andalusia, Spain); Hospital San Cecilio and Hospital Virgen de las Nieves. A total of 255 individuals met the inclusion criteria and were randomly assigned to one of the 2 groups. Conclusions: The results of this randomized controlled trial will provide valuable information regarding the administration of L coryniformis K8 against COVID-19, including whether there are fewer infectious processes due to this virus or, in case of occurrence, whether the disease is milder in participants taking the probiotic strain. Trial Registration: ClinicalTrials.gov NCT04366180; http://www.clinicaltrials.gov/ct2/show/NCT04366180 International Registered Report Identifier (IRRID): RR1-10.2196/37857 ", doi="10.2196/37857", url="https://www.researchprotocols.org/2023/1/e37857", url="http://www.ncbi.nlm.nih.gov/pubmed/37285326" } @Article{info:doi/10.2196/46357, author="Latorre, Eligado Angelica Anne and Nakamura, Keiko and Seino, Kaoruko and Hasegawa, Takanori", title="Vector Autoregression for Forecasting the Number of COVID-19 Cases and Analyzing Behavioral Indicators in the Philippines: Ecologic Time-Trend Study", journal="JMIR Form Res", year="2023", month="Jun", day="27", volume="7", pages="e46357", keywords="COVID-19", keywords="forecasting", keywords="interest by the general public", keywords="mobility", keywords="surveillance", keywords="vector autoregression", abstract="Background: Traditional surveillance systems rely on routine collection of data. The inherent delay in retrieval and analysis of data leads to reactionary rather than preventive measures. Forecasting and analysis of behavior-related data can supplement the information from traditional surveillance systems. Objective: We assessed the use of behavioral indicators, such as the general public's interest in the risk of contracting SARS-CoV-2 and changes in their mobility, in building a vector autoregression model for forecasting and analysis of the relationships of these indicators with the number of COVID-19 cases in the National Capital Region. Methods: An etiologic, time-trend, ecologic study design was used to forecast the daily number of cases in 3 periods during the resurgence of COVID-19. We determined the lag length by combining knowledge on the epidemiology of SARS-CoV-2 and information criteria measures. We fitted 2 models to the training data set and computed their out-of-sample forecasts. Model 1 contains changes in mobility and number of cases with a dummy variable for the day of the week, while model 2 also includes the general public's interest. The forecast accuracy of the models was compared using mean absolute percentage error. Granger causality test was performed to determine whether changes in mobility and public's interest improved the prediction of cases. We tested the assumptions of the model through the Augmented Dickey-Fuller test, Lagrange multiplier test, and assessment of the moduli of eigenvalues. Results: A vector autoregression (8) model was fitted to the training data as the information criteria measures suggest the appropriateness of 8. Both models generated forecasts with similar trends to the actual number of cases during the forecast period of August 11-18 and September 15-22. However, the difference in the performance of the 2 models became substantial from January 28 to February 4, as the accuracy of model 2 remained within reasonable limits (mean absolute percentage error [MAPE]=21.4\%) while model 1 became inaccurate (MAPE=74.2\%). The results of the Granger causality test suggest that the relationship of public interest with number of cases changed over time. During the forecast period of August 11-18, only change in mobility (P=.002) improved the forecasting of cases, while public interest was also found to Granger-cause the number of cases during September 15-22 (P=.001) and January 28 to February 4 (P=.003). Conclusions: To the best of our knowledge, this is the first study that forecasted the number of COVID-19 cases and explored the relationship of behavioral indicators with the number of COVID-19 cases in the Philippines. The resemblance of the forecasts from model 2 with the actual data suggests its potential in providing information about future contingencies. Granger causality also implies the importance of examining changes in mobility and public interest for surveillance purposes. ", doi="10.2196/46357", url="https://formative.jmir.org/2023/1/e46357", url="http://www.ncbi.nlm.nih.gov/pubmed/37368473" } @Article{info:doi/10.2196/42775, author="Verma, Neha and Buch, Bimal and Taralekar, Radha and Acharya, Soumyadipta", title="Diagnostic Concordance of Telemedicine as Compared With Face-to-Face Care in Primary Health Care Clinics in Rural India: Randomized Crossover Trial", journal="JMIR Form Res", year="2023", month="Jun", day="23", volume="7", pages="e42775", keywords="telemedicine", keywords="telehealth", keywords="eHealth", keywords="opensource", keywords="digital assistant", keywords="diagnostic concordance", keywords="COVID-19", keywords="primary care", keywords="rural health", keywords="teleconsultation", keywords="patient care", abstract="Background: With the COVID-19 pandemic, there was an increase and scaling up of provider-to-provider telemedicine programs that connect frontline health providers such as nurses and community health workers at primary care clinics with remote doctors at tertiary facilities to facilitate consultations for rural patients. Considering this new trend of increasing use of telemedicine, this study was conducted to generate evidence for patients, health providers, and policymakers to compare if provider-to-provider telemedicine-based care is equivalent to in-person care and is safe and acceptable in terms of diagnostic and treatment standards. Objective: This study aims to compare the diagnosis and treatment decisions from teleconsultations to those of in-person care in teleclinics in rural Gujarat. Methods: We conducted a diagnostic concordance study using a randomized crossover study design with 104 patients at 10 telemedicine primary care clinics. Patients reporting to 10 telemedicine primary care clinics were randomly assigned to first receive an in-person doctor consultation (59/104, 56.7\%) or to first receive a health worker--assisted telemedicine consultation (45/104, 43.3\%). The 2 groups were then switched, with the first group undergoing a telemedicine consultation following the in-person consultation and the second group receiving an in-person consultation after the teleconsultation. The in-person doctor and remote doctor were blinded to the diagnosis and management plan of the other. The diagnosis and treatment plan of in-person doctors was considered the gold standard. Results: We enrolled 104 patients reporting a range of primary health care issues into the study. We observed 74\% (77/104) diagnostic concordance and 79.8\% (83/104) concordance in the treatment plan between the in-person and remote doctors. No significant association was found between the diagnostic and treatment concordance and the order of the consultation (P=.65 and P=.81, respectively), the frontline health worker--doctor pair (both P=.93), the gender of the patient (both P>.99), or the mode of teleconsultation (synchronous vs asynchronous; P=.32 and P=.29, respectively), as evaluated using Fisher exact tests. A significant association was seen between the diagnostic and treatment concordance and the type of case (P=.004 and P=.03, respectively). The highest diagnostic concordance was seen in the management of hypertension (20/21, 95\% concordance; Cohen kappa=0.93) and diabetes (14/15, 93\% concordance; Cohen kappa=0.89). The lowest values were seen in cardiology (1/3, 33\%) and patients presenting with nonspecific symptoms (3/10, 30\%). The use of a digital assistant to facilitate the consultation resulted in increased adherence to evidence-based care protocols. Conclusions: The findings reflect that telemedicine can be a safe and acceptable alternative mode of care especially in remote rural settings when in-person care is not accessible. Telemedicine has advantages. for the potential gains for improved health care--seeking behavior for patients, reduced costs for the patient, and improved health system efficiency by reducing overcrowding at tertiary health facilities. ", doi="10.2196/42775", url="https://formative.jmir.org/2023/1/e42775", url="http://www.ncbi.nlm.nih.gov/pubmed/37130015" } @Article{info:doi/10.2196/43672, author="Montiel Ishino, Alejandro Francisco and Villalobos, Kevin and Williams, Faustine", title="COVID-19 Vaccination Among US-Born and Non--US-Born Residents of the United States From a Nationally Distributed Survey: Cross-sectional Study", journal="JMIR Form Res", year="2023", month="Jun", day="20", volume="7", pages="e43672", keywords="COVID-19", keywords="vaccination", keywords="nativity", keywords="health disparity", keywords="survey", keywords="sociodemographics", keywords="socioeconomics", keywords="pandemic", keywords="vaccine", keywords="US", keywords="USA", keywords="United States", keywords="birth", keywords="country", abstract="Background: Extended literature has demonstrated that COVID-19 vaccination is crucial for the health of all individuals, regardless of age. Research on vaccination status in the United States (US) among US-born and non--US-born residents is limited. Objective: The objective of our study was to examine COVID-19 vaccination during the pandemic among US-born and non--US-born people, while accounting for sociodemographic and socioeconomic factors gathered through a nationally distributed survey. Methods: A descriptive analysis was conducted on a comprehensive 116-item survey distributed between May 2021 and January 2022 across the US by self-reported COVID-19 vaccination and US/non-US birth status. For participants that responded that they were not vaccinated, we asked if they were ``not at all likely,'' ``slightly to moderately likely,'' or ``very to extremely likely'' to be vaccinated. Race and ethnicity were categorized as White, Black or African American, Asian, American Indian or Alaskan Native, Hawaiian or Pacific Islander, African, Middle Eastern, and multiracial or multiethnic. Additional sociodemographic and socioeconomic variables included gender, sexual orientation, age group, annual household income, educational attainment, and employment status. Results: The majority of the sample, regardless of whether they were US-born or non--US-born, reported being vaccinated (3639/5404, 67.34\%). The US-born participants with the highest proportion of COVID-19 vaccination self-identified as White (1431/2753, 51.98\%), while the highest proportion of vaccination among non--US-born participants was found among participants who self-identified as Hispanic/Latino (310/886, 34.99\%). Comparing US-born and non--US-born participants showed that among those who were not vaccinated, the highest self-reported sociodemographic characteristics by proportion were similar between the groups, and included identifying as a woman, being straight or heterosexual, being aged 18 to 35 years, having an annual household income <\$25,000, and being unemployed or taking part in nontraditional work. Among the 32.66\% (1765/5404) of participants that reported not being vaccinated, 45.16\% (797/1765) stated that they were not at all likely to seek vaccination. Examining US/non--US birth status and the likelihood to be vaccinated for COVID-19 among nonvaccinated participants revealed that the highest proportions of both US-born and non--US-born participants reported being not at all likely to seek vaccination. Non--US-born participants, however, were almost proportionally distributed in their likelihood to seek vaccination; they reported to be ``very to extremely likely'' to vaccinate (112/356, 31.46\%); compared to 19.45\% (274/1409) of US-born individuals reporting the same. Conclusions: Our study highlights the need to further explore factors that can increase the likelihood of seeking vaccination among underrepresented and hard-to-reach populations, with a particular focus on tailoring interventions for US-born individuals. For instance, non--US-born individuals were most likely to vaccinate when reporting COVID-19 nonvaccination than US-born individuals. These findings will aid in identifying points of intervention for vaccine hesitancy and promoting vaccine adoption during current and future pandemics. ", doi="10.2196/43672", url="https://formative.jmir.org/2023/1/e43672", url="http://www.ncbi.nlm.nih.gov/pubmed/37097810" } @Article{info:doi/10.2196/41479, author="Hengst, M. Tessi and Lechner, Lilian and van der Laan, Nynke Laura and Hommersom, Arjen and Dohmen, Daan and Hooft, Lotty and Metting, Esther and Ebbers, Wolfgang and Bolman, W. Catherine A.", title="The Adoption of a COVID-19 Contact-Tracing App: Cluster Analysis", journal="JMIR Form Res", year="2023", month="Jun", day="20", volume="7", pages="e41479", keywords="contact-tracing app", keywords="CTA", keywords="CoronaMelder", keywords="intention", keywords="adoption", keywords="cluster analysis", keywords="application", keywords="psychosocial", keywords="data", keywords="risk", keywords="societal", keywords="social norm", keywords="norm", keywords="COVID-19", keywords="adaptation", keywords="acceptance", keywords="mHealth", keywords="mobile health", abstract="Background: During the COVID-19 pandemic, there was limited adoption of contact-tracing apps (CTAs). Adoption was particularly low among vulnerable people (eg, people with a low socioeconomic position or of older age), while this part of the population tends to have lesser access to information and communication technology and is more vulnerable to the COVID-19 virus. Objective: This study aims to understand the cause of this lagged adoption of CTAs in order to facilitate adoption and find indications to make public health apps more accessible and reduce health disparities. Methods: Because several psychosocial variables were found to be predictive of CTA adoption, data from the Dutch CTA CoronaMelder (CM) were analyzed using cluster analysis. We examined whether subgroups could be formed based on 6 psychosocial perceptions (ie, trust in the government, beliefs about personal data, social norms, perceived personal and societal benefits, risk perceptions, and self-efficacy) of (non)users concerning CM in order to examine how these clusters differ from each other and what factors are predictive of the intention to use a CTA and the adoption of a CTA. The intention to use and the adoption of CM were examined based on longitudinal data consisting of 2 time frames in October/November 2020 (N=1900) and December 2020 (N=1594). The clusters were described by demographics, intention, and adoption accordingly. Moreover, we examined whether the clusters and the variables that were found to influence the adoption of CTAs, such as health literacy, were predictive of the intention to use and the adoption of the CM app. Results: The final 5-cluster solution based on the data of wave 1 contained significantly different clusters. In wave 1, respondents in the clusters with positive perceptions (ie, beneficial psychosocial variables for adoption of a CTA) about the CM app were older (P<.001), had a higher education level (P<.001), and had higher intention (P<.001) and adoption (P<.001) rates than those in the clusters with negative perceptions. In wave 2, the intention to use and adoption were predicted by the clusters. The intention to use CM in wave 2 was also predicted using the adoption measured in wave 1 (P<.001, $\beta$=--2.904). Adoption in wave 2 was predicted by age (P=.022, exp(B)=1.171), the intention to use in wave 1 (P<.001, exp(B)=1.770), and adoption in wave 1 (P<.001, exp(B)=0.043). Conclusions: The 5 clusters, as well as age and previous behavior, were predictive of the intention to use and the adoption of the CM app. Through the distinguishable clusters, insight was gained into the profiles of CM (non)intenders and (non)adopters. Trial Registration: OSF Registries osf.io/cq742; https://osf.io/cq742 ", doi="10.2196/41479", url="https://formative.jmir.org/2023/1/e41479", url="http://www.ncbi.nlm.nih.gov/pubmed/37338969" } @Article{info:doi/10.2196/42740, author="Islam, Ashraful and Chaudhry, Moalla Beenish", title="Design Validation of a Relational Agent by COVID-19 Patients: Mixed Methods Study", journal="JMIR Hum Factors", year="2023", month="Jun", day="8", volume="10", pages="e42740", keywords="COVID-19", keywords="relational agent", keywords="mHealth", keywords="design validation", keywords="health care", keywords="chatbot", keywords="digital health intervention", keywords="health care professional", keywords="heuristic", keywords="health promotion", keywords="mental well-being", keywords="design validation survey", keywords="self-isolation", abstract="Background: Relational agents (RAs) have shown effectiveness in various health interventions with and without doctors and hospital facilities. In situations such as a pandemic like the COVID-19 pandemic when health care professionals (HCPs) and facilities are unable to cope with increased demands, RAs may play a major role in ameliorating the situation. However, they have not been well explored in this domain. Objective: This study aimed to design a prototypical RA in collaboration with COVID-19 patients and HCPs and test it with the potential users, for its ability to deliver services during a pandemic. Methods: The RA was designed and developed in collaboration with people with COVID-19 (n=21) and 2 groups of HCPs (n=19 and n=16, respectively) to aid COVID-19 patients at various stages by performing 4 main tasks: testing guidance, support during self-isolation, handling emergency situations, and promoting postrecovery mental well-being. A design validation survey was conducted with 98 individuals to evaluate the usability of the prototype using the System Usability Scale (SUS), and the participants provided feedback on the design. In addition, the RA's usefulness and acceptability were rated by the participants using Likert scales. Results: In the design validation survey, the prototypical RA received an average SUS score of 58.82. Moreover, 90\% (88/98) of participants perceived it to be helpful, and 69\% (68/98) of participants accepted it as a viable alternative to HCPs. The prototypical RA received favorable feedback from the participants, and they were inclined to accept it as an alternative to HCPs in non-life-threatening scenarios despite the usability rating falling below the acceptable threshold. Conclusions: Based on participants' feedback, we recommend further development of the RA with improved automation and emotional support, ability to provide information, tracking, and specific recommendations. ", doi="10.2196/42740", url="https://humanfactors.jmir.org/2023/1/e42740", url="http://www.ncbi.nlm.nih.gov/pubmed/36350760" } @Article{info:doi/10.2196/46643, author="Muhajarine, Nazeem and Dixon, James and Dyck, Erika and Clifford, Jim and Chass{\'e}, Patrick and Gupta, Datta Suvadra and Christopherson-Cote, Colleen and ", title="Capturing and Documenting the Wider Health Impacts of the COVID-19 Pandemic Through the Remember Rebuild Saskatchewan Initiative: Protocol for a Mixed Methods Interdisciplinary Project", journal="JMIR Res Protoc", year="2023", month="Jun", day="6", volume="12", pages="e46643", keywords="COVID-19", keywords="Saskatchewan, Canada", keywords="mixed methods", keywords="interdisciplinary", keywords="mental health and substance use", keywords="food insecurity", keywords="housing precarity", keywords="archive", abstract="Background: In the Canadian province of Saskatchewan, the global COVID-19 pandemic appeared amidst existing social health challenges in food insecurity, housing precarity and homelessness, poor mental health, and substance misuse. These chronic features intersected with the pandemic, producing a moment in time when the urgency of COVID-19 brought attention to underlying shortcomings in public health services. Objective: The objectives of the program of research are (1) to identify and measure relationships between the pandemic and wider health and social impacts, namely, food insecurity, housing precarity and homelessness, and mental health and substance use in Saskatchewan, and (2) to create an oral history of the pandemic in Saskatchewan in an accessible digital public archive. Methods: We are using a mixed methods approach to identify the impacts of the pandemic on specific equity-seeking groups and areas of social health concern by developing cross-sectional population-based surveys and producing results based on statistical analysis. We augmented the quantitative analysis by conducting qualitative interviews and oral histories to generate more granular details of people's experiences of the pandemic. We are focusing on frontline workers, other service providers, and individuals within equity-seeking groups. We are capturing digital evidence and social media posts; we are collecting and organizing key threads using a free open-source research tool, Zotero, to trace the digital evidence of the pandemic in Saskatchewan. This study is approved by the Research Ethics Board at the University of Saskatchewan (Beh-1945). Results: Funding for this program of research was received in March and April 2022. Survey data were collected between July and November 2022. The collection of oral histories began in June 2022 and concluded in March 2023. In total, 30 oral histories have been collected at the time of this writing. Qualitative interviews began in April 2022 and will continue until March 2024. Survey analysis began in January 2023, and results are expected to be published in mid-2023. All data and stories collected in this work are archived for preservation and freely accessible on the Remember Rebuild Saskatchewan project's website. We will share results in academic journals and conferences, town halls and community gatherings, social and digital media reports, and through collaborative exhibitions with public library systems. Conclusions: The pandemic's ephemeral nature poses a risk of us ``forgetting'' this moment and the attendant social inequities. These challenges inspired a novel fusion among health researchers, historians, librarians, and service providers in the creation of the Remember Rebuild Saskatchewan project, which focuses on preserving the legacy of the pandemic and capturing data to support an equitable recovery in Saskatchewan. International Registered Report Identifier (IRRID): DERR1-10.2196/46643 ", doi="10.2196/46643", url="https://www.researchprotocols.org/2023/1/e46643", url="http://www.ncbi.nlm.nih.gov/pubmed/37279056" } @Article{info:doi/10.2196/44551, author="Frick, Ulrich and Sipar, Dilan and B{\"u}cheler, Leonie and Haug, Fabian and Haug, Julian and Almeqbaali, Mohammed Khalifa and Pryss, R{\"u}diger and Rosner, Rita and Comtesse, Hannah", title="A Mobile-Based Preventive Intervention for Young, Arabic-Speaking Asylum Seekers During the COVID-19 Pandemic in Germany: Design and Implementation", journal="JMIR Form Res", year="2023", month="Jun", day="5", volume="7", pages="e44551", keywords="prevention", keywords="COVID-19", keywords="refugees", keywords="asylum seekers", keywords="adolescents", keywords="feasibility", keywords="behavior planning", keywords="vaccination", keywords="mobile phone", abstract="Background: Most individuals seeking asylum in Germany live in collective housing and are thus exposed to a higher risk of contagion during the COVID-19 pandemic. Objective: In this study, we aimed to test the feasibility and efficacy of a culture-sensitive approach combining mobile app--based interventions and a face-to-face group intervention to improve knowledge about COVID-19 and promote vaccination readiness among collectively accommodated Arabic-speaking adolescents and young adults. Methods: We developed a mobile app that consisted of short video clips to explain the biological basis of COVID-19, demonstrate behavior to prevent transmission, and combat misconceptions and myths about vaccination. The explanations were provided in a YouTube-like interview setting by a native Arabic-speaking physician. Elements of gamification (quizzes and rewards for solving the test items) were also used. Consecutive videos and quizzes were presented over an intervention period of 6 weeks, and the group intervention was scheduled as an add-on for half of the participants in week 6. The manual of the group intervention was designed to provide actual behavioral planning based on the health action process approach. Sociodemographic information, mental health status, knowledge about COVID-19, and available vaccines were assessed using questionnaire-based interviews at baseline and after 6 weeks. Interpreters assisted with the interviews in all cases. Results: Enrollment in the study proved to be very challenging. In addition, owing to tightened contact restrictions, face-to-face group interventions could not be conducted as planned. A total of 88 participants from 8 collective housing institutions were included in the study. A total of 65 participants completed the full-intake interview. Most participants (50/65, 77\%) had already been vaccinated at study enrollment. They also claimed to comply with preventive measures to a very high extent (eg, ``always wearing masks'' was indicated by 43/65, 66\% of participants), but practicing behavior that was not considered as effective against COVID-19 transmission was also frequently reported as a preventive measure (eg, mouth rinsing). By contrast, factual knowledge of COVID-19 was limited. Preoccupation with the information materials presented in the app steeply declined after study enrollment (eg, 12/61, 20\% of participants watched the videos scheduled for week 3). Of the 61 participants, only 18 (30\%) participants could be reached for the follow-up interviews. Their COVID-19 knowledge did not increase after the intervention period (P=.56). Conclusions: The results indicated that vaccine uptake was high and seemed to depend on organizational determinants for the target group. The current mobile app--based intervention demonstrated low feasibility, which might have been related to various obstacles faced during the delivery. Therefore, in the case of future pandemics, transmission prevention in a specific target group should rely more on structural aspects rather than sophisticated psychological interventions. ", doi="10.2196/44551", url="https://formative.jmir.org/2023/1/e44551", url="http://www.ncbi.nlm.nih.gov/pubmed/37134019" } @Article{info:doi/10.2196/38323, author="Fahim, Christine and Cooper, Jeanette and Theivendrampillai, Suvabna and Pham, Ba' and Straus, Sharon", title="Ontarians' Perceptions of Public Health Communications and Misinformation During the COVID-19 Pandemic: Survey Study", journal="JMIR Form Res", year="2023", month="Jun", day="2", volume="7", pages="e38323", keywords="misinformation", keywords="information seeking", keywords="COVID-19", keywords="trust", keywords="dissemination", keywords="health communication", keywords="risk", keywords="communication", keywords="policy maker", keywords="transmission", keywords="health emergency", keywords="age", keywords="gender", keywords="survey", abstract="Background: Clear, accurate, and transparent risk communication is critical to providing policy makers and the public with directions to effectively implement public health strategies during a health emergency. Objective: We aimed to explore the public's preferred sources of obtaining COVID-19 information, perceptions on the prevalence and drivers of misinformation during the pandemic, and suggestions to optimize health communications during future public health emergencies. Methods: We administered a web-based survey that included Likert scale, multiple choice and open-ended response questions to residents of Ontario, Canada. We aimed to recruit a sample that reflected population diversity with respect to age and gender. Data were collected between June 10, 2020, and December 31, 2020, and were analyzed using descriptive statistics; open-ended data were analyzed using content analysis. Subgroup analyses to explore perceptions by age and gender were conducted using ordinal regression. Results: A total of 1823 individuals participated in the survey (n=990, 54\% women; n=703, 39\% men; n=982, 54\% aged 18-40 years; n=518, 28\% aged 41-60 years; and n=215, 12\% aged ?61 years). Participants most commonly obtained COVID-19 information from local television news (n=1118, 61\%) followed by social media (n=938, 51\%), national or international television news (n=888, 49\%), and friends and family (n=835, 46\%). Approximately 55\% (n=1010) of the participants believed they had encountered COVID-19--related misinformation; 70\% (n=1284) of the participants reported high levels of trust in health authority websites and health care providers; 66\% (n=1211) reported high levels of trust in health ministers or public health organizations. Sources perceived to be less trustworthy included friends and family, talk radio, social media, as well as blogs and opinion websites. Men were more likely to report encountering misinformation and to trust friends or family (odds ratio [OR] 1.49, 95\% CI 1.24-1.79) and blogs or opinion websites (OR 1.24, 95\% CI 1.03-1.50), compared to women. Compared to those aged 18-40 years, participants aged ?41years were more likely to trust all assessed information sources, with the exception of web-based media sources, and less likely to report encountering misinformation. Of those surveyed, 58\% (n=1053) had challenges identifying or appraising COVID-19 information. Conclusions: Over half of our participants perceived that they had encountered COVID-19 misinformation, and 58\% had challenges identifying or appraising COVID-19 information. Gender and age differences in perceptions of misinformation and trust in information sources were observed. Future research to confirm the validity of these perceptions and to explore information-seeking patterns by population subgroups may provide useful insights on how to optimize health communication during public health emergencies. ", doi="10.2196/38323", url="https://formative.jmir.org/2023/1/e38323", url="http://www.ncbi.nlm.nih.gov/pubmed/37159394" } @Article{info:doi/10.2196/47008, author="Officer, N. Tara and Tait, Marika and McBride-Henry, Karen and Burnet, Laura and Werkmeister, J. Benjamin", title="Mental Health Client Experiences of Telehealth in Aotearoa New Zealand During the COVID-19 Pandemic: Lessons and Implications", journal="JMIR Form Res", year="2023", month="May", day="26", volume="7", pages="e47008", keywords="telehealth", keywords="mental health service delivery", keywords="COVID-19", keywords="Aotearoa New Zealand", keywords="clients", keywords="patient-centered care", keywords="telemedicine", keywords="mental health", keywords="experience", keywords="satisfaction", keywords="perception", keywords="perspective", keywords="attitude", abstract="Background: The COVID-19 pandemic and consequent lockdowns disrupted mental health service delivery worldwide, accelerating the adoption of telehealth services to provide care continuity. Telehealth-based research largely highlights the value of this service delivery method for a range of mental health conditions. However, only limited research exists exploring client perspectives of mental health services delivered via telehealth during the pandemic. Objective: This study aimed to increase understanding of the perspectives of mental health clients around services provided via telehealth over the 2020 COVID-19 lockdown in Aotearoa New Zealand. Methods: Interpretive description methodology underpinned this qualitative inquiry. Semistructured interviews were conducted with 21 individuals (15 clients and 7 support people; 1 person was both a client and support person) to explore their experiences of outpatient mental health care delivered via telehealth during the COVID-19 pandemic in Aotearoa New Zealand. A thematic analysis approach supported by field notes was used to analyze interview transcripts. Results: The findings reveal that mental health services delivered via telehealth differed from those provided in person and led some participants to feel they need to manage their own care more actively. Participants highlighted several factors affecting their telehealth journey. These included the importance of maintaining and building relationships with clinicians, the creation of safe spaces within client and clinician home environments, and clinician readiness in facilitating care for clients and their support people. Participants noted weaknesses in the ability of clients and clinicians to discern nonverbal cues during telehealth conversations. Participants also emphasized that telehealth was a viable option for service delivery but that the reason for telehealth consultations and the technicalities of service delivery needed to be addressed. Conclusions: Successful implementation requires ensuring solid relationship foundations between clients and clinicians. To safeguard minimum standards in delivering telehealth-based care, health professionals must ensure that the intent behind telehealth appointments is clearly articulated and documented for each person. In turn, health systems must ensure that health professionals have access to training and professional guidance to deliver effective telehealth consultations. Future research should aim to identify how therapeutic engagement with mental health services has changed, following a return to usual service delivery processes. ", doi="10.2196/47008", url="https://formative.jmir.org/2023/1/e47008", url="http://www.ncbi.nlm.nih.gov/pubmed/37234041" } @Article{info:doi/10.2196/46230, author="Smail, J. Emily and Livingston, Torie and Wolach, Adam and Cenko, Erta and Kaufmann, N. Christopher and Manini, M. Todd", title="Media Consumption and COVID-19--Related Precautionary Behaviors During the Early Pandemic: Survey Study of Older Adults", journal="JMIR Form Res", year="2023", month="May", day="22", volume="7", pages="e46230", keywords="health communication", keywords="COVID-19", keywords="older adult", keywords="precautionary behavior change", keywords="behavior change", keywords="behavior", keywords="precaution", keywords="awareness", keywords="behavior modification", keywords="media", keywords="news", keywords="association", abstract="Background: During the COVID-19 pandemic, media sources dedicated significant time and resources to improve knowledge of COVID-19 precautionary behaviors (eg, wearing a mask). Many older adults report using the television, radio, print newspapers, or web-based sources to get information on political news, yet little is known about whether consuming news in the early phase of the pandemic led to behavior change, particularly in older adults. Objective: The goals of this study were to determine (1) whether dosage of news consumption on the COVID-19 pandemic was associated with COVID-19 precautionary behaviors; (2) whether being an ever-user of social media was associated with engagement in COVID-19 precautionary behaviors; and (3) among social media users, whether change in social media use during the early stages of the pandemic was associated with engagement in COVID-19 precautionary behaviors. Methods: Data were obtained from a University of Florida--administered study conducted in May and June of 2020. Linear regression models were used to assess the association between traditional news and social media use on COVID-19 precautionary behaviors (eg, mask wearing, hand washing, and social distancing behaviors). Analyses were adjusted for demographic characteristics, including age, sex, marital status, and education level. Results: In a sample of 1082 older adults (mean age 73, IQR 68-78 years; 615/1082, 56.8\% female), reporting 0 and <1 hour per day of media consumption, relative to >3 hours per day, was associated with lower engagement in COVID-19 precautionary behaviors in models adjusted for demographic characteristics ($\beta$=--2.00; P<.001 and $\beta$=--.41; P=.01, respectively). In addition, increasing social media use (relative to unchanged use) was associated with engagement in more COVID-19 precautionary behaviors ($\beta$=.70, P<.001). No associations were found between being an ever-user of social media and engaging in COVID-19 precautionary behaviors. Conclusions: The results demonstrated an association between higher media consumption and greater engagement in COVID-19 precautionary behaviors in older adults. These findings suggest that media can be effectively used as a public health tool for communication of prevention strategies and best practices during future health threats, even among populations who are historically less engaged in certain types of media. ", doi="10.2196/46230", url="https://formative.jmir.org/2023/1/e46230", url="http://www.ncbi.nlm.nih.gov/pubmed/37213166" } @Article{info:doi/10.2196/44592, author="Chantziara, Sofia and Craddock, J. Ian and Mccallum, H. Claire and Brigden, C. Amberly L.", title="Views and Needs of Students, Parents, and Teachers on Closed-Circuit Television, Proximity Trackers, and Access Cards to Facilitate COVID-19 Contact Tracing in Schools: Thematic Analysis of Focus Groups and Interviews", journal="JMIR Form Res", year="2023", month="May", day="22", volume="7", pages="e44592", keywords="digital contact tracing", keywords="school", keywords="student", keywords="teacher", keywords="focus group", keywords="proximity tracking", keywords="Unified Theory of Technology and Acceptance", keywords="UTAUT", keywords="acceptance", keywords="adoption", keywords="CCTV", keywords="COVID-19", keywords="contact tracing", keywords="public health intervention", keywords="digital health intervention", keywords="implementation", keywords="digital tool", keywords="technology acceptance", keywords="privacy", keywords="surveillance technology", keywords="surveillance", abstract="Background: Contact tracing is considered a key measure in preventing the spread of infectious diseases. Governments around the world adopted contact tracing to limit the spread of COVID-19 in schools. Contact tracing tools utilizing digital technology (eg, GPS chips, Bluetooth radios) can increase efficiency compared to manual methods. However, these technologies can introduce certain privacy challenges in relation to retention, tracking, and the using and sharing of personal data, and little is known about their applicability in schools. Objective: This is the second of two studies exploring the potential of digital tools and systems to help schools deal with the practical challenges of preventing and coping with an outbreak of COVID-19. The aim was to explore the views, needs, and concerns among secondary school stakeholders (parents, teachers, pupils) regarding the implementation of three digital tools for contact tracing: access cards, proximity tracking, and closed-circuit television (CCTV). Methods: Focus groups and interviews were conducted with secondary school students, parents, and teachers. The topic guide was informed by the Unified Theory of Technology and Acceptance. Data-driven and theory-driven approaches were combined to identify themes and subthemes. Results: We recruited 22 participants. Findings showed that there is no single solution that is suitable for all schools, with each technology option having advantages and limitations. Existing school infrastructure (eg, CCTV and smart/access cards technology) and the geography of each school would determine which tools would be optimal for a particular school. Concerns regarding the cost of installing and maintaining equipment were prominent among all groups. Parents and teachers worried about how the application of these solutions will affect students' right to privacy. Parents also appeared not to have adequate knowledge of the surveillance technologies already available in schools (eg, CCTV). Students, who were mostly aware of the presence of surveillance technologies, were less concerned about any potential threats to their privacy, while they wanted reassurances that any solutions would be used for their intended purposes. Conclusions: Findings revealed that there is not one tool that would be suitable for every school and the context will determine which tool would be appropriate. This study highlights important ethical issues such as privacy concerns, balancing invasions of privacy against potential benefits, transparency of communication around surveillance technology and data use, and processes of consent. These issues need to be carefully considered when implementing contact tracing technologies in school settings. Communication, transparency, and consent within the school community could lead to acceptance and engagement with the new tools. ", doi="10.2196/44592", url="https://formative.jmir.org/2023/1/e44592", url="http://www.ncbi.nlm.nih.gov/pubmed/36939667" } @Article{info:doi/10.2196/40669, author="Alaqra, Sarah Ala and Khumalo, C. Akhona", title="Handling Public Well-being During the COVID-19 Crisis: Empirical Study With Representatives From Municipalities in Sweden", journal="JMIR Form Res", year="2023", month="May", day="12", volume="7", pages="e40669", keywords="COVID-19", keywords="Sweden", keywords="government", keywords="well-being", keywords="public health", keywords="information and communications technology", keywords="recreational activities", abstract="Background: COVID-19 has had a significant impact on the public's health and well-being due to infections and restrictions imposed during the crisis. Recreational activities are important for the public's well-being; however, the public's safety from the COVID-19 virus is the top priority. Sweden, a country with a decentralized public health and welfare system, relied on less stringent approaches for handling the crisis. The limited restrictions in Sweden allowed recreational activities to take place despite the pandemic, which could be attributed to considerations for the public's well-being. Objective: The objective of this study was to investigate municipal approaches for handling and supporting recreational activities during the COVID-19 crisis. Methods: We conducted an empirical study (qualitative and quantitative), using an online survey for data collection, with 23 participants. They were representatives holding mostly managerial roles in 18 distinct municipalities (18 counties). A thematic analysis was conducted to analyze open-ended responses, and descriptive statistics were used to summarize the closed-ended responses. Results: In this study, we report on the status of municipalities during the COVID-19 pandemic. The highlighted results showed a significant impact on the municipalities as a result of COVID-19, where 78\% (18/23) of participants stated significant changes due to the pandemic. Moreover, 91\% (21/23) indicated efforts and approaches for supporting recreational activities during COVID-19. Following national guidelines for the public's health and safety was indicated by 78\% (18/23) of participants. Information and communications technology (ICT) was considered significant for dealing with COVID-19 according to 87\% (20/23) of participants. Our qualitative results further showed details of the public's health and safety considerations, the efforts to support recreational activities particularly for youth, and the role and requirements of ICT. Challenges relating to the usability of ICT were also highlighted. Conclusions: Despite the critique of Sweden's lenient strategy for handling the COVID-19 crisis, our results showed significant considerations for the public's safety and well-being by the municipalities (regional and local levels) in this study. The Swedish approach to handling the crisis involved trusting the public with safety guidelines in addition to efforts for the public's safety, supporting the public's well-being with approaches for maintaining recreational activities, and giving special care to the youth. Despite having technological solutions in place, challenges in using digital solutions and requirements for future development were noted. ", doi="10.2196/40669", url="https://formative.jmir.org/2023/1/e40669", url="http://www.ncbi.nlm.nih.gov/pubmed/37053098" } @Article{info:doi/10.2196/38959, author="Tham, Cong Xiang and Whitton, Clare and M{\"u}ller-Riemenschneider, Falk and Petrunoff, Alexander Nicholas", title="Young Adults' Use of Mobile Food Delivery Apps and the Potential Impacts on Diet During the COVID-19 Pandemic: Mixed Methods Study", journal="JMIR Form Res", year="2023", month="May", day="9", volume="7", pages="e38959", keywords="young adults", keywords="food delivery", keywords="mobile app", keywords="COVID-19", keywords="diet", keywords="sugar-sweetened beverages", keywords="mixed methods", keywords="fruits", keywords="vegetables", keywords="physical activity", keywords="mobile phone", abstract="Background: A poor diet contributes substantially to the development of noncommunicable diseases. In Singapore, it is recommended to consume at least 2 servings of fruits and vegetables daily to reduce the risk of developing noncommunicable diseases. However, the adherence rate among young adults is low. The COVID-19 pandemic has led to frequent users of mobile food delivery apps (MFDAs) adopting unhealthy eating habits, including high consumption of sugar-sweetened beverages, making it crucial to gain a deeper understanding of the underlying factors driving their use patterns. Objective: We aimed to examine the use patterns of MFDAs among young adults during the COVID-19 pandemic; investigate the association between MFDA use and sociodemographic factors, dietary factors, and BMI; identify the underlying reasons for the observed use patterns of MFDAs among users; and compare the influences of MFDA use between frequent and infrequent users. Methods: A sequential mixed methods design was used involving a web-based survey and in-depth interviews with a subset of respondents. Poisson regression and thematic analysis were used to analyze the quantitative and qualitative data, respectively. Results: The quantitative results revealed that 41.7\% (150/360) of participants reported using MFDAs frequently, defined as at least once a week. Although not substantial, the study found that frequent users were less likely to consume 2 servings of vegetables per day and more likely to drink sugar-sweetened beverages. Nineteen individuals who had participated in the quantitative component were selected for and completed the interviews. Qualitative analysis identified 4 primary themes: deliberations about other sources of meals versus meals purchased via MFDAs, convenience is vital, preference for unhealthy meals ordered from MFDAs most of the time, and cost is king. Before making any purchase, MFDA users consider all these themes at the same time, with cost being the most important influential factor. A conceptual framework based on these themes was presented. Lack of culinary skills and COVID-19 restrictions were also found to influence frequent use. Conclusions: This study suggests that interventions should focus on promoting healthy dietary patterns in young adults who frequently use MFDAs. Teaching cooking skills, especially among young male individuals, and time management skills could be useful to reduce reliance on MFDAs. This study highlights the need for public health policies that make healthy food options more affordable and accessible. Given the unintended changes in behavior during the pandemic, such as reduced physical activity, sedentary behavior, and altered eating patterns, it is essential to consider behavior change in interventions aimed at promoting healthy lifestyles among young adults who frequently use MFDAs. Further research is needed to evaluate the effectiveness of interventions during COVID-19 restrictions and assess the impact of the post--COVID-19 new normal on dietary patterns and physical activity levels. ", doi="10.2196/38959", url="https://formative.jmir.org/2023/1/e38959", url="http://www.ncbi.nlm.nih.gov/pubmed/37018540" } @Article{info:doi/10.2196/41148, author="Trzebi?ski, Wojciech and Claessens, Toni and Buhmann, Jeska and De Waele, Aur{\'e}lie and Hendrickx, Greet and Van Damme, Pierre and Daelemans, Walter and Poels, Karolien", title="The Effects of Expressing Empathy/Autonomy Support Using a COVID-19 Vaccination Chatbot: Experimental Study in a Sample of Belgian Adults", journal="JMIR Form Res", year="2023", month="May", day="8", volume="7", pages="e41148", keywords="COVID-19", keywords="vaccinations", keywords="chatbot", keywords="empathy", keywords="autonomy support", keywords="perceived user autonomy", keywords="chatbot patronage intention", keywords="vaccination intention", keywords="conversational agent", keywords="public health", keywords="digital health intervention", keywords="health promotion", abstract="Background: Chatbots are increasingly used to support COVID-19 vaccination programs. Their persuasiveness may depend on the conversation-related context. Objective: This study aims to investigate the moderating role of the conversation quality and chatbot expertise cues in the effects of expressing empathy/autonomy support using COVID-19 vaccination chatbots. Methods: This experiment with 196 Dutch-speaking adults living in Belgium, who engaged in a conversation with a chatbot providing vaccination information, used a 2 (empathy/autonomy support expression: present vs absent) {\texttimes} 2 (chatbot expertise cues: expert endorser vs layperson endorser) between-subject design. Chatbot conversation quality was assessed through actual conversation logs. Perceived user autonomy (PUA), chatbot patronage intention (CPI), and vaccination intention shift (VIS) were measured after the conversation, coded from 1 to 5 (PUA, CPI) and from --5 to 5 (VIS). Results: There was a negative interaction effect of chatbot empathy/autonomy support expression and conversation fallback (CF; the percentage of chatbot answers ``I do not understand'' in a conversation) on PUA (PROCESS macro, model 1, B=--3.358, SE 1.235, t186=2.718, P=.007). Specifically, empathy/autonomy support expression had a more negative effect on PUA when the CF was higher (conditional effect of empathy/autonomy support expression at the CF level of +1SD: B=--.405, SE 0.158, t186=2.564, P=.011; conditional effects nonsignificant for the mean level: B=--0.103, SE 0.113, t186=0.914, P=.36; conditional effects nonsignificant for the --1SD level: B=0.031, SE=0.123, t186=0.252, P=.80). Moreover, an indirect effect of empathy/autonomy support expression on CPI via PUA was more negative when CF was higher (PROCESS macro, model 7, 5000 bootstrap samples, moderated mediation index=--3.676, BootSE 1.614, 95\% CI --6.697 to --0.102; conditional indirect effect at the CF level of +1SD: B=--0.443, BootSE 0.202, 95\% CI --0.809 to --0.005; conditional indirect effects nonsignificant for the mean level: B=--0.113, BootSE 0.124, 95\% CI --0.346 to 0.137; conditional indirect effects nonsignificant for the --1SD level: B=0.034, BootSE 0.132, 95\% CI --0.224 to 0.305). Indirect effects of empathy/autonomy support expression on VIS via PUA were marginally more negative when CF was higher. No effects of chatbot expertise cues were found. Conclusions: The findings suggest that expressing empathy/autonomy support using a chatbot may harm its evaluation and persuasiveness when the chatbot fails to answer its users' questions. The paper adds to the literature on vaccination chatbots by exploring the conditional effects of chatbot empathy/autonomy support expression. The results will guide policy makers and chatbot developers dealing with vaccination promotion in designing the way chatbots express their empathy and support for user autonomy. ", doi="10.2196/41148", url="https://formative.jmir.org/2023/1/e41148", url="http://www.ncbi.nlm.nih.gov/pubmed/37074978" } @Article{info:doi/10.2196/42966, author="Curran, R. Vernon and Hollett, Ann and Peddle, Emily", title="Patient Experiences With Virtual Care During the COVID-19 Pandemic: Phenomenological Focus Group Study", journal="JMIR Form Res", year="2023", month="May", day="1", volume="7", pages="e42966", keywords="virtual care", keywords="focus group", keywords="patients", keywords="patient education", keywords="qualitative study", keywords="patient experience", keywords="health care system", keywords="digital literacy", keywords="rural community", keywords="technology adoption", keywords="COVID-19", abstract="Background: Virtual care has expanded during the COVID-19 pandemic and enabled greater access and continuity of care for many patients. From a patient-oriented research perspective, understanding the patient experience with virtual care appointments is an important first step in identifying ways to better support patient use and satisfaction. Objective: The purpose of this qualitative study was (1) to explore patients' experiences and perspectives with the adoption and use of virtual care during COVID-19 in Newfoundland and Labrador, Canada, and (2) identify the education and informational needs of patients to inform future strategies for supporting patient use of virtual care. Methods: Using a phenomenological approach, we conducted a focus group interview with a purposive sample of patient representatives representing a cross-section of the population of the province of Newfoundland and Labrador. Five patient representatives were recruited from the Newfoundland and Labrador Support Patient Advisory Council and participated in the focus group. The focus group was conducted in February 2022 via videoconferencing technology. Using thematic analysis, we identified several recurrent themes that described respondents' experiences with the use of virtual care during COVID-19, as well as their perceptions of education and informational needs to support more effective patient use of virtual care. Results: Respondents felt that virtual care is a beneficial addition to the health care system, enabling greater convenience and access to health care services. Key barriers and challenges in adopting and using virtual care appear to primarily arise from patients' lack of knowledge, understanding, and familiarity with respect to virtual care. Cost, technological access, connectivity, and low digital literacy were challenges for some patients, particularly in rural communities and among older patient population. Patient education and support were critical and needed to be inclusive, easy to understand, and include information regarding privacy, security, consent, and the technology itself. The types of patient education experiences regarded as most helpful included peer support and knowledge sharing among patients themselves. Conclusions: Beyond the COVID-19 pandemic, virtual care will have a continuing role in enhancing the continuity of care for patients through more convenient access. The education and informational needs of patients are important considerations in promoting the adoption and use of virtual care. Key education and informational needs and strategies were identified to enable and empower patients with the knowledge, digital literacy skills, and support to effectively use virtual care. ", doi="10.2196/42966", url="https://formative.jmir.org/2023/1/e42966", url="http://www.ncbi.nlm.nih.gov/pubmed/37036827" } @Article{info:doi/10.2196/43498, author="Hickey, Grainne and Dunne, Claire and Maguire, Lauren and McCarthy, Niamh", title="An Exploration of Practitioners' Experiences of Delivering Digital Social Care Interventions to Children and Families During the COVID-19 Pandemic: Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Apr", day="28", volume="7", pages="e43498", keywords="digital social care", keywords="social care practice", keywords="children and families", keywords="COVID-19", keywords="mobile phone", abstract="Background: Digital technology is an increasing feature of social care practice, and its use has accelerated greatly in response to the COVID-19 pandemic. Objective: This study aimed to assess social care practitioners' experiences of delivering digital interventions to vulnerable children and families during the pandemic. Methods: A mixed methods study combining survey and qualitative research was conducted. In total, 102 social care practitioners working in the Republic of Ireland who delivered a range of digital social care support took part in a web-based survey. This survey captured practitioners' engagement and experiences of delivering digital social care interventions to children and families as well as training and capacity building needs. Subsequently, 19 focus groups with 106 social care practitioners working with children and families were also conducted. These focus groups were directed by a topic guide and explored in more depth practitioners' perceptions of digital social care practice, the perceived impact of digital technology on their work with children and families, and the future application of digital social care interventions. Results: The survey findings revealed that 52.9\% (54/102) and 45.1\% (46/102) of practitioners, respectively, felt ``confident'' and ``comfortable'' engaging in digital service delivery. The vast majority of practitioners (93/102, 91.2\%) identified maintaining connection during the pandemic as a benefit of digital social care practice; approximately three-quarters of practitioners (74/102, 72.5\%) felt that digital social care practice offered service users ``increased access and flexibility''; however, a similar proportion of practitioners (70/102, 68.6\%) identified inadequate home environments (eg, lack of privacy) during service provision as a barrier to digital social care practice. More than half of the practitioners (54/102, 52.9\%) identified poor Wi-Fi or device access as a challenge to child and family engagement with digital social care. In total, 68.6\% (70/102) of practitioners felt that they needed further training on the use of digital platforms for service delivery. Thematic analysis of qualitative (focus group) data revealed 3 overarching themes: perceived advantages and disadvantages for service users, practitioners' challenges in working with children and families through digital technologies, and practitioners' personal challenges and training needs. Conclusions: These findings shed light on practitioners' experiences of delivering digital child and family social care services during the COVID-19 pandemic. Both benefits and challenges within the delivery of digital social care support as well as conflicting findings across the experiences of practitioners were identified. The implications of these findings for the development of therapeutic practitioner--service user relationships through digital practice as well as confidentiality and safeguarding are discussed. Training and support needs for the future implementation of digital social care interventions are also outlined. ", doi="10.2196/43498", url="https://formative.jmir.org/2023/1/e43498", url="http://www.ncbi.nlm.nih.gov/pubmed/36888555" } @Article{info:doi/10.2196/37139, author="Niculaescu, Corina-Elena and Sassoon, Karen Isabel and Landa-Avila, Cecilia Irma and Colak, Ozlem and Jun, Thomas Gyuchan and Balatsoukas, Panagiotis", title="Individual Factors Influencing the Public's Perceptions About the Importance of COVID-19 Immunity Certificates in the United Kingdom: Cross-sectional Web-based Questionnaire Survey", journal="JMIR Form Res", year="2023", month="Apr", day="27", volume="7", pages="e37139", keywords="immunity passports", keywords="immunity certificates", keywords="vaccine passports", keywords="COVID-19", keywords="health belief model", keywords="vaccination", keywords="pandemic", keywords="cross-sectional survey", keywords="low income", keywords="vulnerable population", keywords="socioeconomic", keywords="public perception", keywords="public policy", abstract="Background: Understanding how perceptions around immunity certificates are influenced by individual characteristics is important to inform evidence-based policy making and implementation strategies for services around immunity and vaccine certification. Objective: This study aimed to assess what were the main individual factors influencing people's perception of the importance of using COVID-19 immunity certificates, including health beliefs about COVID-19, vaccination views, sociodemographics, and lifestyle factors. Methods: A cross-sectional web-based survey with a nationally representative sample in the United Kingdom was conducted on August 3, 2021. Responses were collected and analyzed from 534 participants, aged 18 years and older, who were residents of the United Kingdom. The primary outcome measure (dependent variable) was the participants' perceived importance of using immunity certificates, computed as an index of 6 items. The following individual drivers were used as the independent variables: (1) personal beliefs about COVID-19 (using constructs adapted from the Health Belief Model), (2) personal views on vaccination, (3) willingness to share immunity status with service providers, and (4) variables related to respondents' lifestyle and sociodemographic characteristics. Results: The perceived importance of immunity certificates was higher among respondents who felt that contracting COVID-19 would have a severe negative impact on their health ($\beta$=0.2564; P<.001) and felt safer if vaccinated ($\beta$=0.1552; P<.001). The prospect of future economic recovery positively influenced the perceived importance of immunity certificates. Respondents who were employed or self-employed ($\beta$=--0.2412; P=.001) or experienced an increase in income after the COVID-19 pandemic ($\beta$=--0.1287; P=.002) perceived the use of immunity certificates as less important compared to those who were unemployed or had retired or those who had experienced a reduction in their income during the pandemic. Conclusions: The findings of our survey suggest that more vulnerable members in our society (those unemployed or retired and those who believe that COVID-19 would have a severe impact on their health) and people who experienced a reduction in income during the pandemic perceived the severity of not using immunity certificates in their daily life as higher. ", doi="10.2196/37139", url="https://formative.jmir.org/2023/1/e37139", url="http://www.ncbi.nlm.nih.gov/pubmed/36920837" } @Article{info:doi/10.2196/43411, author="Nuss, Kayla and Sui, Wuyou and Rhodes, Ryan and Liu, Sam", title="Motivational Profiles and Associations With Physical Activity Before, During, and After the COVID-19 Pandemic: Retrospective Study", journal="JMIR Form Res", year="2023", month="Apr", day="24", volume="7", pages="e43411", keywords="motivational profile", keywords="self-determination theory", keywords="physical activity", keywords="COVID-19", keywords="health lifestyle", keywords="latent profile analysis", keywords="mental well-being", keywords="health intervention", abstract="Background: In March 2020, the World Health Organization declared the worldwide COVID-19 outbreak a pandemic, triggering many countries, including Canada, to issue stay-at-home orders to their citizens. Research indicates that these stay-at-home orders are associated with a decline in physical activity (PA), a behavior that can reduce disease risk and improve the quality of life. Many behavioral change theories, such as the self-determination theory (SDT) of motivation, state that PA engagement is mediated by psychological constructs, such as motivation. According to the SDT, motivation exists on a continuum from more controlled (external or coerced) to more autonomous (volitional) regulatory forms. Individuals move along the continuum from more controlled to more autonomous forms through the fulfillment of 3 psychological needs: autonomy, competence, and relatedness. Research indicates that moderate-to-vigorous physical activity (MVPA) is positively associated with the autonomous regulatory form of motivation. Recently, researchers have speculated that a better method to describe motivation than movement along the continuum is to generate motivational profiles, which represent combinations of differing levels of controlled and autonomous regulation existing simultaneously. Objective: We aimed to identify distinct motivational profiles and determine their association with MVPA before, during, and after the COVID-19 pandemic. Methods: Using a cross-sectional, retrospective design, we surveyed 977 Canadian adults. We assessed motivation for PA using the Behavioral Regulations in Exercise Questionnaire-3 (BREQ-3). We assessed PA pre--, during, and post--COVID-19 stay-at-home orders in Canada using the International Physical Activity Questionnaire (IPAQ). We derived motivational profiles using latent profile analysis (LPA). Using motivational profiles as an independent variable, we assessed their effect on PA at all 3 time points with multilevel models that included the participant ID as a random variable. Results: We identified 4 profiles: high controlled and high autonomous (HCHA), low overall motivation (LOM), high autonomous and introjected (HAI), and high amotivation and external (HAE). The HCHA profile had the highest levels of weekly MVPA minutes at all 3 time points, followed by the HAI profile. Conclusions: Our results suggest that a combination of both autonomous and controlled regulatory forms may be more effective in influencing MVPA than the controlled or autonomous forms alone, particularly during times of high stress, such as a worldwide pandemic. Although the odds of another global pandemic are low, these results may also be applied to other times of stress, such as job transitions, relationship changes (eg, change in marital status), or the death of a loved one. We suggest that clinicians and practitioners consider developing PA interventions that seek to increase both controlled and autonomous regulatory forms instead of aiming to reduce controlled forms. ", doi="10.2196/43411", url="https://formative.jmir.org/2023/1/e43411", url="http://www.ncbi.nlm.nih.gov/pubmed/36927666" } @Article{info:doi/10.2196/41838, author="Gonzales, Aldren and Custodio, Razel and Lapitan, Carmela Marie and Ladia, Ann Mary", title="End Users' Perspectives on the Quality and Design of mHealth Technologies During the COVID-19 Pandemic in the Philippines: Qualitative Study", journal="JMIR Form Res", year="2023", month="Apr", day="20", volume="7", pages="e41838", keywords="mHealth", keywords="COVID-19", keywords="pandemic", keywords="digital health", keywords="mobile health", keywords="end-user engagement", keywords="focus group", keywords="technology implementation", keywords="Philippines", keywords="technology use", keywords="privacy", keywords="user engagement", abstract="Background: The COVID-19 pandemic has expanded the use of mobile health (mHealth) technologies in contact tracing, communicating COVID-19--related information, and monitoring the health conditions of the general population in the Philippines. However, the limited end-user engagement in the features and feedback along the development cycle of mHealth technologies results in risks in adoption. The World Health Organization (WHO) recommends user-centric design and development of mHealth technologies to ensure responsiveness to the needs of the end users. Objective: The goal of the study is to understand, using end users' perspectives, the design and quality of mHealth technology implementations in the Philippines during the COVID-19 pandemic, with a focus on the areas identified by stakeholders: (1) utility, (2) technology readiness level, (3) design, (4) information, (5) usability, (6) features, and (7) security and privacy. Methods: Using a descriptive qualitative design, we conducted 5 interviews and 3 focus group discussions (FGDs) with a total of 16 participants (6, 37.5\%, males and 10, 62.5\%, females). Questions were based on the Mobile App Rating Scale (MARS). Using the cyclical coding approach, transcripts were analyzed with NVivo 12. Themes were identified. Results: The qualitative analysis identified 18 themes that were organized under the 7 focus areas: (1) utility: use of mHealth technologies and motivations in using mHealth; (2) technology readiness: mobile technology literacy and user segmentation; (3) design: user interface design, language and content accessibility, and technology design; (4) information: accuracy of information and use of information; (5) usability: design factors, dependency on human processes, and technical issues; (6) features: interoperability and data integration, other feature and design recommendations, and technology features and upgrades; and (7) privacy and security: trust that mHealth can secure data, lack of information, and policies. To highlight, accessibility, privacy and security, a simple interface, and integration are some of the design and quality areas that end users find important and consider in using mHealth tools. Conclusions: Engaging end users in the development and design of mHealth technologies ensures adoption and accessibility, making it a valuable tool in curbing the pandemic. The 6 principles for developers, researchers, and implementers to consider when scaling up or developing a new mHealth solution in a low-resource setting are that it should (1) be driven by value in its implementation, (2) be inclusive, (3) address users' physical and cognitive restrictions, (4) ensure privacy and security, (5) be designed in accordance with digital health systems' standards, and (6) be trusted by end users. ", doi="10.2196/41838", url="https://formative.jmir.org/2023/1/e41838", url="http://www.ncbi.nlm.nih.gov/pubmed/36943932" } @Article{info:doi/10.2196/40028, author="Nair, V. Chithira and Moni, Merlin and Edathadathil, Fabia and A, Appukuttan and Prasanna, Preetha and Pushpa Raghavan, Roshni and Sathyapalan, T. Dipu and Jayant, Aveek", title="Incidence and Characterization of Post-COVID-19 Symptoms in Hospitalized COVID-19 Survivors to Recognize Syndemic Connotations in India: Single-Center Prospective Observational Cohort Study", journal="JMIR Form Res", year="2023", month="Apr", day="18", volume="7", pages="e40028", keywords="COVID-19", keywords="follow-up", keywords="incidence", keywords="fatigue", keywords="long COVID", keywords="post-COVID", keywords="post-COVID-19 symptoms", keywords="questionnaire", keywords="tertiary-care center", keywords="intensive care", keywords="symptom monitoring", keywords="prospective observational study", keywords="treatment", keywords="steroid", keywords="viral therapy", keywords="postdischarge", abstract="Background: Long COVID, or post-COVID-19 syndrome, is the persistence of signs and symptoms that develop during or after COVID-19 infection for more than 12 weeks and are not explained by an alternative diagnosis. In spite of health care recouping to prepandemic states, the post-COVID-19 state tends to be less recognized from low- and middle-income country settings and holistic therapeutic protocols do not exist. Owing to the syndemic nature of COVID-19, it is important to characterize post-COVID-19 syndrome. Objective: We aimed to determine the incidence of post-COVID-19 symptoms in a cohort of inpatients who recovered from COVID-19 from February to July 2021 at a tertiary-care center in South India. In addition, we aimed at comparing the prevalence of post-COVID-19 manifestations in intensive care unit (ICU) and non-ICU patients, assessing the persistence, severity, and characteristics of post-COVID-19 manifestations, and elucidating the risk factors associated with the presence of post-COVID-19 manifestations. Methods: A total of 120 adult patients admitted with COVID-19 in the specified time frame were recruited into the study after providing informed written consent. The cohort included 50 patients requiring intensive care and 70 patients without intensive care. The follow-up was conducted on the second and sixth weeks after discharge with a structured questionnaire. The questionnaire was filled in by the patient/family member of the patient during their visit to the hospital for follow-up at 2 weeks and through telephone follow-up at 6 weeks. Results: The mean age of the cohort was 55 years and 55\% were men. Only 5\% of the cohort had taken the first dose of COVID-19 vaccination. Among the 120 patients, 58.3\% had mild COVID-19 and 41.7\% had moderate to severe COVID-19 infection. In addition, 60.8\% (n=73) of patients had at least one persistent symptom at the sixth week of discharge and 50 (41.7\%) patients required intensive care during their inpatient stay. The presence of persistent symptoms at 6 weeks was not associated with severity of illness, age, or requirement for intensive care. Fatigue was the most common reported persistent symptom with a prevalence of 55.8\%, followed by dyspnea (20\%) and weight loss (16.7\%). Female sex (odds ratio [OR] 2.4, 95\% CI 1.03-5.58; P=.04) and steroid administration during hospital stay (OR 4.43, 95\% CI 1.9-10.28; P=.001) were found to be significant risk factors for the presence of post-COVID-19 symptoms at 6 weeks as revealed by logistic regression analysis. Conclusions: Overall, 60.8\% of inpatients treated for COVID-19 had post-COVID-19 symptoms at 6 weeks postdischarge from the hospital. The incidence of post-COVID-19 syndrome in the cohort did not significantly differ across the mild, moderate, and severe COVID-19 severity categories. Female sex and steroid administration during the hospital stay were identified as predictors of the persistence of post-COVID-19 symptoms at 6 weeks. ", doi="10.2196/40028", url="https://formative.jmir.org/2023/1/e40028", url="http://www.ncbi.nlm.nih.gov/pubmed/36920842" } @Article{info:doi/10.2196/41394, author="Ishizuka-Inoue, Mami and Shimoura, Kanako and Nagai-Tanima, Momoko and Aoyama, Tomoki", title="The Relationship Between Health Literacy, Knowledge, Fear, and COVID-19 Prevention Behavior in Different Age Groups: Cross-sectional Web-Based Study", journal="JMIR Form Res", year="2023", month="Apr", day="17", volume="7", pages="e41394", keywords="infodemic", keywords="COVID-19", keywords="health literacy", keywords="fear of COVID-19", keywords="cross-sectional study", keywords="behavior", keywords="age group", keywords="misinformation", keywords="influence", keywords="prevention", keywords="disease", abstract="Background: COVID-19 prevention behaviors have become part of our lives, and they have been reported to be associated with health literacy, knowledge, and fear. However, the COVID-19 pandemic may be characterized by different situations in each age group. Since the severity of the infection and the means of accessing information differ by age group, the relationship between health literacy, knowledge, and fear may differ. Thus, factors that promote preventive behavior may differ by age group. Clarifying the factors related to prevention behaviors by age may help us consider age-appropriate promotion. Objective: This study aims to examine the association between COVID-19 prevention behaviors and health literacy, COVID-19 knowledge, and fear of COVID-19 by age group. Methods: A cross-sectional study was conducted among 512 participants aged 20-69 years, recruited from a web-based sample from November 1 to November 5, 2021. A web-based self-administered questionnaire was used to obtain the participants' characteristics, COVID-19 prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19. The Kruskal-Wallis rank sum test was used to compare the scores of each item for each age group. The relationships among COVID-19 prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19 were analyzed using the Spearman rank correlation analysis. Additionally, multiple regression analysis was conducted with COVID-19 prevention behaviors as dependent variables; health literacy, COVID-19 knowledge, and fear of COVID-19 as independent variables; and sex and age as adjustment variables. Results: For all participants, correlation and multiple regression analyses revealed that prevention behaviors were significantly related to health literacy, COVID-19 knowledge, and fear of COVID-19 (P<.001). Additionally, correlation analysis revealed that fear of COVID-19 was significantly negatively correlated with COVID-19 knowledge (P<.001). There was also a significant positive correlation between health literacy and COVID-19 knowledge (P<.001). Furthermore, analysis by age revealed that the factors associated with prevention behaviors differed by age group. In the age groups 20-29, 30-39, and 40-49 years, multiple factors, including health literacy, influenced COVID-19 prevention behaviors, whereas in the age groups 50-59 and 60-69 years, only fear of COVID-19 had an impact. Conclusions: The results of this study revealed that the factors associated with prevention behaviors differ by age. Age-specific approaches should be considered to prevent infection. ", doi="10.2196/41394", url="https://formative.jmir.org/2023/1/e41394", url="http://www.ncbi.nlm.nih.gov/pubmed/37011226" } @Article{info:doi/10.2196/40821, author="Vike, L. Nicole and Bari, Sumra and Stetsiv, Khrystyna and Woodward, Sean and Lalvani, Shamal and Stefanopoulos, Leandros and Kim, Woo Byoung and Maglaveras, Nicos and Katsaggelos, K. Aggelos and Breiter, C. Hans", title="The Relationship Between a History of High-risk and Destructive Behaviors and COVID-19 Infection: Preliminary Study", journal="JMIR Form Res", year="2023", month="Apr", day="14", volume="7", pages="e40821", keywords="substance use", keywords="gambling", keywords="violent behaviors", keywords="COVID-19", keywords="destructive behaviors", keywords="mental health", abstract="Background: The COVID-19 pandemic has heightened mental health concerns, but the temporal relationship between mental health conditions and SARS-CoV-2 infection has not yet been investigated. Specifically, psychological issues, violent behaviors, and substance use were reported more during the COVID-19 pandemic than before the pandemic. However, it is unknown whether a prepandemic history of these conditions increases an individual's susceptibility to SARS-CoV-2. Objective: This study aimed to better understand the psychological risks underlying COVID-19, as it is important to investigate how destructive and risky behaviors may increase a person's susceptibility to COVID-19. Methods: In this study, we analyzed data from a survey of 366 adults across the United States (aged 18 to 70 years); this survey was administered between February and March of 2021. The participants were asked to complete the Global Appraisal of Individual Needs--Short Screener (GAIN-SS) questionnaire, which indicates an individual's history of high-risk and destructive behaviors and likelihood of meeting diagnostic criteria. The GAIN-SS includes 7 questions related to externalizing behaviors, 8 related to substance use, and 5 related to crime and violence; responses were given on a temporal scale. The participants were also asked whether they ever tested positive for COVID-19 and whether they ever received a clinical diagnosis of COVID-19. GAIN-SS responses were compared between those who reported and those who did not report COVID-19 to determine if those who reported COVID-19 also reported GAIN-SS behaviors (Wilcoxon rank sum test, $\alpha$=.05). In total, 3 hypotheses surrounding the temporal relationships between the recency of GAIN-SS behaviors and COVID-19 infection were tested using proportion tests ($\alpha$=.05). GAIN-SS behaviors that significantly differed (proportion tests, $\alpha$=.05) between COVID-19 responses were included as independent variables in multivariable logistic regression models with iterative downsampling. This was performed to assess how well a history of GAIN-SS behaviors statistically discriminated between those who reported and those who did not report COVID-19. Results: Those who reported COVID-19 more frequently indicated past GAIN-SS behaviors (Q<0.05). Furthermore, the proportion of those who reported COVID-19 was higher (Q<0.05) among those who reported a history of GAIN-SS behaviors; specifically, gambling and selling drugs were common across the 3 proportion tests. Multivariable logistic regression revealed that GAIN-SS behaviors, particularly gambling, selling drugs, and attention problems, accurately modeled self-reported COVID-19, with model accuracies ranging from 77.42\% to 99.55\%. That is, those who exhibited destructive and high-risk behaviors before and during the pandemic could be discriminated from those who did not exhibit these behaviors when modeling self-reported COVID-19. Conclusions: This preliminary study provides insights into how a history of destructive and risky behaviors influences infection susceptibility, offering possible explanations for why some persons may be more susceptible to COVID-19, potentially in relation to reduced adherence to prevention guidelines or not seeking vaccination. ", doi="10.2196/40821", url="https://formative.jmir.org/2023/1/e40821", url="http://www.ncbi.nlm.nih.gov/pubmed/36888554" } @Article{info:doi/10.2196/46661, author="Handayani, Wuri Putu and Zagatti, Augusto Guilherme and Kefi, Hajer and Bressan, St{\'e}phane", title="Impact of Social Media Usage on Users' COVID-19 Protective Behavior: Survey Study in Indonesia", journal="JMIR Form Res", year="2023", month="Apr", day="13", volume="7", pages="e46661", keywords="COVID-19", keywords="pandemic", keywords="infectious diseases", keywords="social media", keywords="trust", keywords="behavior", keywords="Indonesia", abstract="Background: Social media have become the source of choice for many users to search for health information on COVID-19 despite possible detrimental consequences. Several studies have analyzed the association between health information--searching behavior and mental health. Some of these studies examined users' intentions in searching health information on social media and the impact of social media use on mental health in Indonesia. Objective: This study investigates both active and passive participation in social media, shedding light on cofounding effects from these different forms of engagement. In addition, this study analyses the role of trust in social media platforms and its effect on public health outcomes. Thus, the purpose of this study is to analyze the impact of social media usage on COVID-19 protective behavior in Indonesia. The most commonly used social media platforms are Instagram, Facebook, YouTube, TikTok, and Twitter. Methods: We used primary data from an online survey. We processed 414 answers to a structured questionnaire to evaluate the relationship between these users' active and passive participation in social media, trust in social media, anxiety, self-efficacy, and protective behavior to COVID-19. We modeled the data using partial least square structural equation modeling. Results: This study reveals that social media trust is a crucial antecedent, where trust in social media is positively associated with active contribution and passive consumption of COVID-19 content in social media, users' anxiety, self-efficacy, and protective behavior. This study found that active contribution of content related to COVID-19 on social media is positively correlated with anxiety, while passive participation increases self-efficacy and, in turn, protective behavior. This study also found that active participation is associated with negative health outcomes, while passive participation has the opposite effects. The results of this study can potentially be used for other infectious diseases, for example, dengue fever and diseases that can be transmitted through the air and have handling protocols similar to that of COVID-19. Conclusions: Public health campaigns can use social media for health promotion. Public health campaigns should post positive messages and distil the received information parsimoniously to avoid unnecessary and possibly counterproductive increased anxiety of the users. ", doi="10.2196/46661", url="https://formative.jmir.org/2023/1/e46661", url="http://www.ncbi.nlm.nih.gov/pubmed/37052987" } @Article{info:doi/10.2196/39765, author="Li, Dan and Shelby, Tyler and Brault, Marie and Manohar, Rajit and Vermund, Sten and Hagaman, Ashley and Forastiere, Laura and Caruthers, Tyler and Egger, Emilie and Wang, Yizhou and Manohar, Nathan and Manohar, Peter and Davis, Lucian J. and Zhou, Xin", title="Implementation of a Hardware-Assisted Bluetooth-Based COVID-19 Tracking Device in a High School: Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Apr", day="7", volume="7", pages="e39765", keywords="contact tracing", keywords="COVID-19", keywords="digital contact tracing", keywords="Bluetooth device", keywords="school health", keywords="secondary school", keywords="implementation science", keywords="mixed methods", abstract="Background: Contact tracing is a vital public health tool used to prevent the spread of infectious diseases. However, traditional interview-format contact tracing (TCT) is labor-intensive and time-consuming and may be unsustainable for large-scale pandemics such as COVID-19. Objective: In this study, we aimed to address the limitations of TCT. The Yale School of Engineering developed a Hardware-Assisted Bluetooth-based Infection Tracking (HABIT) device. Following the successful implementation of HABIT in a university setting, this study sought to evaluate the performance and implementation of HABIT in a high school setting using an embedded mixed methods design. Methods: In this pilot implementation study, we first assessed the performance of HABIT using mock case simulations in which we compared contact tracing data collected from mock case interviews (TCT) versus Bluetooth devices (HABIT). For each method, we compared the number of close contacts identified and identification of unique contacts. We then conducted an embedded mixed methods evaluation of the implementation outcomes of HABIT devices using pre- and postimplementation quantitative surveys and qualitative focus group discussions with users and implementers according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Results: In total, 17 students and staff completed mock case simulations in which 161 close contact interactions were detected by interview or Bluetooth devices. We detected significant differences in the number of close contacts detected by interview versus Bluetooth devices (P<.001), with most (127/161, 78.9\%) contacts being reported by interview only. However, a significant number (26/161, 16.1\%; P<.001) of contacts were uniquely identified by Bluetooth devices. The interface, ease of use, coherence, and appropriateness were highly rated by both faculty and students. HABIT provided emotional security to users. However, the prototype design and technical difficulties presented barriers to the uptake and sustained use of HABIT. Conclusions: Implementation of HABIT in a high school was impeded by technical difficulties leading to decreased engagement and adherence. Nonetheless, HABIT identified a significant number of unique contacts not reported by interview, indicating that electronic technologies may augment traditional contact tracing once user preferences are accommodated and technical glitches are overcome. Participants indicated a high degree of acceptance, citing emotional reassurance and a sense of security with the device. ", doi="10.2196/39765", url="https://formative.jmir.org/2023/1/e39765", url="http://www.ncbi.nlm.nih.gov/pubmed/36525333" } @Article{info:doi/10.2196/43165, author="Monteiro, Goldnadel Maristela and Pantani, Daniela and Pinsky, Ilana and Hernandes Rocha, Augusto Thiago", title="Using the Pan American Health Organization Digital Conversational Agent to Educate the Public on Alcohol Use and Health: Preliminary Analysis", journal="JMIR Form Res", year="2023", month="Apr", day="6", volume="7", pages="e43165", keywords="alcohol use", keywords="alcohol risk assessment", keywords="digital health worker", keywords="artificial intelligence", keywords="health literacy", keywords="digital health", keywords="chatbot", keywords="misinformation", keywords="online health information", keywords="digital health education", keywords="health risk", keywords="COVID-19", abstract="Background: There is widespread misinformation about the effects of alcohol consumption on health, which was amplified during the COVID-19 pandemic through social media and internet channels. Chatbots and conversational agents became an important piece of the World Health Organization (WHO) response during the COVID-19 pandemic to quickly disseminate evidence-based information related to COVID-19 and tobacco to the public. The Pan American Health Organization (PAHO) seized the opportunity to develop a conversational agent to talk about alcohol-related topics and therefore complement traditional forms of health education that have been promoted in the past. Objective: This study aimed to develop and deploy a digital conversational agent to interact with an unlimited number of users anonymously, 24 hours a day, about alcohol topics, including ways to reduce risks from drinking, that is accessible in several languages, at no cost, and through various devices. Methods: The content development was based on the latest scientific evidence on the impacts of alcohol on health, social norms about drinking, and data from the WHO and PAHO. The agent itself was developed through a nonexclusive license agreement with a private company (Soul Machines) and included Google Digital Flow ES as the natural language processing software and Amazon Web Services for cloud services. Another company was contracted to program all the conversations, following the technical advice of PAHO staff. Results: The conversational agent was named Pahola, and it was deployed on November 19, 2021, through the PAHO website after a launch event with high publicity. No identifiable data were used and all interactions were anonymous, and therefore, this was not considered research with human subjects. Pahola speaks in English, Spanish, and Portuguese and interacts anonymously with a potentially infinite number of users through various digital devices. Users were required to accept the terms and conditions to enable access to their camera and microphone to interact with Pahola. Pahola attracted good attention from the media and reached 1.6 million people, leading to 236,000 clicks on its landing page, mostly through mobile devices. Only 1532 users had a conversation after clicking to talk to Pahola. The average time users spent talking to Pahola was 5 minutes. Major dropouts were observed in different steps of the conversation flow. Some questions asked by users were not anticipated during programming and could not be answered. Conclusions: Our findings showed several limitations to using a conversational agent for alcohol education to the general public. Improvements are needed to expand the content to make it more meaningful and engaging to the public. The potential of chatbots to educate the public on alcohol-related topics seems enormous but requires a long-term investment of resources and research to be useful and reach many more people. ", doi="10.2196/43165", url="https://formative.jmir.org/2023/1/e43165", url="http://www.ncbi.nlm.nih.gov/pubmed/36961920" } @Article{info:doi/10.2196/38491, author="Chen, Emily and Hollowell, Adam and Truong, Tracy and Bentley-Edwards, Keisha and Myers, Evan and Erkanli, Alaattin and Holt, Lauren and Swartz, J. Jonas", title="Contraceptive Access and Use Among Undergraduate and Graduate Students During COVID-19: Online Survey Study", journal="JMIR Form Res", year="2023", month="Mar", day="14", volume="7", pages="e38491", keywords="COVID-19", keywords="contraception", keywords="college", keywords="disparities", keywords="LARC", keywords="sexual health", keywords="social media", keywords="health promotion", keywords="telehealth", keywords="health messaging", keywords="health resource", keywords="health disparity", keywords="risk factor", keywords="healthcare access", abstract="Background: The COVID-19 pandemic led to widespread college campus closures in the months of March to June 2020, endangering students' access to on-campus health resources, including reproductive health services. Objective: To assess contraceptive access and use among undergraduate and graduate students in North Carolina during the COVID-19 pandemic. Methods: We conducted a cross-sectional web-based survey of undergraduate and graduate students enrolled at degree-granting institutions in North Carolina. Participants were recruited using targeted Instagram advertisements. The survey queried several aspects of participants' sexual behavior, including sex drive, level of sexual experience, number of sexual partners, digital sexual experience, dating patterns, and types of contraception used. Participants were asked to compare many of these behaviors before and after the pandemic. The survey also assessed several sociodemographic factors that we hypothesized would be associated with contraceptive use based on prior data, including educational background, sexual orientation and gender minority status (ie, lesbian, gay, bisexual, transgender, queer), health insurance status, race, ethnicity, degree of sensation seeking, religiosity, and desire to become pregnant. Results: Over 10 days, 2035 Instagram users began our survey, of whom 1002 met eligibility criteria. Of these 1002 eligible participants, 934 completed the survey, for a 93\% completion rate. Our respondents were mostly female (665/934, 71\%), cisgender (877/934, 94\%), heterosexual (592/934, 64\%), white (695/934 75\%), not Hispanic (835/934, 89\%), and enrolled at a 4-year college (618/934, 66\%). Over 95\% (895/934) of respondents reported that they maintained access to their preferred contraception during the COVID-19 pandemic. In a multivariable analysis, participants who were enrolled in a 4-year college or graduate program were less likely to lose contraceptive access when compared to participants enrolled in a 2-year college (risk ratio [RR] 0.34, 95\% CI 0.16-0.71); in addition, when compared to cisgender participants, nonbinary and transgender participants were more likely to lose contraceptive access (RR 2.43, 95\% CI 1.01-5.87). Respondents reported that they were more interested in using telehealth to access contraception during the pandemic. The contraceptive methods most commonly used by our participants were, in order, condoms (331/934, 35.4\%), oral contraception (303/934, 32.4\%), and long-acting reversible contraception (LARC; 221/934, 23.7\%). The rate of LARC use among our participants was higher than the national average for this age group (14\%). Emergency contraception was uncommonly used (25/934, 2.7\%). Conclusions: Undergraduate and graduate students in North Carolina overwhelmingly reported that they maintained access to their preferred contraceptive methods during the COVID-19 pandemic and through changing patterns of health care access, including telehealth. Gender nonbinary and transgender students and 2-year college students may have been at greater risk of losing access to contraception during the first year of the COVID-19 pandemic. ", doi="10.2196/38491", url="https://formative.jmir.org/2023/1/e38491", url="http://www.ncbi.nlm.nih.gov/pubmed/36827491" } @Article{info:doi/10.2196/38080, author="Quinn, Emma and Hsiao, Hsun Kai and Johnstone, Travers and Gomez, Maria and Parasuraman, Arun and Ingleton, Andrew and Hirst, Nicholas and Najjar, Zeina and Gupta, Leena", title="Protecting Older Adult Residents in Care Facilities Against Influenza and COVID-19 Using the Influenza Communication, Advice and Reporting (FluCARE) App: Prospective Cohort Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Mar", day="13", volume="7", pages="e38080", keywords="web app", keywords="digital health", keywords="influenza", keywords="COVID-19", keywords="outbreak", keywords="monitoring", keywords="disease control", keywords="infection spread", keywords="infection control", keywords="detect", keywords="aged care", keywords="elderly", keywords="elderly population", keywords="older adult", keywords="long term care", keywords="care home", keywords="AFC", keywords="LTC", keywords="nursing home", keywords="retirement home", keywords="mobile application", keywords="health application", keywords="mHealth", keywords="care facility", keywords="online training", keywords="health impact", keywords="feasibility", keywords="efficacy", keywords="satisfaction", keywords="prevention", keywords="disease spread", keywords="notification", abstract="Background: Early detection and response to influenza and COVID-19 outbreaks in aged care facilities (ACFs) are critical to minimizing health impacts. The Sydney Local Health District (SLHD) Public Health Unit (PHU) has developed and implemented a novel web-based app with integrated functions for online line listings, detection algorithms, and automatic notifications to responders, to assist ACFs in outbreak response. The goal of the Influenza Outbreak Communication, Advice and Reporting (FluCARE) app is to reduce time delays to notifications, which we hope will reduce the spread, duration, and health impacts of an influenza or COVID-19 outbreak, as well as ease workload burdens on ACF staff. Objective: The specific aims of the study were to (1) evaluate the acceptability and user satisfaction of the implementation and use of FluCARE in helping ACFs recognize, notify, and manage influenza and COVID-19 outbreaks in their facility; (2) identify the safety of FluCARE and any potential adverse outcomes of using the app; and (3) identify any perceived barriers or facilitators to the implementation and use of FluCARE from the ACF user perspective. Methods: The FluCARE app was piloted from September 2019 to December 2020 in the SLHD. Associated implementation included promotion and engagement, user training, and operational policies. Participating ACF staff were invited to complete a posttraining survey. Staff were also invited to complete a postpilot evaluation survey that included the user Mobile Application Rating Scale (uMARS) measuring app acceptance, utility, and barriers and facilitators to use. An issues log was also prospectively maintained to assess safety. Survey data were analyzed descriptively or via content analysis where appropriate. Results: Surveys were completed by 31 consenting users from 27 ACFs. FluCARE was rated 3.91 of 5 overall on the uMARS. Of the 31 users, 25 (80\%) would definitely use FluCARE for future outbreaks, and all users agreed that the app was useful for identifying influenza and COVID-19 outbreaks at their facilities. There were no reported critical issues with incorrect or missed outbreak detection. User training, particularly online training modules, and technical support were identified as key facilitators to FluCARE use. Conclusions: FluCARE is an acceptable, useful, and safe app to assist ACF staff with early detection and response to influenza and COVID-19 outbreaks. This study supports feasibility for ongoing implementation and efficacy evaluation, followed by scale-up into other health districts in New South Wales. ", doi="10.2196/38080", url="https://formative.jmir.org/2023/1/e38080", url="http://www.ncbi.nlm.nih.gov/pubmed/36763638" } @Article{info:doi/10.2196/40518, author="Robinson, Eric and Jones, Andrew", title="Hangover-Related Internet Searches Before and During the COVID-19 Pandemic in England: Observational Study", journal="JMIR Form Res", year="2023", month="Mar", day="3", volume="7", pages="e40518", keywords="alcohol", keywords="COVID-19", keywords="hangover", keywords="Google Trends", keywords="social media", keywords="public health", keywords="online information", keywords="alcohol use", keywords="internet search", abstract="Background: It is unclear whether heavy alcohol use and associated hangover symptoms changed as a result of the COVID-19 pandemic. Due to a lack of available accurate and nonretrospective self-reported data, it is difficult to directly assess hangover symptoms during the COVID-19 pandemic. Objective: This study aimed to examine whether alcohol-induced hangover-related internet searches (eg, ``how to cure a hangover?'') increased, decreased, or remained the same in England before versus during the COVID-19 pandemic (2020-2021) and during periods of national lockdown. Secondary aims were to examine if hangover-related internet searches in England differed compared to a country that did not impose similar COVID-19 lockdown restrictions. Methods: Using historical data from Google Trends for England, we compared the relative search volume (RSV) of hangover-related searches in the years before (2016-2019) versus during the COVID-19 pandemic (2020-2021), as well as in periods of national lockdown versus the same periods in 2016-2019. We also compared the RSV of hangover-related searches during the same time frames in a European country that did not introduce national COVID-19 lockdowns at the beginning of the pandemic (Sweden). Hangover-related search terms were identified through consultation with a panel of alcohol researchers and a sample from the general public. Statistical analyses were preregistered prior to data collection. Results: There was no overall significant difference in the RSV of hangover-related terms in England during 2016-2019 versus 2020-2021 (P=.10; robust d=0.02, 95\% CI 0.00-0.03). However, during national lockdowns, searches for hangover-related terms were lower, particularly during the first national lockdown in England (P<.001; d=.19, 95\% CI 0.16-0.24; a 44\% relative decrease). In a comparison country that did not introduce a national lockdown in the early stages of the pandemic (Sweden), there was no significant decrease in hangover-related searches during the same time period (P=.06). However, across both England and Sweden, during later periods of COVID-19 restrictions in 2020 and 2021, the RSV of hangover-related terms was lower than that in the same periods during 2016-2019. Exploratory analyses revealed that national monthly variation in alcohol sales both before and during the COVID-19 pandemic were positively correlated with the frequency of hangover-related searches, suggesting that changes in hangover-related searches may act as a proxy for changes in alcohol consumption. Conclusions: Hangover-related internet searches did not differ before versus during the COVID-19 pandemic in England but did reduce during periods of national lockdown. Further research is required to confirm how changes in hangover-related search volume relate to heavy episodic alcohol use. Trial Registration: Open Science Framework 2Y86E; https://osf.io/2Y86E ", doi="10.2196/40518", url="https://formative.jmir.org/2023/1/e40518", url="http://www.ncbi.nlm.nih.gov/pubmed/36827489" } @Article{info:doi/10.2196/38667, author="Brusk, J. John and Bensley, J. Robert", title="COVID-19 Response Resource Engagement and User Characteristics of the Wichealth Web-Based Nutrition Education System: Comparative Cross-sectional Study", journal="JMIR Form Res", year="2023", month="Mar", day="2", volume="7", pages="e38667", keywords="COVID-19", keywords="user engagement", keywords="infodemic", keywords="Women, Infants, and Children", keywords="WIC", keywords="educational resource", keywords="health care", keywords="digital health", keywords="nutrition", keywords="web-based education", keywords="web-based nutrition", keywords="pediatric", keywords="parenting", keywords="dashboard", abstract="Background: In response to the COVID-19 pandemic, Wichealth launched 4 information resources on the site's user landing dashboard page. These resources were used consistently during the period in which they were available (April 1, 2020, through October 31, 2021); however, only 9\% (n=50,888) of Wichealth users eligible for inclusion in the study accessed at least one resource. User engagement with emergency response resources within the context of a web-based health educational tool has not been well investigated due to a paucity of opportunities and a lack of the ability to evaluate relevant users at scale. Objective: This investigation was carried out to understand if user characteristics and behaviors measured by the Wichealth web-based education system are associated with a participant's motivation, or lack thereof, to engage with the added COVID-19 resources. Methods: Sociodemographic characteristics were gathered from Wichealth users with at least one lesson completed and a complete user profile to identify which factors increase the likelihood of user access of any of the Wichealth COVID-19 response resources during the 19-month period between April 1, 2020, and October 31, 2021. A logistic regression analysis was conducted to determine the relative importance of all factors on the likelihood of a user accessing the COVID-19 resources. Results: A total of 50,888 unique Wichealth users included in the study accessed the COVID-19 response resources 66,849 times during the time period. During the same period, 510,939 unique Wichealth users completed at least one lesson about how to engage in healthy behaviors with respect to parent-child feeding but did not access any COVID-19 resources. Therefore, only 9\% of Wichealth users who completed a lesson during the time when COVID-19 response resources were available accessed any of the information in those resources. Users of the Spanish language Wichealth version, older users, those less educated, and users with prior Wichealth lesson engagement demonstrated the greatest likelihood of COVID-19 resource use. Conclusions: This investigation presents findings that demonstrate significant differences between Wichealth users that opted to access COVID-19--specific resources and those who chose not to during their web-based educational session. Reaching users of a web-based educational system with supplemental information may require multiple strategies to increase coverage and ensure the widest possible distribution. ", doi="10.2196/38667", url="https://formative.jmir.org/2023/1/e38667", url="http://www.ncbi.nlm.nih.gov/pubmed/36787232" } @Article{info:doi/10.2196/36608, author="Howell, Pamella and Abdelhamid, Mohamed", title="Protection Motivation Perspective Regarding the Use of COVID-19 Mobile Tracing Apps Among Public Users: Empirical Study", journal="JMIR Form Res", year="2023", month="Mar", day="1", volume="7", pages="e36608", keywords="COVID-19", keywords="mobile tracing app", keywords="protection motivation theory", keywords="privacy concerns", keywords="global health", abstract="Background: Access to data is crucial for decision-making; this fact has become more evident during the pandemic. Data collected using mobile apps can positively influence diagnosis and treatment, the supply chain, and the staffing resources of health care facilities. Developers and health care professionals have worked to create apps that can track a person's COVID-19 status. For example, these apps can monitor positive COVID-19 test results and vaccination status. Regrettably, people may be concerned about sharing their data with government or private sector organizations that are developing apps. Understanding user perceptions is essential; without substantial user adoption and the use of mobile tracing apps, benefits cannot be achieved. Objective: This study aimed to assess the factors that positively and negatively affect the use of COVID-19 tracing apps by examining individuals' perceptions about sharing data on mobile apps, such as testing regularity, infection, and immunization status. Methods: The hypothesized research model was tested using a cross-sectional survey instrument. The survey contained 5 reflective constructs and 4 control variables selected after reviewing the literature and interviewing health care professionals. A digital copy of the survey was created using Qualtrics. After receiving approval, data were collected from 367 participants through Amazon Mechanical Turk (MTurk). Participants of any gender who were 18 years or older were considered for inclusion to complete the anonymized survey. We then analyzed the theoretical model using structural equation modeling. Results: After analyzing the quality of responses, 325 participants were included. Of these 325 participants, 216 (66.5\%) were male and 109 (33.5\%) were female. Among the participants in the final data set, 72.6\% (236/325) were employed. The results of structural equation modeling showed that perceived vulnerability ($\beta$=0.688; P<.001), self-efficacy ($\beta$=0.292; P<.001), and an individual's prior infection with COVID-19 ($\beta$=0.194; P=.002) had statistically significant positive impacts on the intention to use mobile tracing apps. Privacy concerns ($\beta$=?0.360; P<.001), risk aversion ($\beta$=?0.150; P=.09), and a family member's prior infection with COVID-19 ($\beta$=?0.139; P=.02) had statistically significant negative influences on a person's intention to use mobile tracing apps. Conclusions: This study illustrates that various user perceptions affect whether individuals use COVID-19 tracing apps. By working collaboratively on legislation and the messaging provided to potential users before releasing an app, developers, health care professionals, and policymakers can improve the use of tracking apps. Health care professionals need to emphasize disease vulnerability to motivate people to use mobile tracing apps, which can help reduce the spread of viruses and diseases. In addition, more work is needed at the policy-making level to protect the privacy of users, which in return can increase user engagement. ", doi="10.2196/36608", url="https://formative.jmir.org/2023/1/e36608", url="http://www.ncbi.nlm.nih.gov/pubmed/36735838" } @Article{info:doi/10.2196/36023, author="Cellai, Michele and Roberts, Jodi and Moore, A. Miranda and Gandrakota, Nikhila", title="Clinical Outcomes After Use of Inhaled Corticosteroids or Oral Steroids in a COVID-19 Telemedicine Clinic Cohort: Retrospective Chart Review", journal="JMIR Form Res", year="2023", month="Feb", day="23", volume="7", pages="e36023", keywords="COVID-19", keywords="lung", keywords="post-acute sequela", keywords="steroid use", keywords="ICS", keywords="pandemic", keywords="therapy", keywords="treatment", keywords="steroid treatment", keywords="COVID-19 treatment", keywords="patient outcome", keywords="pulmonary", keywords="COVID symptoms", keywords="telehealth", abstract="Background: COVID-19 concerns remain among health care providers, as there are few outpatient treatment options. In the early days of the pandemic, treatment options for nonhospitalized patients were limited, and symptomatic treatment and home-grown guidelines that used recommendations from the Global Initiative for Asthma Management and Treatment were used. Objective: The possibility that inhaled corticosteroids (ICS) might reduce the risk of respiratory symptoms and promote recovery was the impetus for this review, as it has already been shown that in the nonhospitalized patient population, oral corticosteroids (OCS) in the acute phase could have an adverse effect on recovery. We investigated if (1) patients treated with ICS were less likely to require referral to a post--COVID-19 clinic or pulmonary specialist than patients without ICS treatment or with OCS therapy, and (2) if OCS use was associated with worse health outcomes. Methods: In a retrospective chart review, we identified all patients with acute illness due to COVID-19 that were followed and managed by a telemedicine clinic team between June and December 2020. The data were electronically pulled from electronic medical records through April 2021 and reviewed to determine which patients eventually required referral to a post--COVID-19 clinic or pulmonary specialist due to persistent respiratory symptoms of COVID-19. The data were then analyzed to compare outcomes between patients prescribed OCS and those prescribed ICS. We specifically looked at patients treated acutely with ICS or OCS that then required referral to a pulmonary specialist or post--COVID-19 clinic. We excluded any patients with a history of chronic OCS or ICS use for any reason. Results: Prescribing ICS during the acute phase did not reduce the possibility of developing persistent symptoms. There was no difference in the referral rate to a pulmonary specialist or post--COVID-19 clinic between patients treated with OCS versus ICS. However, our data may not be generalizable to other populations, as it represents a patient population enrolled in a telemedicine program at a single center. Conclusions: We found that ICS, as compared to OCS, did not reduce the risk of developing persistent respiratory symptoms. This finding adds to the body of knowledge that ICS and OCS medications remain potent treatments in patients with acute and postacute COVID-19 seen in an outpatient setting. ", doi="10.2196/36023", url="https://formative.jmir.org/2023/1/e36023", url="http://www.ncbi.nlm.nih.gov/pubmed/36480687" } @Article{info:doi/10.2196/42895, author="Nguyen, Tue Trong and Ho, Tu Cam and Bui, Thu Huong Thi and Ho, Khanh Lam and Ta, Thanh Van", title="Multidimensional Machine Learning for Assessing Parameters Associated With COVID-19 in Vietnam: Validation Study", journal="JMIR Form Res", year="2023", month="Feb", day="16", volume="7", pages="e42895", keywords="COVID-19", keywords="multidimensional analysis", keywords="hierarchical cluster analysis", keywords="regression analysis", keywords="mild", keywords="moderate", keywords="severe", keywords="age", keywords="scoring index of chest x-ray", keywords="percentage and quantity of neutrophils", keywords="albumin", keywords="C-reactive protein", keywords="ratio of lymphocytes", abstract="Background: Machine learning (ML) is a type of artificial intelligence strategy. Its algorithms are used on big data sets to see patterns, learn from their results, and perform tasks autonomously without being instructed on how to address problems. New diseases like COVID-19 provide important data for ML. Therefore, all relevant parameters should be explicitly quantified and modeled. Objective: The purpose of this study was to determine (1) the overall preclinical characteristics, (2) the cumulative cutoff values and risk ratios (RRs), and (3) the factors associated with COVID-19 severity in unidimensional and multidimensional analyses involving 2173 SARS-CoV-2 patients. Methods: The study population consisted of 2173 patients (1587 mild status [mild group] and asymptomatic patients, 377 moderate status patients [moderate group], and 209 severe status patients [severe group]). The status of the patients was recorded from September 2021 to March 2022. Two correlation tests, relative risk, and RR were used to eliminate unbalanced parameters and select the most remarkable parameters. The independent methods of hierarchical cluster analysis and k-means were used to classify parameters according to their r values. Finally, network analysis provided a 3-dimensional view of the results. Results: COVID-19 severity was significantly correlated with age (mild-moderate group: RR 4.19, 95\% CI 3.58-4.95; P<.001), scoring index of chest x-ray (mild-moderate group: RR 3.29, 95\% CI 2.76-3.92; P<.001; moderate-severe group: RR 3.03, 95\% CI 2.4023-3.8314; P<.001), percentage of neutrophils (mild-moderate group: RR 3.18, 95\% CI 2.73-3.70; P<.001; moderate-severe group: RR 3.32, 95\% CI 2.6480-4.1529; P<.001), quantity of neutrophils (moderate-severe group: RR 3.15, 95\% CI 2.6153-3.8025; P<.001), albumin (moderate-severe group: RR 0.46, 95\% CI 0.3650-0.5752; P<.001), C-reactive protein (mild-moderate group: RR 3.4, 95\% CI 2.91-3.97; P<.001), and ratio of lymphocytes (moderate-severe group: RR 0.34, 95\% CI 0.2743-0.4210; P<.001). Significant inversion of correlations among the severity groups is important. Alanine transaminase and leucocytes showed a significant negative correlation (r=?1; P<.001) in the mild group and a significant positive correlation in the moderate group (r=1; P<.001). Transferrin and anion Cl showed a significant positive correlation (r=1; P<.001) in the mild group and a significant negative correlation in the moderate group (r=?0.59; P<.001). The clustering and network analysis showed that in the mild-moderate group, the closest neighbors of COVID-19 severity were ferritin and age. C-reactive protein, scoring index of chest x-ray, albumin, and lactate dehydrogenase were the next closest neighbors of these 3 factors. In the moderate-severe group, the closest neighbors of COVID-19 severity were ferritin, fibrinogen, albumin, quantity of lymphocytes, scoring index of chest x-ray, white blood cell count, lactate dehydrogenase, and quantity of neutrophils. Conclusions: This multidimensional study in Vietnam showed possible correlations between several elements and COVID-19 severity to provide clinical reference markers for surveillance and diagnostic management. ", doi="10.2196/42895", url="https://formative.jmir.org/2023/1/e42895", url="http://www.ncbi.nlm.nih.gov/pubmed/36668902" } @Article{info:doi/10.2196/40772, author="Aolymat, Iman and Abdul Kadir, Lina and Al Nsour, Mohannad and Taha, Hana", title="The Impact of the COVID-19 Pandemic on Female Sexual Function in Jordan: Cross-sectional Study", journal="JMIR Form Res", year="2023", month="Feb", day="16", volume="7", pages="e40772", keywords="COVID-19", keywords="pandemic", keywords="female sexual function", keywords="sexual dysfunction", keywords="stress physiology", keywords="Jordan", abstract="Background: Sexual function is a complex physiological process controlled by neurovascular and endocrine mechanisms that are affected by stressful events. The sexual response cycle consists of four main phases, which are sexual desire or libido, arousal or excitement, orgasm, and resolution. The COVID-19 outbreak is one of the most stressful events historically, causing several unpleasant consequences, including major physical and mental disorders, and sexual dysfunction and alteration in sexual behavior are possible anticipated consequences of the pandemic. Moreover, there are social taboos related to sexual behavior in Jordan, and the current knowledge on changes in Jordanian female sexual function during COVID-19 pandemic is limited. Objective: This study aims to evaluate the impact of COVID?19 on women's sexual function during the early COVID-19 pandemic in Jordan. Methods: This is a cross-sectional study that employed a web-based survey to follow 200 female individuals from the general population in Jordan. The survey evaluated sexual function both during COVID-19 and 6 months prior to the pandemic. The primary outcomes investigated in this study were the changes in sexual intercourse frequency and sexual function aspects, including desire, arousal, satisfaction, orgasm, lubrication, and pain during sexual activity. Data were analyzed using paired t test, McNemar test, Pearson correlations, and multiple linear regression using SPSS 25. Results: During the COVID-19 pandemic, the participants' sexual intercourse frequency increased while their sexual satisfaction was significantly changed. The proportion of participants who had 0-2 times per week of sexual intercourse was decreased during the COVID-19 pandemic compared with that before the pandemic (n=90, 45\% vs n=103, 51.5\%; P=.02). Conversely, the number of female individuals with 3-7 times per week of sexual intercourse increased after the pandemic compared with the prepandemic state (n=103, 51.5\% vs n=91, 45.5\%; P=.04). Female sexual satisfaction was significantly reduced after the COVID-19 pandemic compared with that before the pandemic (3.39 vs 3.30; P=.049). The other categories of sexual function, including desire, arousal, satisfaction, orgasm, lubrication, and dyspareunia showed no significant changes during the COVID-19 pandemic compared with the previous 6 months. There were no significant differences between the total sexual function mean scores during COVID-19 (15.73) compared with the prepandemic scores (15.85; P=.41). The total score of female sexual function during the pandemic was negatively associated with the participants' age and education level. Correlations between various demographics and sexual function categories during the COVID-19 pandemic were identified. Conclusions: This is the first study exploring female sexual function during the COVID-19 outbreak in Jordan. The results suggest that COVID-19--associated stress is influencing women's sexual function, necessitating the provision of adequate emotional and physiological well-being support for women during similar crises. ", doi="10.2196/40772", url="https://formative.jmir.org/2023/1/e40772", url="http://www.ncbi.nlm.nih.gov/pubmed/36745774" } @Article{info:doi/10.2196/42796, author="B{\o}nes, Erlend and Granja, Concei{\c{c}}{\~a}o and Solvoll, Terje", title="Experiences and Expectations of Information and Communication Technologies in Flexible Assertive Community Treatment Teams: Qualitative Study", journal="JMIR Form Res", year="2023", month="Feb", day="9", volume="7", pages="e42796", keywords="mental health", keywords="FACT", keywords="electronic health records", keywords="eHealth", keywords="EHR", keywords="electronic whiteboards", keywords="community", keywords="treatment", keywords="qualitative", keywords="COVID-19", keywords="patient care", keywords="mental illness", keywords="information technology", keywords="thematic analysis", keywords="data access", keywords="information and communication solutions", keywords="ICT", keywords="Norway", keywords="semistructured interviews", abstract="Background: Flexible Assertive Community Treatment (FACT) is a model of integrated care for patients with long-term serious mental illness. FACT teams deliver services using assertive outreach to treat patients who can be hard to reach by the health care service, and focus on both the patient's health and their social situation. However, in Norway, FACT team members have challenges with their information and communication (ICT) solutions. Objective: The aim of this study was to explore Norwegian FACT teams' experiences and expectations of their ICT solutions, including electronic health records, electronic whiteboards, and calendars. Methods: We gathered data in two phases. In the first phase, we conducted semistructured interviews with team leaders and team coordinators, and made observations in FACT teams targeting adults. In the second phase, we conducted semistructured group interviews in FACT teams targeting youth. We performed a thematic analysis of the data in a theoretical manner to address the specific objectives of the study. Results: A total of 8 teams were included, with 5 targeting adults and 3 targeting youth. Due to the COVID-19 pandemic, we were not able to perform observations in 2 of the teams targeting adults. Team leaders and coordinators in all 5 teams targeting adults were interviewed, with a total of 7 team members participating in the teams targeting youth. We found various challenges with communication, documentation, and organization for FACT teams. The COVID-19 pandemic was challenging for the teams and changed the way they used ICT solutions. There were issues with some technical solutions used in the teams, including electronic health records, electronic whiteboards, and calendars. Lack of integration and access to data were some of the main issues identified. Conclusions: Despite the FACT model being successfully implemented in Norway, there are several issues regarding the ICT solutions they use, mainly related to access to data and integration. Further research is required to detail how improved ICT solutions should be designed. While FACT teams targeting adults and youth differ in some ways, their needs for ICT solutions are largely similar. ", doi="10.2196/42796", url="https://formative.jmir.org/2023/1/e42796", url="http://www.ncbi.nlm.nih.gov/pubmed/36730062" } @Article{info:doi/10.2196/41877, author="Schneider, Margaret and Woodworth, Amanda and Mehrabadi, Asgari Milad", title="The Relationship Between Exercise Habits and Stress Among Individuals With Access to Internet-Connected Home Fitness Equipment: Single-Group Prospective Analysis", journal="JMIR Form Res", year="2023", month="Feb", day="8", volume="7", pages="e41877", keywords="stress", keywords="exercise", keywords="internet-connected home fitness equipment", keywords="physical activity", keywords="healthcare cost", keywords="health care", keywords="psychological well-being", keywords="COVID-19", keywords="online survey", keywords="user data", keywords="Peloton", abstract="Background: Physical activity (PA) confers numerous benefits to health and health care costs, yet most adults are not meeting recommended PA guidelines. Stress may be a factor that influences PA behavior. Research investigating the impact of stress on PA has yielded inconsistent findings. Most studies find that stress negatively impacts PA, but there is some evidence that habitual exercising buffers this association. Objective: This study aims to examine the relationship between stress and exercise habits among habitual exercisers with internet-connected home fitness equipment (Peloton Bike) during the COVID-19 lockdown. Methods: Participants were recruited through Facebook (N=146) and asked to complete an internet-based survey that assessed COVID-19--related stressors, perceived stress associated with those stressors, and general perceived stress. Self-reported exercise was assessed on the survey using the Godin Leisure-time Exercise Questionnaire (GLTEQ). Participants were also asked for consent to access their Peloton usage data through the Peloton platform. From their usage data, the frequency and duration of cycling classes was calculated for 4 weeks prior to and 12 weeks following the survey. Hierarchical regression equations tested the association between stress reported on the survey and subsequent exercise participation. Exercise participation was quantified both as the frequency and duration of Peloton cycling over the 12 weeks following the survey and as self-reported moderate to vigorous activity on a second survey completed by a subset of participants 12 weeks after the initial survey. Results: There were 146 participants in our Peloton analysis sample and 66 in the self-reported exercise analysis. Peloton user data showed that study participants cycled frequently (mean 5.9 times per week) in the month prior to the initial survey, and that presurvey Peloton use was a strong predictor of exercise frequency (R2=0.57; F2,143=95.27; P<.001) and duration (R2=0.58; F2,143=102.58; P<.001) for the 12 subsequent weeks. Self-reported overall exercise likewise showed that this sample was very active, with an average of more than 8 times per week of moderate to vigorous exercise at the initial survey. Self-reported exercise on the initial survey was a strong predictor of self-reported exercise 12 weeks later (R2=0.31; F1,64=29.03; P<.001). Perceived stress did not impact Peloton cycling duration or frequency (P=.81 and .76, respectively) or self-reported exercise (P=.28). Conclusions: The results suggest that stress did not negatively impact exercise participation among habitually active adults with access to internet-connected home fitness equipment. Habitual exercise may buffer the impact of stress on participation in regular moderate to vigorous activity. Future research should examine the role that the availability of home-based internet-connected exercise equipment may play in this buffering. ", doi="10.2196/41877", url="https://formative.jmir.org/2023/1/e41877", url="http://www.ncbi.nlm.nih.gov/pubmed/36719817" } @Article{info:doi/10.2196/39994, author="Yang, Liuqing and Ji, Lili and Wang, Qiang and Yang, Guoping and Xiu, Shixin and Cui, Tingting and Shi, Naiyang and Zhu, Lin and Xu, Xuepeng and Jin, Hui and Zhen, Shiqi", title="Understanding Drivers of Vaccine Hesitancy During the COVID-19 Pandemic Among Older Adults in Jiangsu Province, China: Cross-sectional Survey", journal="JMIR Form Res", year="2023", month="Feb", day="7", volume="7", pages="e39994", keywords="vaccine hesitancy", keywords="older adults", keywords="socioeconomic status", keywords="vaccination history", keywords="COVID-19", keywords="3Cs model", keywords="confidence, complacency, and convenience", abstract="Background: Older adults are particularly at risk from infectious diseases, including serve complications, hospitalization, and death. Objective: This study aimed to explore the drivers of vaccine hesitancy among older adults based on the ``3Cs'' (confidence, complacency, and convenience) framework, where socioeconomic status and vaccination history played the role of moderators. Methods: A cross-sectional questionnaire survey was conducted in Jiangsu Province, China, between June 1 and July 20, 2021. Older adults (aged ?60 years) were recruited using a stratified sampling method. Vaccine hesitancy was influenced by the 3Cs in the model. Socioeconomic status and vaccination history processed through the item parceling method were used to moderate associations between the 3Cs and hesitancy. Hierarchical regression analyses and structural equation modeling were used to test the validity of the new framework. We performed 5000 trials of bootstrapping to calculate the 95\% CI of the pathway's coefficients. Results: A total of 1341 older adults participated. The mean age was 71.3 (SD 5.4) years, and 44.7\% (599/1341) of participants were men. Confidence (b=0.967; 95\% CI 0.759-1.201; P=.002), convenience (b=0.458; 95\% CI 0.333-0.590; P=.002), and less complacency (b=0.301; 95\% CI 0.187-0.408; P=.002) were positively associated with less vaccine hesitancy. Socioeconomic status weakened the positive effect of low complacency (b=--0.065; P=.03) on low vaccine hesitancy. COVID-19 vaccination history negatively moderated the positive association between confidence (b=--0.071; P=.02) and lower vaccine hesitancy. Conclusions: Our study identified that confidence was the more influential dimension in reducing vaccine hesitancy among older adults. COVID-19 vaccination history, as well as confidence, had a positive association with less vaccine hesitancy and could weaken the role of confidence in vaccine hesitancy. Socioeconomic status had a substitution relationship with less complacency, which suggested a competitive positive association between them on less vaccine hesitancy. ", doi="10.2196/39994", url="https://formative.jmir.org/2023/1/e39994", url="http://www.ncbi.nlm.nih.gov/pubmed/36693149" } @Article{info:doi/10.2196/38555, author="Tan, Ying Jamaica Pei and Tan, J. Michelle W. and Towle, Marie Rachel and Lee, Win Joanne Sze and Lei, Xiaofeng and Liu, Yong and Goh, Mong Rick Siow and Chee Ping, Tan Franklin and Tan, Choon Teck and Ting, Wei Daniel Shu and Lee, Ee Chen and Low, Leng Lian", title="mHealth App to Facilitate Remote Care for Patients With COVID-19: Rapid Development of the DrCovid+ App", journal="JMIR Form Res", year="2023", month="Feb", day="7", volume="7", pages="e38555", keywords="mobile health", keywords="mHealth", keywords="rapid development", keywords="remote care", keywords="COVID-19", keywords="hospital-at-home", keywords="mobile app", keywords="app development", keywords="virtual care", keywords="Telegram service", keywords="clinical care", keywords="continuity of care", keywords="digital health", abstract="Background: The 2019 novel COVID-19 has severely burdened the health care system through its rapid transmission. Mobile health (mHealth) is a viable solution to facilitate remote monitoring and continuity of care for patients with COVID-19 in a home environment. However, the conceptualization and development of mHealth apps are often time and labor-intensive and are laden with concerns relating to data security and privacy. Implementing mHealth apps is also a challenging feat as language-related barriers limit adoption, whereas its perceived lack of benefits affects sustained use. The rapid development of an mHealth app that is cost-effective, secure, and user-friendly will be a timely enabler. Objective: This project aimed to develop an mHealth app, DrCovid+, to facilitate remote monitoring and continuity of care for patients with COVID-19 by using the rapid development approach. It also aimed to address the challenges of mHealth app adoption and sustained use. Methods: The Rapid Application Development approach was adopted. Stakeholders including decision makers, physicians, nurses, health care administrators, and research engineers were engaged. The process began with requirements gathering to define and finalize the project scope, followed by an iterative process of developing a working prototype, conducting User Acceptance Tests, and improving the prototype before implementation. Co-designing principles were applied to ensure equal collaborative efforts and collective agreement among stakeholders. Results: DrCovid+ was developed on Telegram Messenger and hosted on a cloud server. It features a secure patient enrollment and data interface, a multilingual communication channel, and both automatic and personalized push messaging. A back-end dashboard was also developed to collect patients' vital signs for remote monitoring and continuity of care. To date, 400 patients have been enrolled into the system, amounting to 2822 hospital bed--days saved. Conclusions: The rapid development and implementation of DrCovid+ allowed for timely clinical care management for patients with COVID-19. It facilitated early patient hospital discharge and continuity of care while addressing issues relating to data security and labor-, time-, and cost-effectiveness. The use case for DrCovid+ may be extended to other medical conditions to advance patient care and empowerment within the community, thereby meeting existing and rising population health challenges. ", doi="10.2196/38555", url="https://formative.jmir.org/2023/1/e38555", url="http://www.ncbi.nlm.nih.gov/pubmed/36649223" } @Article{info:doi/10.2196/41729, author="Shi, Yueping and Gu, Pinhua and Wang, Qiufeng and Zhang, Xuelian", title="The Nurse-Physician Relationship During the COVID-19 Pandemic in Shanghai, China: Cross-sectional Study", journal="JMIR Form Res", year="2023", month="Feb", day="6", volume="7", pages="e41729", keywords="nurse", keywords="physician", keywords="collaboration", keywords="online survey", keywords="nursing", keywords="COVID-19", keywords="structural equation modeling", keywords="equation modeling", keywords="nurse-physician", keywords="ordinal logistic regression", abstract="Background: The nurse-physician relationship is important for the stability of collaboration. The COVID-19 pandemic has put unprecedented pressure on the health care system and has placed greater demands on nurse-physician collaboration. Nurses and physicians often struggle to share mutual responsibility and communicate effectively. Objective: This study aimed to evaluate the relationship between nurses and physicians during the COVID-19 pandemic and construct a new model combining the attitude and behaviors of the 2 groups to assess various factors' impacts on job satisfaction and confrontational behavior. Methods: We conducted this quantitative cross-sectional study to assess the relationship between nurses and physicians based on the attitudes and behaviors toward nurse-physician collaboration. We first investigated the satisfaction of nurses and physicians with their relationship and how they thought the COVID-19 pandemic had affected that relationship. We used an adapted and modified Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration questionnaire that consisted of 17 items under 5 dimensions. Structural equation modeling was used to assess the relationships between domains. Ordinal logistic regression was used to evaluate the relationship between different domains of the questionnaire and the satisfaction of the current nurse-physician relationship. Results: We included a total of 176 nurses and 124 physicians in this study. Compared to 7.2\% (9/124) of physicians, 22.7\% (40/176) of nurses were dissatisfied with the current nurse-physician relationship. Most physicians (101/124, 81.5\%) and nurses (131/176, 74.5\%) agreed that the nurse-physician relationship had become better because of the COVID-19 pandemic and that the public had greater respect for them. However, significantly fewer nurses (59/176, 33.5\% vs 79/124, 63.7\%; P<.001) thought that physicians and nurses were treated with the same respect. Nurses scored significantly higher scores in caring versus curing (mean 16.27, SD 2.88 vs mean 17.43, SD 2.50; P<.001) and physician's authority (mean 8.72, SD 3.21 vs mean 7.24, SD 3.32; P<.001) subscales compared with physicians. The shared education and collaboration subscale had a significantly positive relationship with the nurse's autonomy subscale (standardized coefficient=0.98; P<.001). Logistic regression showed that 4 subscales (shared education and collaboration: P<.001; caring versus curing: P<.001; nurse's autonomy: P<.001; and confrontation: P=.01) were significantly associated with the level of satisfaction of the current nurse-physician relationship. Conclusions: This study showed that nurses were more dissatisfied with the current nurse-physician relationship than physicians in Shanghai. Policy makers and managers in the medical and educational system should emphasize an interprofessional collaboration between nurses and physicians. Positive attitudes toward shared collaboration and responsibility may help to improve the relationship between the 2 parties. ", doi="10.2196/41729", url="https://formative.jmir.org/2023/1/e41729", url="http://www.ncbi.nlm.nih.gov/pubmed/36745499" } @Article{info:doi/10.2196/34074, author="Shamiyah, Adnan Khalid and Whitebridge, Simon and Kumar, Nitya and Aljenaee, Khaled and Atkin, L. Stephen and Ali, Fuad Khawla", title="The Impact of COVID-19 on the Prevalence and Perception of Telehealth Use in the Middle East and North Africa Region: Survey Study", journal="JMIR Form Res", year="2023", month="Feb", day="2", volume="7", pages="e34074", keywords="COVID-19", keywords="telehealth", keywords="Instagram", keywords="WhatsApp", keywords="social media", keywords="telemedicine", keywords="impact", keywords="prevalence", keywords="perception", keywords="view", keywords="usage", keywords="utilization", keywords="safety", keywords="acceptability", keywords="survey", abstract="Background: Due to the COVID-19 pandemic, telehealth has become a safer way to access health care. The telehealth industry has rapidly expanded over the last decade as a modality to provide patient-centered care. However, the prevalence of its use and patient acceptability remains unclear in the Middle East and North Africa (MENA) region. Objective: The primary aim was to assess the prevalence of telehealth use before and during the pandemic by using social media (Instagram) as an online platform for survey administration across different countries simultaneously. Our secondary aim was to assess the perceptions regarding telehealth among those using it. Methods: An Instagram account that reaches 130,000 subjects daily was used to administer a questionnaire that assessed the current prevalence of telehealth use and public attitudes and acceptability toward this modality of health care delivery during the COVID-19 pandemic. Results: A total of 1524 respondents participated in the survey (n=1356, 89\% female; median age 31 years), of whom 97.6\% (n=1487) lived in the Gulf Cooperation Council (GCC) region. Prior to COVID-19, 1350 (88.6\%) had no exposure to telehealth. Following the COVID-19 pandemic, telehealth use increased by 251\% to a total of 611 users (40\% of all users). About 89\% (571/640) of telehealth users used virtual visits for specialist visits. Of the 642 participants who reported using telehealth, 236 (36.8\%) reported their willingness to continue using telehealth, 241 (37.5\%) were unsure, and 164 (25.5\%) did not wish to continue to use telehealth after the COVID-19 pandemic. An inverse trend, although not statistically significant, was seen between willingness to continue telehealth use and the number of medical comorbidities (odds ratio [OR] 0.81, 95\% CI 0.64-1.03; P=.09). Compared to the respondents who chose only messaging as the modality they used for telehealth, respondents who chose both messaging and phone calls were significantly less likely to recommend telehealth (OR 0.42, 95\% CI 0.22-0.80; P=.009). Overall, there was general satisfaction with telehealth, and respondents reported that telehealth consultations made them feel safer and saved both time and money. Conclusions: Telehealth use increased dramatically after the COVID-19 pandemic, and telehealth was found to be acceptable among some young adult groups on Instagram. However, further innovation is warranted to increase acceptability and willingness to continue telehealth use for the delivery of health care. ", doi="10.2196/34074", url="https://formative.jmir.org/2023/1/e34074", url="http://www.ncbi.nlm.nih.gov/pubmed/36652596" } @Article{info:doi/10.2196/41913, author="Sinha, Chaitali and Meheli, Saha and Kadaba, Madhura", title="Understanding Digital Mental Health Needs and Usage With an Artificial Intelligence--Led Mental Health App (Wysa) During the COVID-19 Pandemic: Retrospective Analysis", journal="JMIR Form Res", year="2023", month="Jan", day="26", volume="7", pages="e41913", keywords="digital mental health", keywords="COVID-19", keywords="engagement", keywords="retention", keywords="perceived needs", keywords="pandemic waves", keywords="chatbot", keywords="conversational agent", keywords="mental health app", keywords="mobile health", keywords="digital health intervention", abstract="Background: There has been a surge in mental health concerns during the COVID-19 pandemic, which has prompted the increased use of digital platforms. However, there is little known about the mental health needs and behaviors of the global population during the pandemic. This study aims to fill this knowledge gap through the analysis of real-world data collected from users of a digital mental health app (Wysa) regarding their engagement patterns and behaviors, as shown by their usage of the service. Objective: This study aims to (1) examine the relationship between mental health distress, digital health uptake, and COVID-19 case numbers; (2) evaluate engagement patterns with the app during the study period; and (3) examine the efficacy of the app in improving mental health outcomes for its users during the pandemic. Methods: This study used a retrospective observational design. During the COVID-19 pandemic, the app's installations and emotional utterances were measured from March 2020 to October 2021 for the United Kingdom, the United States of America, and India and were mapped against COVID-19 case numbers and their peaks. The engagement of the users from this period (N=4541) with the Wysa app was compared to that of equivalent samples of users from a pre--COVID-19 period (1000 iterations). The efficacy was assessed for users who completed pre-post assessments for symptoms of depression (n=2061) and anxiety (n=1995) on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) test measures, respectively. Results: Our findings demonstrate a significant positive correlation between the increase in the number of installs of the Wysa mental health app and the peaks of COVID-19 case numbers in the United Kingdom (P=.02) and India (P<.001). Findings indicate that users (N=4541) during the COVID period had a significantly higher engagement than the samples from the pre-COVID period, with a medium to large effect size for 80\% of these 1000 iterative samples, as observed on the Mann-Whitney test. The PHQ-9 and GAD-7 pre-post assessments indicated statistically significant improvement with a medium effect size (PHQ-9: P=.57; GAD-7: P=.56). Conclusions: This study demonstrates that emotional distress increased substantially during the pandemic, prompting the increased uptake of an artificial intelligence--led mental health app (Wysa), and also offers evidence that the Wysa app could support its users and its usage could result in a significant reduction in symptoms of anxiety and depression. This study also highlights the importance of contextualizing interventions and suggests that digital health interventions can provide large populations with scalable and evidence-based support for mental health care. ", doi="10.2196/41913", url="https://formative.jmir.org/2023/1/e41913", url="http://www.ncbi.nlm.nih.gov/pubmed/36540052" } @Article{info:doi/10.2196/39045, author="Perez-Ramos, G. Jose and Leon-Thomas, Mariela and Smith, L. Sabrina and Silverman, Laura and Perez-Torres, Claudia and Hall, C. Wyatte and Iadarola, Suzannah", title="COVID-19 Vaccine Equity and Access: Case Study for Health Care Chatbots", journal="JMIR Form Res", year="2023", month="Jan", day="25", volume="7", pages="e39045", keywords="mHealth", keywords="ICT", keywords="Information and Communication Technology", keywords="community", keywords="chatbot", keywords="COVID-19", keywords="health equity", keywords="mobile health", keywords="health outcome", keywords="health disparity", keywords="minority population", keywords="health care gap", keywords="chatbot tool", keywords="user experience", keywords="chatbot development", keywords="health information", abstract="Background: Disparities in COVID-19 information and vaccine access have emerged during the pandemic. Individuals from historically excluded communities (eg, Black and Latin American) experience disproportionately negative health outcomes related to COVID-19. Community gaps in COVID-19 education, social, and health care services (including vaccines) should be prioritized as a critical effort to end the pandemic. Misinformation created by the politicization of COVID-19 and related public health measures has magnified the pandemic's challenges, including access to health care, vaccination and testing efforts, as well as personal protective equipment. Information and Communication Technology (ICT) has been demonstrated to reduce the gaps of marginalization in education and access among communities. Chatbots are an increasingly present example of ICTs, particularly in health care and in relation to the COVID-19 pandemic. Objective: This project aimed to (1) follow an inclusive and theoretically driven design process to develop and test a COVID-19 information ICT bilingual (English and Spanish) chatbot tool named ``Ana'' and (2) characterize and evaluate user experiences of these innovative technologies. Methods: Ana was developed following a multitheoretical framework, and the project team was comprised of public health experts, behavioral scientists, community members, and medical team. A total of 7 iterations of {\ss} chatbots were tested, and a total of 22 {\ss} testers participated in this process. Content was curated primarily to provide users with factual answers to common questions about COVID-19. To ensure relevance of the content, topics were driven by community concerns and questions, as ascertained through research. Ana's repository of educational content was based on national and international organizations as well as interdisciplinary experts. In the context of this development and pilot project, we identified an evaluation framework to explore reach, engagement, and satisfaction. Results: A total of 626 community members used Ana from August 2021 to March 2022. Among those participants, 346 used the English version, with an average of 43 users per month; and 280 participants used the Spanish version, with an average of 40 users monthly. Across all users, 63.87\% (n=221) of English users and 22.14\% (n=62) of Spanish users returned to use Ana at least once; 18.49\% (n=64) among the English version users and 18.57\% (n=52) among the Spanish version users reported their ranking. Positive ranking comprised the ``smiley'' and ``loved'' emojis, and negative ranking comprised the ``neutral,'' ``sad,'' and ``mad'' emojis. When comparing negative and positive experiences, the latter was higher across Ana's platforms (English: n=41, 64.06\%; Spanish: n=41, 77.35\%) versus the former (English: n=23, 35.93\%; Spanish: n=12, 22.64\%). Conclusions: This pilot project demonstrated the feasibility and capacity of an innovative ICT to share COVID-19 information within diverse communities. Creating a chatbot like Ana with bilingual content contributed to an equitable approach to address the lack of accessible COVID-19--related information. ", doi="10.2196/39045", url="https://formative.jmir.org/2023/1/e39045", url="http://www.ncbi.nlm.nih.gov/pubmed/36630649" } @Article{info:doi/10.2196/38500, author="Wlasak, Wendy and Zwanenburg, Paul Sander and Paton, Chris", title="Supporting Autonomous Motivation for Physical Activity With Chatbots During the COVID-19 Pandemic: Factorial Experiment", journal="JMIR Form Res", year="2023", month="Jan", day="25", volume="7", pages="e38500", keywords="autonomous motivation", keywords="chatbots", keywords="self-determination theory", keywords="physical activity", keywords="factorial experiment", keywords="mobile phone", keywords="COVID-19", abstract="Background: Although physical activity can mitigate disease trajectories and improve and sustain mental health, many people have become less physically active during the COVID-19 pandemic. Personal information technology, such as activity trackers and chatbots, can technically converse with people and possibly enhance their autonomous motivation to engage in physical activity. The literature on behavior change techniques (BCTs) and self-determination theory (SDT) contains promising insights that can be leveraged in the design of these technologies; however, it remains unclear how this can be achieved. Objective: This study aimed to evaluate the feasibility of a chatbot system that improves the user's autonomous motivation for walking based on BCTs and SDT. First, we aimed to develop and evaluate various versions of a chatbot system based on promising BCTs. Second, we aimed to evaluate whether the use of the system improves the autonomous motivation for walking and the associated factors of need satisfaction. Third, we explored the support for the theoretical mechanism and effectiveness of various BCT implementations. Methods: We developed a chatbot system using the mobile apps Telegram (Telegram Messenger Inc) and Google Fit (Google LLC). We implemented 12 versions of this system, which differed in 3 BCTs: goal setting, experimenting, and action planning. We then conducted a feasibility study with 102 participants who used this system over the course of 3 weeks, by conversing with a chatbot and completing questionnaires, capturing their perceived app support, need satisfaction, physical activity levels, and motivation. Results: The use of the chatbot systems was satisfactory, and on average, its users reported increases in autonomous motivation for walking. The dropout rate was low. Although approximately half of the participants indicated that they would have preferred to interact with a human instead of the chatbot, 46.1\% (47/102) of the participants stated that the chatbot helped them become more active, and 42.2\% (43/102) of the participants decided to continue using the chatbot for an additional week. Furthermore, the majority thought that a more advanced chatbot could be very helpful. The motivation was associated with the satisfaction of the needs of competence and autonomy, and need satisfaction, in turn, was associated with the perceived system support, providing support for SDT underpinnings. However, no substantial differences were found across different BCT implementations. Conclusions: The results provide evidence that chatbot systems are a feasible means to increase autonomous motivation for physical activity. We found support for SDT as a basis for the design, laying a foundation for larger studies to confirm the effectiveness of the selected BCTs within chatbot systems, explore a wider range of BCTs, and help the development of guidelines for the design of interactive technology that helps users achieve long-term health benefits. ", doi="10.2196/38500", url="https://formative.jmir.org/2023/1/e38500", url="http://www.ncbi.nlm.nih.gov/pubmed/36512402" } @Article{info:doi/10.2196/43639, author="Kittipimpanon, Kamonrat and Noyudom, Angun and Panjatharakul, Pawanrat and Visudtibhan, Janepanish Poolsuk", title="Use of and Satisfaction With Mobile Health Education During the COVID-19 Pandemic in Thailand: Cross-sectional Study", journal="JMIR Form Res", year="2023", month="Jan", day="24", volume="7", pages="e43639", keywords="mHealth", keywords="COVID-19", keywords="chatbot", keywords="use", keywords="satisfaction", abstract="Background: RamaCovid is a mobile health (mHealth) education system that provides the Thai population with information about COVID-19 and self-risk assessment. RamaCovid has a chatbot system that provides automatic conversations (available 24 hours per day) and a live chat function that allows users to directly communicate with health professionals (available 4 hours per day in the evening). The system consists of (1) COVID-19 vaccine information, (2) self-care after vaccination, (3) frequently asked questions, (4) self-risk assessment, (5) hospital finding, (6) contact number finding, and (7) live chat with a health professional. Objective: This study investigates the use of and satisfaction with the RamaCovid system. Methods: Overall, 400 people were recruited via RamaCovid by broadcasting an infographic about the study. Questionnaires collected demographic data, users' experiences of RamaCovid, and the use of and satisfaction with the system. The questions were answered using a 5-point Likert scale. Descriptive statistics were used to describe the participant characteristics and their use of and satisfaction with the RamaCovid system. The Mann-Whitney U test was performed to examine the difference in use and satisfaction between the adult and older adult groups. Results: The participants showed high use of and satisfaction with the RamaCovid system. They used the information to take care of themselves and their family, and they gained information about their COVID-19 risk. The users were satisfied with the system because the information was easy to understand, trustworthy, and up to date. However, the older adult group had lower use of and satisfaction with the system compared to the adult group. Conclusions: RamaCovid is an example of the successful implementation of mHealth education. It was an alternative way to work with the call center during the COVID-19 pandemic and increased access to health information and health care services. Providing ongoing updated information, improving the attractiveness of the media information, and the age group difference are important issues for further system development. ", doi="10.2196/43639", url="https://formative.jmir.org/2023/1/e43639", url="http://www.ncbi.nlm.nih.gov/pubmed/36596210" } @Article{info:doi/10.2196/43905, author="Hoogendoorn, Petra and Versluis, Anke and van Kampen, Sanne and McCay, Charles and Leahy, Matt and Bijlsma, Marlou and Bonacina, Stefano and Bonten, Tobias and Bonthuis, Marie-Jos{\'e} and Butterlin, Anouk and Cobbaert, Koen and Duijnhoven, Thea and Hallensleben, Cynthia and Harrison, Stuart and Hastenteufel, Mark and Holappa, Terhi and Kokx, Ben and Morlion, Birgit and Pauli, Norbert and Ploeg, Frank and Salmon, Mark and Schnoor, Kyma and Sharp, Mary and Sottile, Angelo Pier and V{\"a}rri, Alpo and Williams, Patricia and Heidenreich, Georg and Oughtibridge, Nicholas and Stegwee, Robert and Chavannes, H. Niels", title="What Makes a Quality Health App---Developing a Global Research-Based Health App Quality Assessment Framework for CEN-ISO/TS 82304-2: Delphi Study", journal="JMIR Form Res", year="2023", month="Jan", day="23", volume="7", pages="e43905", keywords="health app", keywords="wellness app", keywords="mobile health", keywords="mHealth", keywords="Delphi technique", keywords="quality assessment", keywords="assessment framework", keywords="standard", keywords="standardization", keywords="COVID-19", abstract="Background: The lack of an international standard for assessing and communicating health app quality and the lack of consensus about what makes a high-quality health app negatively affect the uptake of such apps. At the request of the European Commission, the international Standard Development Organizations (SDOs), European Committee for Standardization, International Organization for Standardization, and International Electrotechnical Commission have joined forces to develop a technical specification (TS) for assessing the quality and reliability of health and wellness apps. Objective: This study aimed to create a useful, globally applicable, trustworthy, and usable framework to assess health app quality. Methods: A 2-round Delphi technique with 83 experts from 6 continents (predominantly Europe) participating in one (n=42, 51\%) or both (n=41, 49\%) rounds was used to achieve consensus on a framework for assessing health app quality. Aims included identifying the maximum 100 requirement questions for the uptake of apps that do or do not qualify as medical devices. The draft assessment framework was built on 26 existing frameworks, the principles of stringent legislation, and input from 20 core experts. A follow-up survey with 28 respondents informed a scoring mechanism for the questions. After subsequent alignment with related standards, the quality assessment framework was tested and fine-tuned with manufacturers of 11 COVID-19 symptom apps. National mirror committees from the 52 countries that participated in the SDO technical committees were invited to comment on 4 working drafts and subsequently vote on the TS. Results: The final quality assessment framework includes 81 questions, 67 (83\%) of which impact the scores of 4 overarching quality aspects. After testing with people with low health literacy, these aspects were phrased as ``Healthy and safe,'' ``Easy to use,'' ``Secure data,'' and ``Robust build.'' The scoring mechanism enables communication of the quality assessment results in a health app quality score and label, alongside a detailed report. Unstructured interviews with stakeholders revealed that evidence and third-party assessment are needed for health app uptake. The manufacturers considered the time needed to complete the assessment and gather evidence (2-4 days) acceptable. Publication of CEN-ISO/TS 82304-2:2021 Health software -- Part 2: Health and wellness apps -- Quality and reliability was approved in May 2021 in a nearly unanimous vote by 34 national SDOs, including 6 of the 10 most populous countries worldwide. Conclusions: A useful and usable international standard for health app quality assessment was developed. Its quality, approval rate, and early use provide proof of its potential to become the trusted, commonly used global framework. The framework will help manufacturers enhance and efficiently demonstrate the quality of health apps, consumers, and health care professionals to make informed decisions on health apps. It will also help insurers to make reimbursement decisions on health apps. ", doi="10.2196/43905", url="https://formative.jmir.org/2023/1/e43905", url="http://www.ncbi.nlm.nih.gov/pubmed/36538379" } @Article{info:doi/10.2196/37811, author="Baldwin, M. Molly and Daynes, Enya and Chaplin, Emma and Goddard, Amye and Lloyd-Evans, I. Phoebe H. and Mills, George and Hong, Annabel and Gardiner, Nikki and Singh, J. Sally", title="Public Use of the ``Your COVID Recovery'' Website Designed to Help Individuals Manage Their COVID-19 Recovery: Observational Study", journal="JMIR Form Res", year="2023", month="Jan", day="20", volume="7", pages="e37811", keywords="COVID-19", keywords="coronavirus", keywords="pandemic", keywords="symptom management", keywords="digital healthcare", keywords="Google Analytics", keywords="website analysis", keywords="digital health tool", keywords="user behavior", keywords="healthcare platform", abstract="Background: At the start of the COVID-19 pandemic, unprecedented pressure was placed on health care services globally. An opportunity to alleviate this pressure was to introduce a digital health platform that provided COVID-19--related advice and helped individuals understand and manage their COVID-19 symptoms. Therefore, in July 2020, the Your COVID Recovery website was launched by the National Health Service of England with the aim of creating a practical tool that provides advice and support to individuals recovering from COVID-19. The website includes information on many of the key COVID-19 symptoms. To date, public use of the Your COVID Recovery website and user behavior remain unknown. However, this information is likely to afford insight into the impact of the website and most commonly experienced COVID-19 symptoms. Objective: This study aimed to evaluate public use of the Your COVID Recovery website, a digital health platform that provides support to individuals recovering from COVID-19, and determine user behavior during its first year of operation. Methods: Google Analytics software that was integrated into the Your COVID Recovery website was used to assess website use and user behavior between July 31, 2020, and July 31, 2021. Variables that were tracked included the number of users, user country of residence, traffic source, number of page views, number of session views, and mean session duration. User data were compared to COVID-19 case data downloaded from the UK government's website. Results: During the study period, 2,062,394 users accessed the Your COVID Recovery website. The majority of users were located in the United Kingdom (1,265,061/2,062,394, 61.30\%) and accessed the website via a search engine (1,443,057/2,062,394, 69.97\%). The number of daily website users (n=15,298) peaked on January 18, 2021, during the second wave of COVID-19 in the United Kingdom. The most frequently visited pages after the home page were for the following COVID-19 symptoms: Cough (n=550,190, 12.17\%), Fatigue (n=432,421, 9.56\%), Musculoskeletal pain (n=406,859, 9.00\%), Taste and smell (n=270,599, 5.98\%), and Breathlessness (n=203,136, 4.49\%). The average session duration was 1 minute 13 seconds. Conclusions: A large cohort of individuals actively sought help with their COVID-19 recovery from the website, championing the potential of this tool to target an unmet health care need. User behavior demonstrated that individuals were primarily seeking advice on how to relieve and manage COVID-19 symptoms, especially symptoms of cough, fatigue, and musculoskeletal pain. COVID-19 rehabilitation programs should use the results of this study to ensure that the program content meets the needs of the post--COVID-19 population. ", doi="10.2196/37811", url="https://formative.jmir.org/2023/1/e37811", url="http://www.ncbi.nlm.nih.gov/pubmed/36626648" } @Article{info:doi/10.2196/39231, author="Rao, Suchitra and Bozio, Catherine and Butterfield, Kristen and Reynolds, Sue and Reese, E. Sarah and Ball, Sarah and Steffens, Andrea and Demarco, Maria and McEvoy, Charlene and Thompson, Mark and Rowley, Elizabeth and Porter, M. Rachael and Fink, V. Rebecca and Irving, A. Stephanie and Naleway, Allison", title="Accuracy of COVID-19--Like Illness Diagnoses in Electronic Health Record Data: Retrospective Cohort Study", journal="JMIR Form Res", year="2023", month="Jan", day="17", volume="7", pages="e39231", keywords="COVID-19", keywords="COVID-like illness", keywords="COVID-19 case definition", keywords="sensitivity", keywords="specificity", keywords="positive predictive value", keywords="negative predictive value", abstract="Background: Electronic health record (EHR) data provide a unique opportunity to study the epidemiology of COVID-19, clinical outcomes of the infection, comparative effectiveness of therapies, and vaccine effectiveness but require a well-defined computable phenotype of COVID-19--like illness (CLI). Objective: The objective of this study was to evaluate the performance of pathogen-specific and other acute respiratory illness (ARI) International Statistical Classification of Diseases-9 and -10 codes in identifying COVID-19 cases in emergency department (ED) or urgent care (UC) and inpatient settings. Methods: We conducted a retrospective observational cohort study using EHR, claims, and laboratory information system data of ED or UC and inpatient encounters from 4 health systems in the United States. Patients who were aged ?18 years, had an ED or UC or inpatient encounter for an ARI, and underwent a SARS-CoV-2 polymerase chain reaction test between March 1, 2020, and March 31, 2021, were included. We evaluated various CLI definitions using combinations of International Statistical Classification of Diseases-10 codes as follows: COVID-19--specific codes; CLI definition used in VISION network studies; ARI signs, symptoms, and diagnosis codes only; signs and symptoms of ARI only; and random forest model definitions. We evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of each CLI definition using a positive SARS-CoV-2 polymerase chain reaction test as the reference standard. We evaluated the performance of each CLI definition for distinct hospitalization and ED or UC cohorts. Results: Among 90,952 hospitalizations and 137,067 ED or UC visits, 5627 (6.19\%) and 9866 (7.20\%) were positive for SARS-CoV-2, respectively. COVID-19--specific codes had high sensitivity (91.6\%) and specificity (99.6\%) in identifying patients with SARS-CoV-2 positivity among hospitalized patients. The VISION CLI definition maintained high sensitivity (95.8\%) but lowered specificity (45.5\%). By contrast, signs and symptoms of ARI had low sensitivity and positive predictive value (28.9\% and 11.8\%, respectively) but higher specificity and negative predictive value (85.3\% and 94.7\%, respectively). ARI diagnoses, signs, and symptoms alone had low predictive performance. All CLI definitions had lower sensitivity for ED or UC encounters. Random forest approaches identified distinct CLI definitions with high performance for hospital encounters and moderate performance for ED or UC encounters. Conclusions: COVID-19--specific codes have high sensitivity and specificity in identifying adults with positive SARS-CoV-2 test results. Separate combinations of COVID-19-specific codes and ARI codes enhance the utility of CLI definitions in studies using EHR data in hospital and ED or UC settings. ", doi="10.2196/39231", url="https://formative.jmir.org/2023/1/e39231", url="http://www.ncbi.nlm.nih.gov/pubmed/36383633" } @Article{info:doi/10.2196/40291, author="Kaplan, Samantha and von Isenburg, Megan and Waldrop, Lucy", title="Prepandemic Antivaccination Websites' COVID-19 Vaccine Behavior: Content Analysis of Archived Websites", journal="JMIR Form Res", year="2023", month="Jan", day="11", volume="7", pages="e40291", keywords="antivaccination behavior", keywords="web archiving", keywords="content analysis", keywords="COVID-19 vaccines", keywords="COVID-19", keywords="vaccine", keywords="website", keywords="web", keywords="pandemic", keywords="safety", keywords="science", keywords="content", abstract="Background: The onset of the COVID-19 pandemic and the concurrent development of vaccines offered a rare and somewhat unprecedented opportunity to study antivaccination behavior as it formed over time via the use of archived versions of websites. Objective: This study aims to assess how existing antivaccination websites modified their content to address COVID-19 vaccines and pandemic restrictions. Methods: Using a preexisting collection of 25 antivaccination websites curated by the IvyPlus Web Collection Program prior to the pandemic and crawled every 6 months via Archive-It, we conducted a content analysis to see how these websites acknowledged or ignored COVID-19 vaccines and pandemic restrictions. Websites were assessed for financial behaviors such as having storefronts, mention of COVID-19 vaccines in general or by manufacturer name, references to personal freedom such as masking, safety concerns like side effects, and skepticism of science. Results: The majority of websites addressed COVID-19 vaccines in a negative fashion, with more websites making appeals to personal freedom or expressing skepticism of science than questioning safety. This can potentially be attributed to the lack of available safety data about the vaccines at the time of data collection. Many of the antivaccination websites we evaluated actively sought donations and had a membership option, evidencing these websites have financial motivations and actively build a community around these issues. The content analysis also offered the opportunity to test the viability of archived websites for use in scholarly research. The archived versions of the websites had significant shortcomings, particularly in search functionality, and required supplementation with the live websites. For web archiving to be a viable source of stand-alone content for research, the technology needs to make significant improvements in its capture abilities. Conclusions: In summary, we found antivaccination websites existing prior to the COVID-19 pandemic largely adapted their messaging to address COVID-19 vaccines with very few sites ignoring the pandemic altogether. This study also demonstrated the timely and significant need for more robust web archiving capabilities as web-based environments become more ephemeral and unstable. ", doi="10.2196/40291", url="https://formative.jmir.org/2023/1/e40291", url="http://www.ncbi.nlm.nih.gov/pubmed/36548948" } @Article{info:doi/10.2196/37587, author="Ishigaki, Yo and Yokogawa, Shinji and Minamoto, Yuki and Saito, Akira and Kitamura, Hiroko and Kawauchi, Yuto", title="Pilot Evaluation of Possible Airborne Transmission in a Geriatric Care Facility Using Carbon Dioxide Tracer Gas: Case Study", journal="JMIR Form Res", year="2022", month="Dec", day="30", volume="6", number="12", pages="e37587", keywords="nursing home", keywords="care home", keywords="airborne transmission", keywords="ventilation frequency", keywords="air change rate", keywords="ACR", keywords="computational fluid dynamics", keywords="CFD", keywords="mobile phone", abstract="Background: Although several COVID-19 outbreaks have occurred in older adult care facilities throughout Japan, no field studies focusing on airborne infections within these settings have been reported. Countermeasures against airborne infection not only consider the air change rate (ACR) in a room but also the airflow in and between rooms. However, a specific method has not yet been established by Japanese public health centers or infectious disease--related organizations. Objective: In April 2021, 59 COVID-19 cases were reported in an older adult care facility in Miyagi, Japan, and airborne transmission was suspected. The objective of this study was to simultaneously reproduce the ACR and aerosol advection in this facility using the carbon dioxide (CO2) tracer gas method to elucidate the specific location and cause of the outbreak. These findings will guide our recommendations to the facility to prevent recurrence. Methods: In August 2021, CO2 sensors were placed in 5 rooms where airborne infection was suspected, and the CO2 concentration was intentionally increased using dry ice, which was subsequently removed. The ACR was then estimated by applying the Seidel equation to the time-series changes in the CO2 concentration due to ventilation. By installing multiple sensors outside the room, advection outside the room was monitored simultaneously. Aerosol advection was verified using computer simulations. Although the windows were closed at the time of the outbreak, we conducted experiments under open-window conditions to quantify the effects of window opening. Results: The ACR values at the time of the outbreak were estimated to be 2.0 to 6.8 h?1 in the rooms of the facility. A low-cost intervention of opening windows improved the ventilation frequency by a factor of 2.2 to 5.7. Ventilation depended significantly on the window-opening conditions (P values ranging from .001 to .03 for all rooms). Aerosol advection was detected from the private room to the day room in agreement with the simulation results. Considering that the individual who initiated the infection was in the private room on the day of infection, and several residents, who later became secondarily infected, were gathered in the day room, it was postulated that the infectious aerosol was transmitted by this air current. Conclusions: The present results suggest that secondary infections can occur owing to aerosol advection driven by large-scale flow, even when the building design adheres to the ventilation guidelines established in Japan. Moreover, the CO2 tracer gas method facilitates the visualization of areas at a high risk of airborne infection and demonstrates the effectiveness of window opening, which contributes to improved facility operations and recurrence prevention. ", doi="10.2196/37587", url="https://formative.jmir.org/2022/12/e37587", url="http://www.ncbi.nlm.nih.gov/pubmed/36583933" } @Article{info:doi/10.2196/37533, author="Konteh, Hassan Frederick and Mannion, Russell and Jacobs, Rowena", title="IT and the Quality and Efficiency of Mental Health Care in a Time of COVID-19: Case Study of Mental Health Providers in England", journal="JMIR Form Res", year="2022", month="Dec", day="29", volume="6", number="12", pages="e37533", keywords="COVID-19", keywords="mental health care", keywords="information technology", keywords="digital", keywords="inequalities", keywords="sociotechnical systems", abstract="Background: In England, COVID-19 has significantly affected mental health care and tested the resilience of health care providers. In many areas, the increased use of IT has enabled traditional modes of service delivery to be supported or even replaced by remote forms of provision. Objective: This study aimed to assess the use and impact of IT, in remote service provision, on the quality and efficiency of mental health care during the pandemic. We drew on sociotechnical systems theory as a conceptual framework to help structure the gathering, analysis, and interpretation of data. Methods: We conducted a national scoping survey that involved documentary analysis and semistructured interviews with 6 national stakeholders and case studies of 4 purposefully selected mental health providers in England involving interviews with 53 staff members. Results: Following the outbreak of COVID-19, mental health providers rapidly adjusted their traditional forms of service delivery, switching to digital and telephone consultations for most services. The informants provided nuanced perspectives on the impact on the quality and efficiency of remote service delivery during the pandemic. Notably, it has allowed providers to attend to as many patients as possible in the face of COVID-19 restrictions, to the convenience of both patients and staff. Among its negative effects are concerns about the unsuitability of remote consultation for some people with mental health conditions and the potential to widen the digital divide and exacerbate existing inequalities. Sociotechnical systems theory was found to be a suitable framework for understanding the range of systemic and sociotechnical factors that influence the use of technology in mental health care delivery in times of crisis and normalcy. Conclusions: Although the use of IT has boosted mental health care delivery during the pandemic, it has had mixed effects on quality and efficiency. In general, patients have benefited from the convenience of remote consultation when face-to-face contact was impossible. In contrast, patient choice was often compromised, and patient experience and outcomes might have been affected for some people with mental health conditions for which remote consultation is less suitable. However, the full impact of IT on the quality and efficiency of mental health care provision along with the systemic and sociotechnical determinants requires more sustained and longitudinal research. ", doi="10.2196/37533", url="https://formative.jmir.org/2022/12/e37533", url="http://www.ncbi.nlm.nih.gov/pubmed/36423321" } @Article{info:doi/10.2196/37582, author="Cai, Ruilie and Zhang, Jiajia and Li, Zhenlong and Zeng, Chengbo and Qiao, Shan and Li, Xiaoming", title="Using Twitter Data to Estimate the Prevalence of Symptoms of Mental Disorders in the United States During the COVID-19 Pandemic: Ecological Cohort Study", journal="JMIR Form Res", year="2022", month="Dec", day="20", volume="6", number="12", pages="e37582", keywords="mental health", keywords="anxiety disorder", keywords="depressive disorder", keywords="COVID-19", keywords="national survey", keywords="social media", keywords="Twitter", keywords="mixed model", keywords="anxiety", keywords="National Household Pulse survey", keywords="geospatial", abstract="Background: Existing research and national surveillance data suggest an increase of the prevalence of mental disorders during the COVID-19 pandemic. Social media platforms, such as Twitter, could be a source of data for estimation owing to its real-time nature, high availability, and large geographical coverage. However, there is a dearth of studies validating the accuracy of the prevalence of mental disorders on Twitter compared to that reported by the Centers for Disease Control and Prevention (CDC). Objective: This study aims to verify the feasibility of Twitter-based prevalence of mental disorders symptoms being an instrument for prevalence estimation, where feasibility is gauged via correlations between Twitter-based prevalence of mental disorder symptoms (ie, anxiety and depressive symptoms) and that based on national surveillance data. In addition, this study aims to identify how the correlations changed over time (ie, the temporal trend). Methods: State-level prevalence of anxiety and depressive symptoms was retrieved from the national Household Pulse Survey (HPS) of the CDC from April 2020 to July 2021. Tweets were retrieved from the Twitter streaming application programming interface during the same period and were used to estimate the prevalence of symptoms of mental disorders for each state using keyword analysis. Stratified linear mixed models were used to evaluate the correlations between the Twitter-based prevalence of symptoms of mental disorders and those reported by the CDC. The magnitude and significance of model parameters were considered to evaluate the correlations. Temporal trends of correlations were tested after adding the time variable to the model. Geospatial differences were compared on the basis of random effects. Results: Pearson correlation coefficients between the overall prevalence reported by the CDC and that on Twitter for anxiety and depressive symptoms were 0.587 (P<.001) and 0.368 (P<.001), respectively. Stratified by 4 phases (ie, April 2020, August 2020, October 2020, and April 2021) defined by the HPS, linear mixed models showed that Twitter-based prevalence for anxiety symptoms had a positive and significant correlation with CDC-reported prevalence in phases 2 and 3, while a significant correlation for depressive symptoms was identified in phases 1 and 3. Conclusions: Positive correlations were identified between Twitter-based and CDC-reported prevalence, and temporal trends of these correlations were found. Geospatial differences in the prevalence of symptoms of mental disorders were found between the northern and southern United States. Findings from this study could inform future investigation on leveraging social media platforms to estimate symptoms of mental disorders and the provision of immediate prevention measures to improve health outcomes. ", doi="10.2196/37582", url="https://formative.jmir.org/2022/12/e37582", url="http://www.ncbi.nlm.nih.gov/pubmed/36459569" } @Article{info:doi/10.2196/36827, author="Abou-Arraj, Elias Nadeem and Maddah, Diana and Buhamdan, Vanessa and Abbas, Roua and Jawad, Kamel Nadine and Karaki, Fatima and Alami, H. Nael and Geldsetzer, Pascal", title="Perceptions of, and Obstacles to, SARS-CoV-2 Vaccination Among Adults in Lebanon: Cross-sectional Online Survey", journal="JMIR Form Res", year="2022", month="Dec", day="14", volume="6", number="12", pages="e36827", keywords="Lebanon", keywords="COVID-19", keywords="SARS-CoV-2", keywords="coronavirus", keywords="vaccination", keywords="vaccine hesitancy", keywords="vaccine acceptance", keywords="health care system", keywords="misinformation", keywords="public health", abstract="Background: The COVID-19 pandemic is an additional burden on Lebanon's fragmented health care system and adds to its ongoing political, economic, and refugee crises. Vaccination is an important means of reducing the impact of the pandemic. Objective: Our study's aims were to (1) assess the prevalences of intention to vaccinate and vaccine hesitancy in Lebanon; (2) determine how vaccine hesitancy in Lebanon varies by sociodemographic, economic, and geographic characteristics; and (3) understand individuals' motivations for vaccinating as well as concerns and obstacles to vaccination. Methods: We performed a cross-sectional study from January 29, 2021, to March 11, 2021, using an online questionnaire of open- and closed-ended questions in Arabic via convenience ``snowball'' sampling to assess the perceptions of adults residing in Lebanon. Results: Of the 1185 adults who participated in the survey, 46.1\% (95\% CI: 43.2\%-49.0\%) intended to receive the SARS-CoV-2 vaccine when available to them, 19.0\% (95\% CI 16.8\%-21.4\%) indicated they would not, and 34.0\% (95\% CI 31.3\%-36.8\%) were unsure (with an additional 0.9\% skipping this question). The most common reasons for hesitancy were concerns about safety, limited testing, side effects, and efficacy. Top motivations for vaccinating were to protect oneself, protect one's family and the public, and end the pandemic. Despite financial hardships in Lebanon, barriers to vaccine access were not frequently described as concerns. Established health care facilities, rather than new temporary vaccination centers, were most frequently selected as preferred vaccination sites. Conclusions: Vaccine hesitancy appears to be high in Lebanon. Disseminating clear, consistent, evidence-based safety and efficacy information on vaccines may help reduce vaccine hesitancy, especially among the large proportion of adults who appear to be unsure about (rather than opposed to) vaccination. ", doi="10.2196/36827", url="https://formative.jmir.org/2022/12/e36827", url="http://www.ncbi.nlm.nih.gov/pubmed/36383635" } @Article{info:doi/10.2196/39570, author="Villius Zetterholm, My and Nilsson, Lina and Jokela, P{\"a}ivi", title="Using a Proximity-Detection Technology to Nudge for Physical Distancing in a Swedish Workplace During the COVID-19 Pandemic: Retrospective Case Study", journal="JMIR Form Res", year="2022", month="Dec", day="12", volume="6", number="12", pages="e39570", keywords="case study", keywords="COVID-19", keywords="feasibility", keywords="mixed methods", keywords="nudging", keywords="physical distance", keywords="preventive behavior", keywords="preventive technologies", keywords="proximity detecting technology", keywords="wearables", abstract="Background: The recent COVID-19 pandemic has contributed to the emergence of several technologies for infectious disease management. Although much focus has been placed on contact-tracing apps, another promising new tactic is proximity tracing, which focuses on health-related behavior and can be used for primary prevention. Underpinned by theories on behavioral design, a proximity-detection system can be devised that provides a user with immediate nudges to maintain physical distance from others. However, the practical feasibility of proximity detection during an infectious disease outbreak has not been sufficiently investigated. Objective: We aimed to evaluate the feasibility of using a wearable device to nudge for distance and to gather important insights about how functionality and interaction are experienced by users. The results of this study can guide future research and design efforts in this emerging technology. Methods: In this retrospective case study, a wearable proximity-detection technology was used in a workplace for 6 weeks during the production of a music competition. The purpose of the technology was to nudge users to maintain their physical distance using auditory feedback. We used a mixed methods sequential approach, including interviews (n=8) and a survey (n=30), to compile the experiences of using wearable technology in a real-life setting. Results: We generated themes from qualitative analysis based on data from interviews and open-text survey responses. The quantitative data were subsequently integrated into these themes: feasibility (implementation and acceptance---establishing a shared problem; distance tags in context---strategy, environment, and activities; understanding and learning; and accomplishing the purpose) and design aspects (a purposefully annoying device; timing, tone, and proximity; and additional functions). Conclusions: This empirical study reports on the feasibility of using wearable technology based on proximity detection to nudge individuals to maintain physical distance in the workplace. The technology supports attention to distance, but the usability of this approach is dependent on the context and situation. In certain situations, the audio signal is frustrating, but most users agree that it needs to be annoying to ensure sufficient behavioral adaption. We proposed a dual nudge that involves vibration followed by sound. There are indications that the technology also facilitates learning how to maintain a greater distance from others, and that this behavior can persist beyond the context of technology use. This study demonstrates that the key value of this technology is that it places the user in control and enables immediate action when the distance to others is not maintained. This study provides insights into the emerging field of personal and wearable technologies used for primary prevention during infectious disease outbreaks. Future research is needed to evaluate the preventive effect on transmission and investigate behavioral changes in detail and in relation to different forms of feedback. ", doi="10.2196/39570", url="https://formative.jmir.org/2022/12/e39570", url="http://www.ncbi.nlm.nih.gov/pubmed/36343202" } @Article{info:doi/10.2196/40302, author="Zhang, Zhan and Vaghefi, Isaac", title="Continued Use of Contact-Tracing Apps in the United States and the United Kingdom: Insights From a Comparative Study Through the Lens of the Health Belief Model", journal="JMIR Form Res", year="2022", month="Dec", day="8", volume="6", number="12", pages="e40302", keywords="contact tracing", keywords="app adoption", keywords="app continued use", keywords="public attitudes", keywords="health belief model", keywords="COVID-19", abstract="Background: To contain the spread of SARS-CoV-2, contact-tracing (CT) mobile apps were developed and deployed to identify and notify individuals who have exposure to the virus. However, the effectiveness of these apps depends not only on their adoption by the general population but also on their continued use in the long term. Limited research has investigated the facilitators of and barriers to the continued use of CT apps. Objective: In this study, we aimed to examine factors influencing the continued use intentions of CT apps based on the health belief model. In addition, we investigated the differences between users and nonusers and between the US and UK populations. Methods: We administered a survey in the United States and the United Kingdom. Respondents included individuals who had previously used CT technologies and those without experience. We used the structural equation modeling technique to validate the proposed research model and hypotheses. Results: Analysis of data collected from 362 individuals showed that perceived benefits, self-efficacy, perceived severity, perceived susceptibility, and cues to action positively predicted the continued use intentions of CT apps, while perceived barriers could reduce them. We observed few differences between the US and UK groups; the only exception was the effect of COVID-19 threat susceptibility, which was significant for the UK group but not for the US group. Finally, we found that the only significant difference between users and nonusers was related to perceived barriers, which may not influence nonusers' continued use intentions but significantly reduce experienced users' intentions. Conclusions: Our findings have implications for technological design and policy. These insights can potentially help governments, technology companies, and media outlets to create strategies and policies to promote app adoption for new users and sustain continued use for existing users in the long run. ", doi="10.2196/40302", url="https://formative.jmir.org/2022/12/e40302", url="http://www.ncbi.nlm.nih.gov/pubmed/36351080" } @Article{info:doi/10.2196/42031, author="Wells, Kenneth and Thames, Denise April and Young, S. Alexander and Zhang, Lily and Heilemann, V. MarySue and Romero, Flores Daniela and Oliva, Adrian and Jones, Felica and Tang, Lingqi and Brymer, Melissa and Elliott, Thomas and Arevian, Armen and ", title="Engagement, Use, and Impact of Digital Mental Health Resources for Diverse Populations in COVID-19: Community-Partnered Evaluation", journal="JMIR Form Res", year="2022", month="Dec", day="7", volume="6", number="12", pages="e42031", keywords="digital mental health", keywords="prevention", keywords="COVID-19", keywords="depression", keywords="hotline use", keywords="health disparity", keywords="community health", keywords="public health", keywords="health resource", keywords="mental well-being", keywords="ethnic", keywords="website engagement", keywords="minority population", keywords="digital resource", abstract="Background: The COVID-19 pandemic increased disparities for communities burdened by structural barriers such as reduced affordable housing, with mental health consequences. Limited data are available on digital resources for public mental health prevention during the COVID-19 pandemic. Objective: The study aim was to evaluate engagement in and impact of free digital resources on the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website during COVID-19 in California. Methods: A pilot evaluation of T4W/Juntos was performed, with partner agencies inviting providers, clients, and partners to visit the website and complete surveys at baseline (September 20, 2021, to April 4, 2022) and at 4-6--week follow-up (October 22, 2021, to May 17, 2022). Website use was assessed by three engagement items (ease of use, satisfaction, relevance), comfort in use, and use of six resource categories. Primary outcomes at follow-up were depression and anxiety (scores?3 on Patient Health Questionnaire-2 item [PHQ2] and Generalized Anxiety Disorder-2 item [GAD2] scales). Secondary outcomes were post-pre differences in PHQ2 and GAD2 scores, and use of behavioral health hotlines and services the month before follow-up. Results: Of 366 eligible participants, 315 (86.1\%) completed baseline and 193 (61.3\%) completed follow-up surveys. Of baseline participants, 72.6\% identified as female, and 21.3\% identified as lesbian, gay, bisexual, transgender, queer/questioning, and others (LGBTQ+). In terms of ethnicity, 44.0\% identified as Hispanic, 17.8\% as African American, 26.9\% as non-Hispanic white, and 11.4\% as other ethnicity. Overall, 32.7\% had moderate anxiety or depression (GAD2/PHQ2?3) at baseline. Predictors of baseline website engagement included being Hispanic versus other race/ethnicity ($\beta$=.27, 95\% CI .10-.44; P=.002) and number of COVID-19--related behavior changes ($\beta$=.09, 95\% CI .05-.13; P<.001). Predictors of comfort using the website were preferring English for website use (odds ratio [OR] 5.57, 95\% CI 2.22-13.96; P<.001) and COVID-19--related behavior changes (OR 1.37, 95\% CI 1.12-1.66; P=.002); receiving overnight behavioral health treatment in the prior 6 months (OR 0.15, 95\% CI 0.03-0.69, P=.015) was associated with less comfort in website use. The main predictor of depression at follow-up (PHQ2?3) was baseline depression (OR 6.24, 95\% CI 2.77-14.09; P<.001). Engagement in T4W/Juntos was associated with lower likelihood of depression (OR 0.54, 95\% CI 0.34-0.86; P=.01). Website use the month before follow-up was associated with a post-pre reduction in PHQ2 score ($\beta$=--.62, 95\% CI --1.04 to --0.20; P=.004). The main predictor of GAD2?3 at follow-up was baseline GAD2?3 (OR 13.65, 95\% CI 6.06-30.72; P<.001). Greater baseline website engagement predicted reduced hotline use (OR 0.36, 95\% CI 0.18-0.71; P=.004). Conclusions: Ethnicity/language and COVID-19--related behavior changes were associated with website engagement; engagement and use predicted reduced follow-up depression and behavioral hotline use. Findings are based on participants recommended by community agencies with moderate follow-up rates; however, significance was similar when weighting for nonresponse. This study may inform research and policy on digital mental health prevention resources. ", doi="10.2196/42031", url="https://formative.jmir.org/2022/12/e42031", url="http://www.ncbi.nlm.nih.gov/pubmed/36346902" } @Article{info:doi/10.2196/37507, author="Flaks-Manov, Natalie and Bai, Jiawei and Zhang, Cindy and Malpani, Anand and Ray, C. Stuart and Taylor, Overby Casey", title="Assessing Associations Between COVID-19 Symptomology and Adverse Outcomes After Piloting Crowdsourced Data Collection: Cross-sectional Survey Study", journal="JMIR Form Res", year="2022", month="Dec", day="6", volume="6", number="12", pages="e37507", keywords="COVID-19", keywords="coronavirus", keywords="symptoms", keywords="symptomology", keywords="crowdsourcing", keywords="adverse outcomes", keywords="data quality", abstract="Background: Crowdsourcing is a useful way to rapidly collect information on COVID-19 symptoms. However, there are potential biases and data quality issues given the population that chooses to participate in crowdsourcing activities and the common strategies used to screen participants based on their previous experience. Objective: The study aimed to (1) build a pipeline to enable data quality and population representation checks in a pilot setting prior to deploying a final survey to a crowdsourcing platform, (2) assess COVID-19 symptomology among survey respondents who report a previous positive COVID-19 result, and (3) assess associations of symptomology groups and underlying chronic conditions with adverse outcomes due to COVID-19. Methods: We developed a web-based survey and hosted it on the Amazon Mechanical Turk (MTurk) crowdsourcing platform. We conducted a pilot study from August 5, 2020, to August 14, 2020, to refine the filtering criteria according to our needs before finalizing the pipeline. The final survey was posted from late August to December 31, 2020. Hierarchical cluster analyses were performed to identify COVID-19 symptomology groups, and logistic regression analyses were performed for hospitalization and mechanical ventilation outcomes. Finally, we performed a validation of study outcomes by comparing our findings to those reported in previous systematic reviews. Results: The crowdsourcing pipeline facilitated piloting our survey study and revising the filtering criteria to target specific MTurk experience levels and to include a second attention check. We collected data from 1254 COVID-19--positive survey participants and identified the following 6 symptomology groups: abdominal and bladder pain (Group 1); flu-like symptoms (loss of smell/taste/appetite; Group 2); hoarseness and sputum production (Group 3); joint aches and stomach cramps (Group 4); eye or skin dryness and vomiting (Group 5); and no symptoms (Group 6). The risk factors for adverse COVID-19 outcomes differed for different symptomology groups. The only risk factor that remained significant across 4 symptomology groups was influenza vaccine in the previous year (Group 1: odds ratio [OR] 6.22, 95\% CI 2.32-17.92; Group 2: OR 2.35, 95\% CI 1.74-3.18; Group 3: OR 3.7, 95\% CI 1.32-10.98; Group 4: OR 4.44, 95\% CI 1.53-14.49). Our findings regarding the symptoms of abdominal pain, cough, fever, fatigue, shortness of breath, and vomiting as risk factors for COVID-19 adverse outcomes were concordant with the findings of other researchers. Some high-risk symptoms found in our study, including bladder pain, dry eyes or skin, and loss of appetite, were reported less frequently by other researchers and were not considered previously in relation to COVID-19 adverse outcomes. Conclusions: We demonstrated that a crowdsourced approach was effective for collecting data to assess symptomology associated with COVID-19. Such a strategy may facilitate efficient assessments in a dynamic intersection between emerging infectious diseases, and societal and environmental changes. ", doi="10.2196/37507", url="https://formative.jmir.org/2022/12/e37507", url="http://www.ncbi.nlm.nih.gov/pubmed/36343205" } @Article{info:doi/10.2196/38821, author="Craighead, G. Caitlin and Collart, Christina and Frankel, Richard and Rose, Susannah and Misra-Hebert, D. Anita and Tucker Edmonds, Brownsyne and Michie, Marsha and Chien, Edward and Coleridge, Marissa and Goje, Oluwatosin and Ranzini, C. Angela and Farrell, M. Ruth", title="Impact of Telehealth on the Delivery of Prenatal Care During the COVID-19 Pandemic: Mixed Methods Study of the Barriers and Opportunities to Improve Health Care Communication in Discussions About Pregnancy and Prenatal Genetic Testing", journal="JMIR Form Res", year="2022", month="Dec", day="5", volume="6", number="12", pages="e38821", keywords="prenatal health care delivery", keywords="health care communication", keywords="telehealth", keywords="access to health care", keywords="COVID-19", keywords="pregnancy", abstract="Background: The COVID-19 pandemic brought significant changes in health care, specifically the accelerated use of telehealth. Given the unique aspects of prenatal care, it is important to understand the impact of telehealth on health care communication and quality, and patient satisfaction. This mixed methods study examined the challenges associated with the rapid and broad implementation of telehealth for prenatal care delivery during the pandemic. Objective: In this study, we examined patients' perspectives, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time. Methods: Pregnant patients who received outpatient prenatal care in Cleveland, Ohio participated in in-depth interviews and completed the Coronavirus Perinatal Experiences-Impact Survey (COPE-IS) between January and December 2021. Transcripts were coded using NVivo 12, and qualitative analysis was used, an approach consistent with the grounded theory. Quantitative data were summarized and integrated during analysis. Results: Thematic saturation was achieved with 60 interviews. We learned that 58\% (35/60) of women had telehealth experience prior to their current pregnancy. However, only 8\% (5/60) of women had used both in-person and virtual visits during this pregnancy, while the majority (54/60, 90\%) of women participated in only in-person visits. Among 59 women who responded to the COPE-IS, 59 (100\%) felt very well supported by their provider, 31 (53\%) were moderately to highly concerned about their child's health, and 17 (29\%) reported that the single greatest stress of COVID-19 was its impact on their child. Lead themes focused on establishing patient-provider relationships that supported shared decision-making, accessing the information needed for shared decision-making, and using technology effectively to foster discussions during the COVID-19 pandemic. Key findings indicated that participants felt in-person visits were more personal, established greater rapport, and built better trust in the patient-provider relationship as compared to telehealth visits. Further, participants felt they could achieve a greater dialogue and ask more questions regarding time-sensitive information, including prenatal genetic testing information, through an in-person visit. Finally, privacy concerns arose if prenatal genetic testing or general pregnancy conversations were to take place outside of the health care facility. Conclusions: While telehealth was recognized as an option to ensure timely access to prenatal care during the COVID-19 pandemic, it also came with multiple challenges for the patient-provider relationship. These findings highlighted the barriers and opportunities to achieve effective and patient-centered communication with the continued integration of telehealth in prenatal care delivery. It is important to address the unique needs of this population during the pandemic and as health care increasingly adopts a telehealth model. ", doi="10.2196/38821", url="https://formative.jmir.org/2022/12/e38821", url="http://www.ncbi.nlm.nih.gov/pubmed/36383634" } @Article{info:doi/10.2196/39109, author="Nguyen, Elaine and Wright, Melanie and Holmes, John and Cleveland, Kevin and Oliphant, Catherine and Nies, Mary and Robinson, Renee", title="Influences, Barriers, and Facilitators to COVID-19 Vaccination: Cross-sectional Survey on Vaccine Hesitancy in 2 Rural States", journal="JMIR Form Res", year="2022", month="Dec", day="1", volume="6", number="12", pages="e39109", keywords="COVID-19", keywords="COVID-19 vaccines", keywords="vaccine hesitancy", keywords="cross-sectional studies", keywords="rural populations", abstract="Background: Vaccination remains one of the most effective ways to limit the spread of infectious diseases such as that caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19. Unfortunately, vaccination hesitancy continues to be a threat to national and global health. Further research is necessary to determine the modifiable and nonmodifiable factors contributing to COVID-19 vaccine hesitancy in under-resourced, underserved, and at-risk rural and urban communities. Objective: This study aimed to identify, understand, and address modifiable barriers and factors contributing to COVID-19 vaccine hesitancy among vaccine-eligible individuals with access to the vaccine in Alaska and Idaho. Methods: An electronic survey based on the World Health Organization (WHO) Strategic Advisory Group on Experts (SAGE) on Immunization survey tool and investigators' previous work was created and distributed in June 2021 and July 2021. To be eligible to participate in the survey, individuals had to be ?18 years of age and reside in Alaska or Idaho. Responses were grouped into 4 mutually exclusive cohorts for data analysis and reporting based on intentions to be vaccinated. Respondent characteristics and vaccine influences between cohorts were compared using Chi-square tests and ANOVA. Descriptive statistics were also used. Results: There were data from 736 usable surveys with 40 respondents who did not intend to be vaccinated, 27 unsure of their intentions, 8 who intended to be fully vaccinated with no doses received, and 661 fully vaccinated or who intended to be vaccinated with 1 dose received. There were significant differences in characteristics and influences between those who were COVID-19 vaccine-hesitant and those who had been vaccinated. Concerns related to possible side effects, enough information on long-term side effects, and enough information that is specific to the respondent's health conditions were seen in those who did not intend to be fully vaccinated and unsure about vaccination. In all cohorts except those who did not intend to be fully vaccinated, more information about how well the vaccine works was a likely facilitator to vaccination. Conclusions: These survey results from 2 rural states indicate that recognition of individual characteristics may influence vaccine choices. However, these individual characteristics represent only a starting point to delivering tailored messages that should come from trusted sources to address vaccination barriers. ", doi="10.2196/39109", url="https://formative.jmir.org/2022/12/e39109", url="http://www.ncbi.nlm.nih.gov/pubmed/36067411" } @Article{info:doi/10.2196/38357, author="Pullyblank, Kristin and Atav, Serdar", title="Enrollment and Completion Characteristics for Novel Remote Delivery Modes of the Self-management Programs During the COVID-19 Pandemic: Exploratory Analysis", journal="JMIR Form Res", year="2022", month="Nov", day="30", volume="6", number="11", pages="e38357", keywords="self-management programs", keywords="self management", keywords="internet-based intervention", keywords="health promotion", keywords="COVID-19", keywords="health equity", keywords="socioeconomic status", keywords="remote healthcare", keywords="health delivery", keywords="virtual care", keywords="remote care", keywords="remote delivery", keywords="videoconference", keywords="videoconferencing", keywords="adherence", keywords="attrition", keywords="completion", keywords="virtual health", abstract="Background: In-person, evidence-based, peer-facilitated chronic disease self-management programs have been shown to be effective for individuals from a variety of backgrounds, including rural and minority populations and those with lower socioeconomic status. Based in social learning theory, these programs use group processes to help participants better manage their chronic disease symptoms and improve their quality of life. During the pandemic, these in-person programs were forced to rapidly transition to remote delivery platforms, and it was unclear whether doing so increased disparities within our rural population. Objective: The objectives of this analysis were to ascertain self-management program enrollment and completion characteristics between 2 remote delivery platforms, as well as determine the individual level characteristics that drove enrollment and completion across delivery modes. Methods: We analyzed enrollment and completion characteristics of 183 individuals who either enrolled in a self-management workshop delivered through a web-based videoconference (VC) system or through a traditional, audio-only conference call (CC) offered by our health care network between April and December 2020. Chi-square tests of association were used to describe the characteristics of and differences between groups. Logistic regression analysis was used to determine significant predictors of enrollment and completion. Results: Those who enrolled in the VC platform were significantly likelier to be younger and college educated than those who enrolled in the CC platform. Those who completed a program, regardless of delivery mode, were likelier to be older and college educated than those who did not complete a program. Multivariate analyses indicated that of those enrolled in the CC platform, completers were likelier to not be enrolled in Medicaid. Among those enrolled in the VC platform, completers were older, college graduates, female, and likelier to have reported poorer health than those who did not complete the program. Conclusions: The transition of self-management programs to remote delivery modes, particularly to those that rely on VC platforms, revealed that certain demographic groups may no longer be able or willing to access the service. Efforts need to be made to increase engagement in remote self-management workshops. In addition, equivalent quality services that do not rely on a digital platform must continue to be offered in order to promote health equity. ", doi="10.2196/38357", url="https://formative.jmir.org/2022/11/e38357", url="http://www.ncbi.nlm.nih.gov/pubmed/36413622" } @Article{info:doi/10.2196/41847, author="Yagiz, Ismail Jan and Goderis, Geert", title="The Impact of the COVID-19 Pandemic on eHealth Use in the Daily Practice and Life of Dutch-Speaking General Practitioners in Belgium: Qualitative Study With Semistructured Interviews", journal="JMIR Form Res", year="2022", month="Nov", day="28", volume="6", number="11", pages="e41847", keywords="COVID-19", keywords="impact", keywords="eHealth", keywords="GPs", keywords="Flemish", keywords="practice", keywords="qualitative study", keywords="semistructured interviews", abstract="Background: The COVID-19 crisis has led to rapid and far-reaching changes in digital health care, but little is known about what, why, and how changes occurred in eHealth use in Flemish general practice during the pandemic. Objective: This study aims to understand how general practitioners (GPs) perceive and evaluate eHealth solutions and their eHealth experience during the COVID-19 pandemic. Methods: This qualitative study was conducted using in-depth 1-on-1 semistructured interviews with the help of an interview guide. Several areas were identified beforehand to help assess the impact of the COVID-19 pandemic: perceptions of digital technologies in GP practices; changes in the use of these technologies during and after the COVID-19 pandemic; GPs' adaptation to digitalization, benefits, risks, and challenges of eHealth; GPs motivations to change practice; and future perspectives on eHealth. In this study, purposive sampling and snowballing methods were used. Between October 2021 and April 2022, we interviewed 15 Dutch-speaking GPs in the Flemish region via the Zoom online conferencing tool. Results: GPs indicated that eHealth was used more frequently during the COVID-19 pandemic than before, a change that helped them reduce their workload, enabling greater accessibility to health care services and the complementary use of digital and physical consultations. Our findings suggest that physicians underwent a significant cognitive shift in their perceptions, causing them to be more open and prepared to adopt eHealth solutions. However, there remains significant doubt and uncertainty about digital literacy for certain groups, privacy, data security, reimbursement, and the burden of technical information and communication technologies (ICT) issues. Conclusions: The COVID-19 pandemic seems to have been a turning point for eHealth by Flemish GPs. eHealth is an essential complementary health care service that can reduce pressure on health care as well as increase health care accessibility. Sensitive aspects, such as privacy, data security, digital literacy, reimbursement, and the burden of technical ICT issues, are particularly emphasized. With our results, we can offer recommendations to health IT policymakers and developers that will help maintain the continuity of eHealth solutions beyond the COVID-19 pandemic, considering the expectations and sensitivities presented in the study. ", doi="10.2196/41847", url="https://formative.jmir.org/2022/11/e41847", url="http://www.ncbi.nlm.nih.gov/pubmed/36399650" } @Article{info:doi/10.2196/39185, author="Pech, Marion and Gbessemehlan, Antoine and Dupuy, Lucile and Sauz{\'e}on, H{\'e}l{\`e}ne and Lafitte, St{\'e}phane and Bachelet, Philippe and Amieva, H{\'e}l{\`e}ne and P{\'e}r{\`e}s, Karine", title="Lessons Learned From the SoBeezy Program for Older Adults During the COVID-19 Pandemic: Experimentation and Evaluation", journal="JMIR Form Res", year="2022", month="Nov", day="24", volume="6", number="11", pages="e39185", keywords="voice assistance", keywords="social isolation", keywords="healthy aging", keywords="living in place", keywords="acceptability", keywords="technologies", keywords="digital divide", keywords="older adults", keywords="aging", keywords="elderly population", keywords="voice assistant", keywords="COVID-19", abstract="Background: The SoBeezy program is an innovative intervention aimed at promoting and fostering healthy aging and aging in place by proposing to older adults concrete solutions to face daily life, tackle loneliness, promote social participation, and reduce the digital divide, thanks to a specific, easy-to-use voice assistant (the BeeVA smart display). Objective: This study aims to assess the acceptability of the SoBeezy program and its voice assistant and to identify potential areas of improvement. Methods: A 12-month experimentation of the program was deployed in real-life conditions among older adults living in the community in 4 pilot cities of France. Launched during the first lockdown of the COVID-19 crisis, this multisite study aimed to assess acceptability using questionnaires and interviews conducted at baseline and at the end of the experimentation. In addition, a series of meetings were conducted with SoBeezy staff members to obtain direct feedback from the ground. Results: In total, 109 older individuals were equipped with BeeVA to use the SoBeezy program; of these, 32 (29.4\%) left the experimentation before its end and 69 (63.3\%) completed the final questionnaires. In total, 335 interventions were conducted and 27 (39\%) of the participants requested services, mainly for supportive calls and visits and assistance with shopping, transportation, and crafting-gardening. Of the whole sample, 52 (75\%) considered BeeVA as a reassuring presence, and few persons (15/69, 22\%) reported a negative opinion about the program. Among the participants, the voice assistant appeared easy to use (n=57, 82\%) and useful (n=53, 77\%). They also were positive about the BeeVA smart display and the SoBeezy intervention. Conclusions: This multisite study conducted in real-life conditions among more than 100 older adults living in the community provides enlightening results of the reality from the ground of digital tools designed for the aging population. The COVID-19 context appeared both as an opportunity, given the massive needs of the older adults during this crisis, and as limiting due to sanitary constraints. Nevertheless, the experimentation showed overall good acceptability of the voice assistant and a high level of satisfaction of the participants among those who really used the system and could be a way of improving the autonomy and well-being of older adults and their families. However, the findings also highlighted resistance to change and difficulties for the users to ask for help. The experimentation also emphasized levers for next deployments and future research. The next step will be the experimentation of the activity-sharing component that could not be tested due to the COVID-19 context. ", doi="10.2196/39185", url="https://formative.jmir.org/2022/11/e39185", url="http://www.ncbi.nlm.nih.gov/pubmed/36355629" } @Article{info:doi/10.2196/38425, author="Ackleh-Tingle, V. Jonathan and Jordan, M. Natalie and Onwubiko, N. Udodirim and Chandra, Christina and Harton, E. Paige and Rentmeester, T. Shelby and Chamberlain, T. Allison", title="Prevalence and Correlates of COVID-19 Vaccine Information on Family Medicine Practices' Websites in the United States: Cross-sectional Website Content Analysis", journal="JMIR Form Res", year="2022", month="Nov", day="17", volume="6", number="11", pages="e38425", keywords="primary care", keywords="vaccine hesitancy", keywords="COVID-19", keywords="health communications", keywords="health information", keywords="health website", keywords="family practice", keywords="vaccine information", keywords="online health", keywords="health platform", keywords="online information", abstract="Background: Primary care providers are regarded as trustworthy sources of information about COVID-19 vaccines. Although primary care practices often provide information about common medical and public health topics on their practice websites, little is known about whether they also provide information about COVID-19 vaccines on their practice websites. Objective: This study aimed to investigate the prevalence and correlates of COVID-19 vaccine information on family medicine practices' website home pages in the United States. Methods: We used the Centers for Medicare and Medicaid National Provider Identifier records to create a sampling frame of all family medicine providers based in the United States, from which we constructed a nationally representative random sample of 964 family medicine providers. Between September 20 and October 8, 2021, we manually examined the practice websites of these providers and extracted data on the availability of COVID-19 vaccine information, and we implemented a 10\% cross-review quality control measure to resolve discordances in data abstraction. We estimated the prevalence of COVID-19 vaccine information on practice websites and website home pages and used Poisson regression with robust error variances to estimate crude and adjusted prevalence ratios for correlates of COVID-19 vaccine information, including practice size, practice region, university affiliation, and presence of information about seasonal influenza vaccines. Additionally, we performed sensitivity analyses to account for multiple comparisons. Results: Of the 964 included family medicine practices, most (n=509, 52.8\%) had ?10 distinct locations, were unaffiliated with a university (n=838, 87.2\%), and mentioned seasonal influenza vaccines on their websites (n=540, 56.1\%). In total, 550 (57.1\%) practices mentioned COVID-19 vaccines on their practices' website home page, specifically, and 726 (75.3\%) mentioned COVID-19 vaccines anywhere on their practice website. As practice size increased, the likelihood of finding COVID-19 vaccine information on the home page increased (n=66, 27.7\% among single-location practices, n=114, 52.5\% among practices with 2-9 locations, n=66, 56.4\% among practices with 10-19 locations, and n=304, 77.6\% among practices with 20 or more locations, P<.001 for trend). Compared to clinics in the Northeast, those in the West and Midwest United States had a similar prevalence of COVID-19 vaccine information on website home pages, but clinics in the south had a lower prevalence (adjusted prevalence ratio 0.8, 95\% CI 0.7 to 1.0; P=.02). Our results were largely unchanged in sensitivity analyses accounting for multiple comparisons. Conclusions: Given the ongoing COVID-19 pandemic, primary care practitioners who promote and provide vaccines should strongly consider utilizing their existing practice websites to share COVID-19 vaccine information. These existing platforms have the potential to serve as an extension of providers' influence on established and prospective patients who search the internet for information about COVID-19 vaccines. ", doi="10.2196/38425", url="https://formative.jmir.org/2022/11/e38425", url="http://www.ncbi.nlm.nih.gov/pubmed/36343211" } @Article{info:doi/10.2196/35730, author="Anderson, M. Katherine and Stockman, K. Jamila", title="Fear of COVID-19 and Prevention Behaviors: Cross-Lagged Panel Analysis", journal="JMIR Form Res", year="2022", month="Nov", day="17", volume="6", number="11", pages="e35730", keywords="fear appeals", keywords="structural equation modelling", keywords="cross-lagged model", keywords="prevention behavior", keywords="COVID-19", keywords="fear", keywords="women", keywords="behavior", keywords="change", keywords="health", keywords="physical distance", keywords="relationships", keywords="pandemic", keywords="research", keywords="association", keywords="prevention", keywords="experience", keywords="panel", keywords="interest", keywords="public", keywords="distancing", abstract="Background: The ongoing COVID-19 pandemic has brought forth conversations about effective behavior change models for increasing prevention behavior, ranging from wearing masks in public to physical distancing. Among the considered behavior change techniques is the use of fear appeals, through which a negative possible outcome is emphasized to invoke fear, which in turn may promote prevention behaviors to counter the likelihood of the negative outcome. Although fear is hypothesized as health promoting in some theories of health behavior, little research has rigorously assessed the relationship. Objective: In our exploratory analyses, we aim to examine the association, including directionality of the association between fear of COVID-19 and COVID-19 prevention behaviors across 2 time points during the early COVID-19 pandemic among a sample of US women. Methods: The COPE study, a web-based survey of US women's COVID-19 experiences, was deployed in May-June 2020 (time 1) with follow-up in December 2020-January 2021 (time 2; n=200). Demographic characteristics as well as fear of COVID-19 and COVID-19 prevention behaviors (eg, staying home except for essential activities, physical distancing in public, and masking in public) were measured. Descriptive and bivariate analyses were used to characterize COVID-19 prevention behaviors and fear of COVID-19 among participants. Cross-lagged panel analysis, a type of structural equation modeling that assesses directionality of temporal associations, was used to understand relationships, if any, between variables of interest. Results: We found cross-sectional associations between fear of COVID-19 and staying home and physical distancing, as well as temporal associations between fear at time 1 and time 2 and prevention behaviors at time 1 and time 2. However, results of the cross-lagged panel analysis indicated no cross-lagged temporal relationships between fear of COVID-19 and COVID-19 prevention behaviors 6 months apart. Conclusions: Fear of COVID-19 did not appear to predict COVID-19 prevention behaviors 6 months after initial measurements among the sample of women recruited for our study. Future research should rigorously test these associations longitudinally, and alternative methods of public health prevention promotion should be considered. ", doi="10.2196/35730", url="https://formative.jmir.org/2022/11/e35730", url="http://www.ncbi.nlm.nih.gov/pubmed/36346895" } @Article{info:doi/10.2196/34388, author="Nu{\~n}ez, R. Tania and Pallasch, Nina and Radtke, Theda", title="Students' Emotional Well-being and Academic Functioning Before, During, and After Lockdown in Germany: Cohort Study", journal="JMIR Form Res", year="2022", month="Nov", day="15", volume="6", number="11", pages="e34388", keywords="self-efficacy", keywords="academic self-concept", keywords="test anxiety", keywords="achievement motivation", keywords="positive and negative affect", keywords="mobile phone", keywords="COVID-19", abstract="Background: The COVID-19 lockdowns have led to social detriments and altered learning environments among university students. Recent research indicates that such ramifications may engender various impairments to students' mental health. However, such research has major limitations, such as the lack of a prepandemic control measure, the focus on singular well-being parameters, or the investigation of only the early phases of the pandemic. Objective: To address these research gaps, this comprehensive and nationwide study compared 3 student cohorts (aged 17-48 years) in Germany: a prepandemic cohort (January-February 2020), a postlockdown cohort (May 2020-July 2020), and an intralockdown cohort (January-February 2021) regarding students' general emotional well-being and academic functioning. It was hypothesized that, because of rigorous lockdown-related restrictions, students in the intralockdown cohort would report diminished general emotional well-being compared with the other cohorts. Furthermore, because of ongoing remote learning since the beginning of the pandemic, it was expected that students' academic functioning would decrease across all 3 cohorts. Methods: The data collection was performed over 3 consecutive semesters (fall semester 2019-2020, spring semester 2020, and fall semester 2020-2021). Students were surveyed on the web on various aspects regarding their general emotional well-being (eg, stress and general well-being) and academic functioning (eg, concentration and study-related flow). Data analyses were performed using multivariate ANOVAs. Results: A total of 787 students participated in this study. Results indicated higher general well-being in the postlockdown cohort than in the intralockdown cohort (P=.02). As for students' academic functioning, our results revealed that students in the prepandemic cohort reported higher study-related flow (P=.007) and concentration (P=.001) than those in the intralockdown cohort. In addition, students reported higher flow (P=.04) and concentration (P=.04) in the postlockdown cohort than those in the intralockdown cohort. No cohort effects were revealed for other aspects of general emotional well-being (eg, perceived stress) and academic functioning (eg, procrastination). Conclusions: This study indicates that students' general emotional well-being as well as motivational and attentional components of academic functioning can be impaired owing to the COVID-19 lockdowns and ongoing remote learning formats. The necessity and design of interventional programs remedying such effects in light of the ongoing crisis need to be addressed. ", doi="10.2196/34388", url="https://formative.jmir.org/2022/11/e34388", url="http://www.ncbi.nlm.nih.gov/pubmed/36228133" } @Article{info:doi/10.2196/37698, author="Chen, Xi and Yik, Michelle", title="The Emotional Anatomy of the Wuhan Lockdown: Sentiment Analysis Using Weibo Data", journal="JMIR Form Res", year="2022", month="Nov", day="14", volume="6", number="11", pages="e37698", keywords="Wuhan lockdown", keywords="COVID-19", keywords="public health emergency", keywords="emotion", keywords="circumplex model of affect", keywords="Weibo", keywords="jiayou", abstract="Background: On January 23, 2020, the city of Wuhan, China, was sealed off in response to the COVID-19 pandemic. Studies have found that the lockdown was associated with both positive and negative emotions, although their findings are not conclusive. In these studies, emotional responses to the Wuhan lockdown were identified using lexicons based on limited emotion types. Objective: This study aims to map Chinese people's emotional responses to the Wuhan lockdown and compare Wuhan residents' emotions with those of people elsewhere in China by analyzing social media data from Weibo using a lexicon based on the circumplex model of affect. Methods: Social media posts on Weibo from 2 weeks before to 2 weeks after the Wuhan lockdown was imposed (January 9, 2020, to February 6, 2020) were collected. Each post was coded using a valence score and an arousal score. To map emotional trajectories during the study period, we used a data set of 359,190 posts. To compare the immediate emotional responses to the lockdown and its longer-term emotional impact on Wuhan residents (n=1236) and non-Hubei residents (n=12,714), we used a second data set of 57,685 posts for multilevel modeling analyses. Results: Most posts (248,757/359,190, 69.25\%) made during the studied lockdown period indicated a pleasant mood with low arousal. A gradual increase in both valence and arousal before the lockdown was observed. The posts after the lockdown was imposed had higher valence and arousal than prelockdown posts. On the day of lockdown, the non-Hubei group had a temporarily boosted valence ($\gamma$20=0.118; SE 0.021; P<.001) and arousal ($\gamma$30=0.293; SE 0.022; P<.001). Compared with non-Hubei residents, the Wuhan group had smaller increases in valence ($\gamma$21=?0.172; SE 0.052; P<.001) and arousal ($\gamma$31=?0.262; SE 0.053; P<.001) on the day of lockdown. Weibo users' emotional valence ($\gamma$40=0.000; SE 0.001; P=.71) and arousal ($\gamma$40=0.001; SE 0.001; P=.56) remained stable over the 2 weeks after the lockdown was imposed regardless of geographical location (valence: $\gamma$41=?0.004, SE 0.003, and P=.16; arousal: $\gamma$41=0.003, SE 0.003, and P=.26). Conclusions: During the early stages of the pandemic, most Weibo posts indicated a pleasant mood with low arousal. The overall increase in the posts' valence and arousal after the lockdown announcement might indicate collective cohesion and mutual support in web-based communities during a public health crisis. Compared with the temporary increases in valence and arousal of non-Hubei users on the day of lockdown, Wuhan residents' emotions were less affected by the announcement. Overall, our data suggest that Weibo users were not influenced by the lockdown measures in the 2 weeks after the lockdown announcement. Our findings offer policy makers insights into the usefulness of social connections in maintaining the psychological well-being of people affected by a lockdown. ", doi="10.2196/37698", url="https://formative.jmir.org/2022/11/e37698", url="http://www.ncbi.nlm.nih.gov/pubmed/36166650" } @Article{info:doi/10.2196/39634, author="Wilczewski, Hattie and Paige, R. Samantha and Ong, Triton and Soni, Hiral and Barrera, F. Janelle and Welch, M. Brandon and Bunnell, E. Brian", title="Providers' Perspectives on Telemental Health Usage After the COVID-19 Pandemic: Retrospective Analysis", journal="JMIR Form Res", year="2022", month="Nov", day="11", volume="6", number="11", pages="e39634", keywords="telemedicine", keywords="telehealth", keywords="COVID-19", keywords="telemental health", keywords="mental health", keywords="pandemic", keywords="perception", keywords="use", keywords="usefulness", keywords="usage", keywords="workflow", abstract="Background: Mental health care pivoted to telemedicine during the COVID-19 pandemic, and there is uncertainty around the sustainability of this rapid shift. Objective: This study examined how intentions to continue using telemedicine after the COVID-19 pandemic are influenced by provider perceptions of usefulness, ease of use, and professional social influence, facilitating organizational conditions. Methods: We conducted a web-based, cross-sectional survey of 369 telemental health providers between February and March 2021. A hierarchical linear regression analysis was conducted to predict intentions to continue using telemedicine after the COVID-19 pandemic. Results: Most providers began using telemedicine in March 2020 or later (257/369, 69.6\%) and attended to ?50\% of their clients via telemedicine (299/369, 81.0\%). Intention to continue using telemedicine after the COVID-19 pandemic was predicted by the telemedicine caseload ($\beta$=.10; P=.005), perceived usefulness in general ($\beta$=.10; P=.008), ease of use ($\beta$=.08; P=.04), social influence ($\beta$=.68; P<.001), and facilitating conditions ($\beta$=.08; P=.047). Conclusions: Exploration of the predictors of telemedicine usage beyond the COVID-19 pandemic aids in surveillance of telemedicine usage, integration with future clinic workflows, and the shaping of public policy. It is important to consider telemedicine services as not only a response to a crisis but also an effective and useful solution for everyday life. Our results suggest widespread, sustainable telemedicine adoption. ", doi="10.2196/39634", url="https://formative.jmir.org/2022/11/e39634", url="http://www.ncbi.nlm.nih.gov/pubmed/36322787" } @Article{info:doi/10.2196/38562, author="Tump, Danielle and Narayan, Nitin and Verbiest, Vera and Hermsen, Sander and Goris, Annelies and Chiu, Chui-De and Van Stiphout, Ruud", title="Stressors and Destressors in Working From Home Based on Context and Physiology From Self-Reports and Smartwatch Measurements: International Observational Study Trial", journal="JMIR Form Res", year="2022", month="Nov", day="10", volume="6", number="11", pages="e38562", keywords="stress", keywords="telework", keywords="wearables", keywords="COVID-19", keywords="pandemic", keywords="remote working", keywords="employees", keywords="stressors", keywords="destressors", keywords="remote work", keywords="mental health", keywords="psychological health", keywords="smartphone", keywords="digital questionnaire", keywords="stress management", keywords="occupational health", keywords="stress detection", keywords="prediction model", abstract="Background: The COVID-19 pandemic has greatly boosted working from home as a way of working, which is likely to continue for most companies in the future, either in fully remote or in hybrid form. To manage stress levels in employees working from home, insights into the stressors and destressors in a home office first need to be studied. Objective: We present an international remote study with employees working from home by making use of state-of-the-art technology (ie, smartwatches and questionnaires through smartphones) first to determine stressors and destressors in people working from home and second to identify smartwatch measurements that could represent these stressors and destressors. Methods: Employees working from home from 3 regions of the world (the United States, the United Kingdom, and Hong Kong) were asked to wear a smartwatch continuously for 7 days and fill in 5 questionnaires each day and 2 additional questionnaires before and after the measurement week. The entire study was conducted remotely. Univariate statistical analyses comparing variable distributions between low and high stress levels were followed by multivariate analysis using logistic regression, considering multicollinearity by using variance inflation factor (VIF) filtering. Results: A total of 202 people participated, with 198 (98\%) participants finishing the experiment. Stressors found were other people and daily life getting in the way of work (P=.05), job intensity (P=.01), a history of burnout (P=.03), anxiety toward the pandemic (P=.04), and environmental noise (P=.01). Destressors found were access to sunlight (P=.02) and fresh air (P<.001) during the workday and going outdoors (P<.001), taking breaks (P<.001), exercising (P<.001), and having social interactions (P<.001). The smartwatch measurements positively related to stress were the number of active intensity periods (P<.001), the number of highly active intensity periods (P=.04), steps (P<.001), and the SD in the heart rate (HR; P<.001). In a multivariate setting, only a history of burnout (P<.001) and family and daily life getting in the way of work (P<.001) were positively associated with stress, while self-reports of social activities (P<.001) and going outdoors (P=.03) were negatively associated with stress. Stress prediction models based on questionnaire data had a similar performance (F1=0.51) compared to models based on automatic measurable data alone (F1=0.47). Conclusions: The results show that there are stressors and destressors when working from home that should be considered when managing stress in employees. Some of these stressors and destressors are (in)directly measurable with unobtrusive sensors, and prediction models based on these data show promising results for the future of automatic stress detection and management. Trial Registration: Netherlands Trial Register NL9378; https://trialsearch.who.int/Trial2.aspx?TrialID=NL9378 ", doi="10.2196/38562", url="https://formative.jmir.org/2022/11/e38562", url="http://www.ncbi.nlm.nih.gov/pubmed/36265030" } @Article{info:doi/10.2196/36933, author="Logaras, Evangelos and Billis, Antonis and Kyparissidis Kokkinidis, Ilias and Ketseridou, Nafsika Smaranda and Fourlis, Alexios and Tzotzis, Aristotelis and Imprialos, Konstantinos and Doumas, Michael and Bamidis, Panagiotis", title="Risk Assessment of COVID-19 Cases in Emergency Departments and Clinics With the Use of Real-World Data and Artificial Intelligence: Observational Study", journal="JMIR Form Res", year="2022", month="Nov", day="8", volume="6", number="11", pages="e36933", keywords="COVID-19 pandemic", keywords="risk assessment", keywords="wearable device", keywords="respiration evaluation", keywords="emergency department", keywords="artificial intelligence", keywords="real-world data", abstract="Background: The recent COVID-19 pandemic has highlighted the weaknesses of health care systems around the world. In the effort to improve the monitoring of cases admitted to emergency departments, it has become increasingly necessary to adopt new innovative technological solutions in clinical practice. Currently, the continuous monitoring of vital signs is only performed in patients admitted to the intensive care unit. Objective: The study aimed to develop a smart system that will dynamically prioritize patients through the continuous monitoring of vital signs using a wearable biosensor device and recording of meaningful clinical records and estimate the likelihood of deterioration of each case using artificial intelligence models. Methods: The data for the study were collected from the emergency department and COVID-19 inpatient unit of the Hippokration General Hospital of Thessaloniki. The study was carried out in the framework of the COVID-X H2020 project, which was funded by the European Union. For the training of the neural network, data collection was performed from COVID-19 cases hospitalized in the respective unit. A wearable biosensor device was placed on the wrist of each patient, which recorded the primary characteristics of the visual signal related to breathing assessment. Results: A total of 157 adult patients diagnosed with COVID-19 were recruited. Lasso penalty function was used for selecting 18 out of 48 predictors and 2 random forest--based models were implemented for comparison. The high overall performance was maintained, if not improved, by feature selection, with random forest achieving accuracies of 80.9\% and 82.1\% when trained using all predictors and a subset of them, respectively. Preliminary results, although affected by pandemic limitations and restrictions, were promising regarding breathing pattern recognition. Conclusions: This study represents a novel approach that involves the use of machine learning methods and Edge artificial intelligence to assist the prioritization and continuous monitoring procedures of patients with COVID-19 in health departments. Although initial results appear to be promising, further studies are required to examine its actual effectiveness. ", doi="10.2196/36933", url="https://formative.jmir.org/2022/11/e36933", url="http://www.ncbi.nlm.nih.gov/pubmed/36197836" } @Article{info:doi/10.2196/41914, author="Gabashvili, S. Irene", title="The Incidence and Effect of Adverse Events Due to COVID-19 Vaccines on Breakthrough Infections: Decentralized Observational Study With Underrepresented Groups", journal="JMIR Form Res", year="2022", month="Nov", day="4", volume="6", number="11", pages="e41914", keywords="COVID-19", keywords="COVID-19 vaccines", keywords="vaccine adverse events", keywords="breakthrough infections", keywords="decentralized participatory study", keywords="elderly", keywords="older individuals", keywords="medically underserved populations", keywords="aging", keywords="elderly population", keywords="vaccination", keywords="genetic disparity", keywords="microbiome disparity", keywords="impaired immunity", abstract="Background: Despite continuing efforts to improve the inclusion of underserved groups in clinical research, gaps in diversity remain. Participation of special populations is especially important when facing problems of unprecedented complexity such as the COVID-19 pandemic. A better understanding of factors associated with the immune response in diverse populations would advance future preventive and curative approaches. Objective: The objective of this study was to investigate the factors potentially responsible for adverse events following COVID-19 immunization. The study population included adults from rural areas, transitional countries, and those with medically understudied conditions, across a broad age range. Methods: The study evolved from peer support networks developed during the COVID-19 pandemic. Participants were recruited digitally through online neighborhood and health communities. Some of the participants volunteered as study investigators assisting with offline recruitment and safety monitoring. Individuals who consented to participate were asked to share their vaccination experiences either using constantly evolving web-based surveys or via one-on-one communication. Inferential statistical analysis to estimate differences between study groups was performed using parametric and nonparametric tests. Results: Of 1430 participants who shared their vaccination experiences, 648 had outcome measures at their 1.5-year follow-up. Significant differences were found between age groups, types of vaccine adverse events (VAEs), incidences of breakthrough infections, and health conditions linked to the microbiome. Pairwise comparisons showed that VAEs interfering with daily activities were significantly higher in both younger (18-59 years) and older age groups (80-100 years, P<.001) than in the 60-79--year age group. Short-term VAEs were associated with lower incidence of breakthrough COVID-19 infections relative to those who reported either minimal or long-term adverse events (P<.001). A genetic origin was suggested for some adverse reactions. Conclusions: The findings of this study demonstrate that vaccine adverse reactions in older individuals are being overlooked, and the incidence of VAEs impairing immunity may be higher than previously perceived. Better preventive measures are needed for all those at risk for life-threatening and long-term adverse events due to vaccination. Supportive community-based studies focusing on these populations could add important data to the current body of knowledge. Further and more comprehensive studies should follow. Trial Registration: ClinicalTrials.gov NCT04832932; https://clinicaltrials.gov/ct2/show/NCT04832932 International Registered Report Identifier (IRRID): RR2-10.1101/2021.06.28.21256779 ", doi="10.2196/41914", url="https://formative.jmir.org/2022/11/e41914", url="http://www.ncbi.nlm.nih.gov/pubmed/36309347" } @Article{info:doi/10.2196/39861, author="Lee, Katherine and Bolton, Shay-Lee and Shterenberg, Ravit and Bolton, M. James and Hensel, M. Jennifer", title="Early Learning From a Low-Resource COVID-Response Virtual Mental Health Crisis Ward: Mixed Methods Study", journal="JMIR Form Res", year="2022", month="Nov", day="4", volume="6", number="11", pages="e39861", keywords="virtual ward", keywords="mental health", keywords="COVID-19", keywords="implementation", keywords="driver diagram", keywords="virtual care", keywords="virtual health care", keywords="acceptance", keywords="psychiatric support", keywords="crisis support", keywords="provider perspectives", abstract="Background: The COVID-19 pandemic was accompanied by the accelerated uptake of virtual care, leading to a proliferation of virtual ward models as alternatives to facility-based care. Early in the pandemic, our program implemented a virtual mental health crisis ward (vWard) to provide options for individuals requiring intense psychiatric and/or crisis support but who preferred to remain in the community and were deemed safe to do so. Objective: The aim of this study was to identify early learnings from the vWard, which was implemented rapidly in a resource-constrained environment, to inform the future state should it be sustained beyond the pandemic. Methods: Mixed methods of data collection were used to evaluate provider perspectives on the vWard, develop archetypes for individuals who are a good fit for the vWard model, and create a driver diagram. Data sources included an anonymous survey of clinical and managerial staff involved in the vWard, a service planning workshop, and program discharge forms for all individuals admitted between March 2020 and April 2021. Survey responses were coded for themes under categories of ``benefits'' and ``challenges.'' Discharge forms where the team indicated that the vWard was a good fit for an individual were examined for characteristics common to these admissions. These findings were reviewed in the service planning workshop and refined with input from the participants into patient archetypes. A driver diagram was created for the future state. Results: Survey respondents (N=60) represented diverse roles in crisis services and the vWard team. Ten providers took part in the service planning workshop. A total of 467 discharge forms were reviewed. The vWard was felt to be a model that worked by 39 survey respondents, one respondent felt it did not work, and the remaining participants had no response. Several benefits for the individual and the system were identified alongside challenges, including certain processes and materials related to the nature of rapid implementation during the pandemic, and others due to lack of fit for certain individuals. The model was felt to be a good fit for 67.5\% of admissions. Four patient archetypes representing a good fit with the model were developed. The driver diagram connected the program aim with primary drivers of (1) reduce barriers to care; (2) improve outcomes; and (3) provide collaborative, patient- and family-centered care to secondary drivers and interventions that leveraged virtual technology among other crisis care interventions. Conclusions: Despite some challenges, the vWard demonstrated high levels of provider acceptance and a range of mechanisms by which the model works for a variety of patient archetypes. These early learnings provide a foundation for growth, sustainability, and spread of this model going forward beyond the pandemic. ", doi="10.2196/39861", url="https://formative.jmir.org/2022/11/e39861", url="http://www.ncbi.nlm.nih.gov/pubmed/36252139" } @Article{info:doi/10.2196/38904, author="van Gend, Elmar Joris and van 't Klooster, Roderick Jan Willem Jaap and Bolman, Wilhelmina Catherine Adriana and van Gemert-Pijnen, Cornelia Julia Elisabeth Wilhelmina", title="The Dutch COVID-19 Notification App: Lessons Learned From a Mixed Methods Evaluation Among End Users and Contact-Tracing Employees", journal="JMIR Form Res", year="2022", month="Nov", day="4", volume="6", number="11", pages="e38904", keywords="eHealth", keywords="contact tracing", keywords="digital contact tracing", keywords="contact-tracing apps", keywords="COVID-19", keywords="adherence", keywords="public health", keywords="mobile health", keywords="topic analysis", keywords="health service", keywords="user experience", keywords="eHealth intervention", keywords="mobile phone", abstract="Background: The Dutch CoronaMelder (CM) app is the official Dutch contact-tracing app (CTA). It has been used to contain the spread of the SARS-CoV-2 in the Netherlands. It allows its users and those of connected apps to anonymously exchange warnings about potentially high-risk contacts with individuals infected with the SARS-CoV-2. Objective: The goal of this mixed methods study is to understand the use of CTA in the pandemic and its integration into the Municipal Health Services (MHS) efforts of containment through contact tracing. Moreover, the study aims to investigate both the motivations and user experience--related factors concerning adherence to quarantine and isolation measures. Methods: A topic analysis of 56 emails and a web-based survey of 1937 adults from the Netherlands, combined with a series of 48 in-depth interviews with end users of the app and 14 employees of the Dutch MHS involved in contact tracing, were conducted. Mirroring sessions were held (n=2) with representatives from the development (n=2) and communication teams (n=2) responsible for the creation and implementation of the CM app. Results: Topic analysis and interviews identified procedural and technical issues in the use of the CTA. Procedural issues included the lack of training of MHS employees in the use of CTAs. Technical issues identified for the end users included the inability to send notifications without phone contact with the MHS, unwarranted notifications, and nightly notifications. Together, these issues undermined confidence in and satisfaction with the app's use. The interviews offered a deeper understanding of the various factors at play and their effects on users; for example, the mixed experiences of the app's users, the end user's own fears, and uncertainties concerning the SARS-CoV-2; problematic infrastructure at the time of the app's implementation on the side of the health services; the effects of the society-wide efforts in containment of the SARS-CoV-2 on the CM app's perception, resulting in further doubts concerning the app's effectiveness among MHS workers and citizens; and problems with adherence to behavioral measures propagated by the app because of the lack of confidence in the app and uncertainty concerning the execution of the behavioral measures. All findings were evaluated with the app's creators and have since contributed to improvements. Conclusions: Although most participants perceived the app positively, procedural and technical issues identified in this study limited satisfaction and confidence in the CM app and affected its adoption and long-term use. Moreover, these same issues negatively affected the CM app's effectiveness in improving compliance with behavioral measures aimed at reducing the spread of the SARS-CoV-2. This study offers lessons learned for future eHealth interventions in pandemics. Lessons that can aid in more effective design, implementation, and communication for more effective and readily adoptable eHealth applications. ", doi="10.2196/38904", url="https://formative.jmir.org/2022/11/e38904", url="http://www.ncbi.nlm.nih.gov/pubmed/36074930" } @Article{info:doi/10.2196/38794, author="Ismail, Nashwa and Kbaier, Dhouha and Farrell, Tracie and Kane, Annemarie", title="The Experience of Health Professionals With Misinformation and Its Impact on Their Job Practice: Qualitative Interview Study", journal="JMIR Form Res", year="2022", month="Nov", day="2", volume="6", number="11", pages="e38794", keywords="health misinformation", keywords="social media", keywords="health professional", keywords="patients", keywords="trust", keywords="communication, COVID-19", keywords="intervention", keywords="qualitative research", keywords="interpretive phenomenological analysis", keywords="thematic analysis", keywords="misinformation", keywords="health practitioner", keywords="infodemiology", abstract="Background: Misinformation is often disseminated through social media, where information is spread rapidly and easily. Misinformation affects many patients' decisions to follow a treatment prescribed by health professionals (HPs). For example, chronic patients (eg, those with diabetes) may not follow their prescribed treatment plans. During the recent pandemic, misinformed people rejected COVID-19 vaccines and public health measures, such as masking and physical distancing, and used unproven treatments. Objective: This study investigated the impact of health-threatening misinformation on the practices of health care professionals in the United Kingdom, especially during the outbreaks of diseases where a great amount of health-threatening misinformation is produced and released. The study examined the misinformation surrounding the COVID-19 outbreak to determine how it may have impacted practitioners' perceptions of misinformation and how that may have influenced their practice. In particular, this study explored the answers to the following questions: How do HPs react when they learn that a patient has been misinformed? What misinformation do they believe has the greatest impact on medical practice? What aspects of change and intervention in HPs' practice are in response to misinformation? Methods: This research followed a qualitative approach to collect rich data from a smaller subset of health care practitioners working in the United Kingdom. Data were collected through 1-to-1 online interviews with 13 health practitioners, including junior and senior physicians and nurses in the United Kingdom. Results: Research findings indicated that HPs view misinformation in different ways according to the scenario in which it occurs. Some HPs consider it to be an acute incident exacerbated by the pandemic, while others see it as an ongoing phenomenon (always present) and address it as part of their daily work. HPs are developing pathways for dealing with misinformation. Two main pathways were identified: first, to educate the patient through coaching, advising, or patronizing and, second, to devote resources, such as time and effort, to facilitate 2-way communication between the patient and the health care provider through listening and talking to them. Conclusions: HPs do not receive the confidence they deserve from patients. The lack of trust in health care practitioners has been attributed to several factors, including (1) trusting alternative sources of information (eg, social media) (2) patients' doubts about HPs' experience (eg, a junior doctor with limited experience), and (3) limited time and availability for patients, especially during the pandemic. There are 2 dimensions of trust: patient-HP trust and patient-information trust. There are 2 necessary actions to address the issue of lack of trust in these dimensions: (1) building trust and (2) maintaining trust. The main recommendations of the HPs are to listen to patients, give them more time, and seek evidence-based resources. ", doi="10.2196/38794", url="https://formative.jmir.org/2022/11/e38794", url="http://www.ncbi.nlm.nih.gov/pubmed/36252133" } @Article{info:doi/10.2196/36412, author="Chantziara, Sofia and Brigden L C, Amberly and Mccallum, H. Claire and Craddock, J. Ian", title="Using Digital Tools for Contact Tracing to Improve COVID-19 Safety in Schools: Qualitative Study Exploring Views and Experiences Among School Staff", journal="JMIR Form Res", year="2022", month="Nov", day="1", volume="6", number="11", pages="e36412", keywords="schools", keywords="contact tracing", keywords="COVID-19 mitigation", keywords="COVID-19", keywords="pandemic", keywords="disease prevention", keywords="health technology", keywords="COVID-19 management", keywords="technology support", keywords="digital tool", keywords="mobile health", keywords="mobile technology", abstract="Background: Throughout the pandemic, governments worldwide have issued guidelines to manage the spread and impact of COVID-19 in schools, including measures around social distancing and contact tracing. Whether schools required support to implement these guidelines has not yet been explored in depth. Despite the development of a range of technologies to tackle COVID-19, such as contact-tracing apps and electronic vaccine certificates, research on their usefulness in school settings has been limited. Objective: The aim of the study was to explore the needs of school staff in managing COVID-19 and their experiences and perspectives on technological support in relation to contact tracing. School staff are the ones likely to make key implementation decisions regarding new technologies, and they are also the ones responsible for using the new tools daily. Including both management staff and class teachers in the development of school-based technologies can lead to their successful adoption by schools. Methods: Semistructured interviews were conducted with UK school staff, including primary and secondary school teachers and school managers. Thematic analysis, facilitated by NVivo, was used to analyze the data. Two of the authors independently coded 5 (28\%) of the interviews and reached a consensus on a coding framework. Results: Via purposive sampling, we recruited 18 participants from 5 schools. Findings showed that primary schools did not perform contact tracing, while in secondary schools, digital seating plans were used to identify close contacts in the classroom and manual investigations were also conducted identify social contacts. Participants reported that despite their efforts, high-risk interactions between students were not adequately monitored. There was a need to improve accuracy when identifying close contacts in common areas where students congregate. Proximity tracking, use of access cards, and closed-circuit television (CCTV) emerged as potential solutions, but there were concerns surrounding false alerts, burden, and security. Conclusions: School staff have found it difficult to monitor and implement social distancing and contact-tracing provisions. There are opportunities for mobile digital technologies and CCTV to support school staff in keeping their students and colleagues safe; however, these must place minimal demands on staff and prioritize security measures. Study findings can help researchers and practitioners who work in different contexts and settings understand what particular challenges are faced by school staff, and inform further research on the design and application of digital solutions for contact tracing. ", doi="10.2196/36412", url="https://formative.jmir.org/2022/11/e36412", url="http://www.ncbi.nlm.nih.gov/pubmed/36191172" } @Article{info:doi/10.2196/39157, author="Okonkwo, Wilfred Chinedu and Amusa, Babatunde Lateef and Twinomurinzi, Hossana", title="COVID-Bot, an Intelligent System for COVID-19 Vaccination Screening: Design and Development", journal="JMIR Form Res", year="2022", month="Oct", day="27", volume="6", number="10", pages="e39157", keywords="chatbot", keywords="COVID-Bot", keywords="COVID-19", keywords="students", keywords="vaccine", keywords="exemption letter", keywords="vaccination", keywords="artificial intelligence", abstract="Background: Coronavirus continues to spread worldwide, causing various health and economic disruptions. One of the most important approaches to controlling the spread of this disease is to use an artificial intelligence (AI)--based technological intervention, such as a chatbot system. Chatbots can aid in the fight against the spread of COVID-19. Objective: This paper introduces COVID-Bot, an intelligent interactive system that can help screen students and confirm their COVID-19 vaccination status. Methods: The design and development of COVID-Bot followed the principles of the design science research (DSR) process, which is a research method for creating a new scientific artifact. COVID-Bot was developed and implemented using the SnatchBot chatbot application programming interface (API) and its predefined tools, which are driven by various natural language processing algorithms. Results: An evaluation was carried out through a survey that involved 106 university students in determining the functionality, compatibility, reliability, and usability of COVID-Bot. The findings indicated that 92 (86.8\%) of the participants agreed that the chatbot functions well, 85 (80.2\%) agreed that it fits well with their mobile devices and their lifestyle, 86 (81.1\%) agreed that it has the potential to produce accurate and consistent responses, and 85 (80.2\%) agreed that it is easy to use. The average obtained $\alpha$ was .87, indicating satisfactory reliability. Conclusions: This study demonstrates that incorporating chatbot technology into the educational system can combat the spread of COVID-19 among university students. The intelligent system does this by interacting with students to determine their vaccination status. ", doi="10.2196/39157", url="https://formative.jmir.org/2022/10/e39157", url="http://www.ncbi.nlm.nih.gov/pubmed/36301616" } @Article{info:doi/10.2196/36656, author="Woodward, F. Sean and Bari, Sumra and Vike, Nicole and Lalvani, Shamal and Stetsiv, Khrystyna and Kim, Woo Byoung and Stefanopoulos, Leandros and Maglaveras, Nicos and Breiter, Hans and Katsaggelos, K. Aggelos", title="Anxiety, Post--COVID-19 Syndrome-Related Depression, and Suicidal Thoughts and Behaviors in COVID-19 Survivors: Cross-sectional Study", journal="JMIR Form Res", year="2022", month="Oct", day="25", volume="6", number="10", pages="e36656", keywords="COVID-19", keywords="post--COVID-19 syndrome", keywords="suicidality", keywords="depression", keywords="Patient Health Questionnaire-9", keywords="PHQ-9", keywords="State Trait Anxiety Index", keywords="STAI", abstract="Background: Although the mental health impacts of COVID-19 on the general population have been well studied, studies of the long-term impacts of COVID-19 on infected individuals are relatively new. To date, depression, anxiety, and neurological symptoms associated with post--COVID-19 syndrome (PCS) have been observed in the months following COVID-19 recovery. Suicidal thoughts and behavior (STB) have also been preliminarily proposed as sequelae of COVID-19. Objective: We asked 3 questions. First, do participants reporting a history of COVID-19 diagnosis or a close relative having severe COVID-19 symptoms score higher on depression (Patient Health Questionnaire-9 [PHQ-9]) or state anxiety (State Trait Anxiety Index) screens than those who do not? Second, do participants reporting a COVID-19 diagnosis score higher on PCS-related PHQ-9 items? Third, do participants reporting a COVID-19 diagnosis or a close relative having severe COVID-19 symptoms score higher in STB before, during, or after the first year of the pandemic? Methods: This preliminary study analyzed responses to a COVID-19 and mental health questionnaire obtained from a US population sample, whose data were collected between February 2021 and March 2021. We used the Mann-Whitney U test to detect differences in the medians of the total PHQ-9 scores, PHQ-9 component scores, and several STB scores between participants claiming a past clinician diagnosis of COVID-19 and those denying one, as well as between participants claiming severe COVID-19 symptoms in a close relative and those denying them. Where significant differences existed, we created linear regression models to predict the scores based on COVID-19 response as well as demographics to identify potential confounding factors in the Mann-Whitney relationships. Moreover, for STB scores, which corresponded to 5 questions asking about 3 different time intervals (i.e., past 1 year or more, past 1 month to 1 year, and past 1 month), we developed repeated-measures ANOVAs to determine whether scores tended to vary over time. Results: We found greater total depression (PHQ-9) and state anxiety (State Trait Anxiety Index) scores in those with COVID-19 history than those without (Bonferroni P=.001 and Bonferroni P=.004) despite a similar history of diagnosed depression and anxiety. Greater scores were noted for a subset of depression symptoms (PHQ-9 items) that overlapped with the symptoms of PCS (all Bonferroni Ps<.05). Moreover, we found greater overall STB scores in those with COVID-19 history, equally in time windows preceding, during, and proceeding infection (all Bonferroni Ps<.05). Conclusions: We confirm previous studies linking depression and anxiety diagnoses to COVID-19 recovery. Moreover, our findings suggest that depression diagnoses associated with COVID-19 history relate to PCS symptoms, and that STB associated with COVID-19 in some cases precede infection. ", doi="10.2196/36656", url="https://formative.jmir.org/2022/10/e36656", url="http://www.ncbi.nlm.nih.gov/pubmed/35763757" } @Article{info:doi/10.2196/35426, author="Herbert, Carly and Broach, John and Heetderks, William and Qashu, Felicia and Gibson, Laura and Pretz, Caitlin and Woods, Kelsey and Kheterpal, Vik and Suvarna, Thejas and Nowak, Christopher and Lazar, Peter and Ayturk, Didem and Barton, Bruce and Achenbach, Chad and Murphy, Robert and McManus, David and Soni, Apurv", title="Feasibility of At-Home Serial Testing Using Over-the-Counter SARS-CoV-2 Tests With a Digital Smartphone App for Assistance: Longitudinal Cohort Study", journal="JMIR Form Res", year="2022", month="Oct", day="18", volume="6", number="10", pages="e35426", keywords="COVID-19", keywords="SARS-CoV-2", keywords="rapid tests", keywords="MyDataHelps smartphone app", keywords="mHealth", keywords="mobile health", keywords="serial self-testing", keywords="digital health", keywords="pandemic", keywords="self test", abstract="Background: The ongoing SARS-CoV-2 pandemic necessitates the development of accurate, rapid, and affordable diagnostics to help curb disease transmission, morbidity, and mortality. Rapid antigen tests are important tools for scaling up testing for SARS-CoV-2; however, little is known about individuals' use of rapid antigen tests at home and how to facilitate the user experience. Objective: This study aimed to describe the feasibility and acceptability of serial self-testing with rapid antigen tests for SARS-CoV-2, including need for assistance and the reliability of self-interpretation. Methods: A total of 206 adults in the United States with smartphones were enrolled in this single-arm feasibility study in February and March 2021. All participants were asked to self-test for COVID-19 at home using rapid antigen tests daily for 14 days and use a smartphone app for testing assistance and to report their results. The main outcomes were adherence to the testing schedule, the acceptability of testing and smartphone app experiences, and the reliability of participants versus study team's interpretation of test results. Descriptive statistics were used to report the acceptability, adherence, overall rating, and experience of using the at-home test and MyDataHelps app. The usability, acceptability, adherence, and quality of at-home testing were analyzed across different sociodemographic, age, and educational attainment groups. Results: Of the 206 enrolled participants, 189 (91.7\%) and 159 (77.2\%) completed testing and follow-up surveys, respectively. In total, 51.3\% (97/189) of study participants were women, the average age was 40.7 years, 34.4\% (65/189) were non-White, and 82\% (155/189) had a bachelor's degree or higher. Most (n=133/206, 64.6\%) participants showed high testing adherence, meaning they completed over 75\% of the assigned tests. Participants' interpretations of test results demonstrated high agreement (2106/2130, 98.9\%) with the study verified results, with a $\kappa$ score of 0.29 (P<.001). Participants reported high satisfaction with self-testing and the smartphone app, with 98.7\% (157/159) reporting that they would recommend the self-test and smartphone app to others. These results were consistent across age, race/ethnicity, and gender. Conclusions: Participants' high adherence to the recommended testing schedule, significant reliability between participants and study staff's test interpretation, and the acceptability of the smartphone app and self-test indicate that self-tests for SARS-CoV-2 with a smartphone app for assistance and reporting is a highly feasible testing modality among a diverse population of adults in the United States. ", doi="10.2196/35426", url="https://formative.jmir.org/2022/10/e35426", url="http://www.ncbi.nlm.nih.gov/pubmed/36041004" } @Article{info:doi/10.2196/40215, author="Severson, A. Marie and Cassada, A. David and Huber, C. Victor and Snow, D. Daniel and McFadden, M. Lisa", title="Population Health Metrics During the Early Stages of the COVID-19 Pandemic: Correlative Pilot Study", journal="JMIR Form Res", year="2022", month="Oct", day="17", volume="6", number="10", pages="e40215", keywords="COVID-19", keywords="ethyl glucuronide", keywords="wastewater", keywords="stress", keywords="helpline", abstract="Background: COVID-19 has caused nearly 1 million deaths in the United States, not to mention job losses, business and school closures, stay-at-home orders, and mask mandates. Many people have suffered increased anxiety and depression since the pandemic began. Not only have mental health symptoms become more prevalent, but alcohol consumption has also increased during this time. Helplines offer important insight into both physical and mental wellness of a population by offering immediate, anonymous, cheap, and accessible resources for health and substance use disorders (SUD) that was unobstructed by many of the mandates of the pandemic. Further, the pandemic also launched the use of wastewater surveillance, which has the potential for tracking not only population infections but also consumption of substances such as alcohol. Objective: This study assessed the feasibility of using multiple public surveillance metrics, such as helpline calls, COVID-19 cases, and alcohol metabolites in wastewater, to better understand the need for interventions or public health programs in the time of a public health emergency. Methods: Ethanol metabolites were analyzed from wastewater collected twice weekly from September 29 to December 4, 2020, in a Midwestern state. Calls made to the helpline regarding housing, health care, and mental health/SUD were correlated with ethanol metabolites analyzed from wastewater samples, as well as the number of COVID-19 cases during the sampling period. Results: Correlations were observed between COVID-19 cases and helpline calls regarding housing and health care needs. No correlation was observed between the number of COVID-19 cases and mental health/SUD calls. COVID-19 cases on Tuesdays were correlated with the alcohol metabolite ethyl glucuronide (EtG). Finally, EtG levels were negatively associated with mental health/SUD helpline calls. Conclusions: Although helpline calls provided critical services for health care and housing-related concerns early in the pandemic, evidence suggests helpline calls for mental health/SUD-related concerns were unrelated to COVID-19 metrics. Instead, COVID metrics were associated with alcohol metabolites in wastewater. Although this research was formative, with continued and expanded monitoring of population metrics, such as helpline usage, COVID-19 metrics, and wastewater, strategies can be implemented to create precision programs to address the needs of the population. ", doi="10.2196/40215", url="https://formative.jmir.org/2022/10/e40215", url="http://www.ncbi.nlm.nih.gov/pubmed/36219745" } @Article{info:doi/10.2196/37642, author="Tsai, A. Krystle and Cassidy, Omni and Arshonsky, Josh and Bond, Sara and Del Giudice, M. In{\'e}s and Bragg, A. Marie", title="COVID-Washing in US Food and Beverage Marketing on Twitter: Content Analysis", journal="JMIR Form Res", year="2022", month="Oct", day="14", volume="6", number="10", pages="e37642", keywords="COVID-19", keywords="food and beverage marketing", keywords="Twitter", keywords="obesity", keywords="social media", keywords="nutrition", keywords="risk factor", keywords="health advertising", keywords="marketing", abstract="Background: Food companies have increased digital and social media ad expenditures during the COVID-19 pandemic, capitalizing on the coinciding increase in social media use during the pandemic. The extent of pandemic-related social media advertising and marketing tactics have been previously reported. No studies, however, have evaluated how food and beverage companies used COVID-washing on social media posts in the United States or analyzed the nutritional content of advertised food and beverage products. This study was designed to address these gaps by evaluating how food and beverage companies capitalize on the COVID-19 pandemic to promote unhealthy foods and sugary beverages. Objective: We aimed to document the types and frequencies of COVID-19--related themes in US food and beverage companies' Twitter posts during the first wave of the pandemic in the United States, and assess the nutritional quality of food and beverage products featured in these tweets. Methods: Research assistants visited the Twitter accounts of the most-marketed food and beverage brands, and screen-captured all tweets posted between March 1 and May 31, 2020. Researchers documented the date of the tweet; the number of likes, views, comments, and ``retweets''; and the type of food and beverage products. We coded tweets for the following 10 COVID-19 themes: (1) social distancing, staying home, or working remotely; (2) contactless delivery or pick-up; (3) handwashing or sanitizing; (4) masks; (5) safety or protection; (6) staying connected with others; (7) staying active; (8) frontline or essential workers; (9) monetary relief, donations, or unemployment; and (10) pandemic, unprecedented, or difficult times. Researchers calculated the nutrient profile index scores for featured foods and sorted beverages into categories based on sugar content. Results: Our final sample included 874 COVID-19--themed tweets from 52 food and beverage brands. Social distancing themes appeared most frequently (n=367, 42\%), followed by pandemic, unprecedented, or difficult times (n=246, 28.2\%), and contactless delivery (n=237, 27.1\%). The majority of tweets (n=682, 78\%) promoted foods and beverages. Among those tweets featuring foods and beverages, 89.6\% (n=611) promoted unhealthy products, whereas 17.2\% (n=117) promoted healthy products. Conclusions: Our findings point to a concerning marketing tactic in which major food and beverage companies promote unhealthy foods and sugary beverages during the COVID-19 pandemic. Given that nutrition-related diseases such as obesity and diabetes are risk factors for COVID-19 morbidity and mortality, food and beverage companies should reduce the promotion of unhealthy products to help decrease the prevalence of health conditions that place people at higher risk for severe illness and death due to COVID-19. ", doi="10.2196/37642", url="https://formative.jmir.org/2022/10/e37642", url="http://www.ncbi.nlm.nih.gov/pubmed/36040957" } @Article{info:doi/10.2196/35744, author="Fu, Chunye and Lyu, Xiaokang and Mi, Mingdi", title="Collective Value Promotes the Willingness to Share Provaccination Messages on Social Media in China: Randomized Controlled Trial", journal="JMIR Form Res", year="2022", month="Oct", day="4", volume="6", number="10", pages="e35744", keywords="individual value", keywords="collective value", keywords="vaccination", keywords="message-sharing willingness", keywords="perceived responsibility", keywords="misinformation", keywords="vaccine misinformation", keywords="public health", keywords="influenza vaccine", keywords="social media", keywords="COVID-19", abstract="Background: The proliferation of vaccine misinformation on social media has seriously corrupted the public's confidence in vaccination. Proactively sharing provaccination messages on social media is a cost-effective way to enhance global vaccination rates and resist vaccine misinformation. However, few strategies for encouraging the public to proactively share vaccine-related knowledge on social media have been developed. Objective: This research examines the effect of value type (individual vs collective) and message framing (gain vs loss) on influenza vaccination intention (experiment 1) and the willingness to share provaccination messages (experiment 2) among Chinese adults during the COVID-19 pandemic. The primary aim was to evaluate whether messages that emphasized collective value were more effective in increasing the willingness to share than messages that emphasized individual value. Methods: We enrolled 450 Chinese adults for experiment 1 (n=250, 55.6\%) and experiment 2 (n=200, 44.4\%). Participants were randomly assigned to individual-gain, individual-loss, collective-gain, or collective-loss conditions with regard to the message in each experiment using the online survey platform's randomization function. Experiment 1 also included a control group. The primary outcome was influenza vaccination intention in experiment 1 and the willingness to share provaccination messages in experiment 2. Results: The valid sample included 213 adults in experiment 1 (females: n=151, 70.9\%; mean age 29 [SD 9] years; at least some college education: n=202, 94.8\%; single: n=131, 61.5\%) and 171 adults in experiment 2 (females: n=106, 62.0\%; mean age 28 [SD 7] years; at least some college education: n=163, 95.3\%; single: n=95, 55.6\%). Influenza vaccination intention was stronger in the individual-value conditions than in the collective-value conditions (F3,166=4.96, P=.03, $\eta$2=0.03). The reverse result was found for the willingness to share provaccination messages (F3,165=6.87, P=.01, $\eta$2=0.04). Specifically, participants who received a message emphasizing collective value had a higher intention to share the message than participants who read a message emphasizing individual value (F3,165=6.87, P=.01, $\eta$2=0.04), and the perceived responsibility for message sharing played a mediating role (indirect effect=0.23, 95\% lower limit confidence interval [LLCI] 0.41, 95\% upper limit confidence interval [ULCI] 0.07). In addition, gain framing facilitated influenza vaccination intention more than loss framing (F3,166=5.96, P=.02, $\eta$2=0.04). However, experiment 2 did not find that message framing affected message-sharing willingness. Neither experiment found an interaction between value type and message framing. Conclusions: Strengthened individual value rather than collective value is more likely to persuade Chinese adults to vaccinate. However, these adults are more likely to share a message that emphasizes collective rather than individual value, and the perceived responsibility for message sharing plays a mediating role. ", doi="10.2196/35744", url="https://formative.jmir.org/2022/10/e35744", url="http://www.ncbi.nlm.nih.gov/pubmed/36067417" } @Article{info:doi/10.2196/36660, author="Li, Zhongqiang and Li, Zheng and Yao, Luke and Chen, Qing and Zhang, Jian and Li, Xin and Feng, Ji-Ming and Li, Yanping and Xu, Jian", title="Multiple-Inputs Convolutional Neural Network for COVID-19 Classification and Critical Region Screening From Chest X-ray Radiographs: Model Development and Performance Evaluation", journal="JMIR Bioinform Biotech", year="2022", month="Oct", day="4", volume="3", number="1", pages="e36660", keywords="COVID-19", keywords="chest X-ray radiography", keywords="multiple-inputs convolutional neural network", keywords="screening critical COVID regions", abstract="Background: The COVID-19 pandemic is becoming one of the largest, unprecedented health crises, and chest X-ray radiography (CXR) plays a vital role in diagnosing COVID-19. However, extracting and finding useful image features from CXRs demand a heavy workload for radiologists. Objective: The aim of this study was to design a novel multiple-inputs (MI) convolutional neural network (CNN) for the classification of COVID-19 and extraction of critical regions from CXRs. We also investigated the effect of the number of inputs on the performance of our new MI-CNN model. Methods: A total of 6205 CXR images (including 3021 COVID-19 CXRs and 3184 normal CXRs) were used to test our MI-CNN models. CXRs could be evenly segmented into different numbers (2, 4, and 16) of individual regions. Each region could individually serve as one of the MI-CNN inputs. The CNN features of these MI-CNN inputs would then be fused for COVID-19 classification. More importantly, the contributions of each CXR region could be evaluated through assessing the number of images that were accurately classified by their corresponding regions in the testing data sets. Results: In both the whole-image and left- and right-lung region of interest (LR-ROI) data sets, MI-CNNs demonstrated good efficiency for COVID-19 classification. In particular, MI-CNNs with more inputs (2-, 4-, and 16-input MI-CNNs) had better efficiency in recognizing COVID-19 CXRs than the 1-input CNN. Compared to the whole-image data sets, the efficiency of LR-ROI data sets showed approximately 4\% lower accuracy, sensitivity, specificity, and precision (over 91\%). In considering the contributions of each region, one of the possible reasons for this reduced performance was that nonlung regions (eg, region 16) provided false-positive contributions to COVID-19 classification. The MI-CNN with the LR-ROI data set could provide a more accurate evaluation of the contribution of each region and COVID-19 classification. Additionally, the right-lung regions had higher contributions to the classification of COVID-19 CXRs, whereas the left-lung regions had higher contributions to identifying normal CXRs. Conclusions: Overall, MI-CNNs could achieve higher accuracy with an increasing number of inputs (eg, 16-input MI-CNN). This approach could assist radiologists in identifying COVID-19 CXRs and in screening the critical regions related to COVID-19 classifications. ", doi="10.2196/36660", url="https://bioinform.jmir.org/2022/1/e36660", url="http://www.ncbi.nlm.nih.gov/pubmed/36277075" } @Article{info:doi/10.2196/39582, author="Koss, Jonathan and Bohnet-Joschko, Sabine", title="Social Media Mining of Long-COVID Self-Medication Reported by Reddit Users: Feasibility Study to Support Drug Repurposing", journal="JMIR Form Res", year="2022", month="Oct", day="3", volume="6", number="10", pages="e39582", keywords="social media mining", keywords="drug repurposing", keywords="long-COVID", keywords="crowdsourcing", keywords="COVID-19", keywords="Reddit", keywords="social media", keywords="content analysis", keywords="network analysis", keywords="recognition algorithm", keywords="treatment", abstract="Background: Since the beginning of the COVID-19 pandemic, over 480 million people have been infected and more than 6 million people have died from COVID-19 worldwide. In some patients with acute COVID-19, symptoms manifest over a longer period, which is also called ``long-COVID.'' Unmet medical needs related to long-COVID are high, since there are no treatments approved. Patients experiment with various medications and supplements hoping to alleviate their suffering. They often share their experiences on social media. Objective: The aim of this study was to explore the feasibility of social media mining methods to extract important compounds from the perspective of patients. The goal is to provide an overview of different medication strategies and important agents mentioned in Reddit users' self-reports to support hypothesis generation for drug repurposing, by incorporating patients' experiences. Methods: We used named-entity recognition to extract substances representing medications or supplements used to treat long-COVID from almost 70,000 posts on the ``/r/covidlonghaulers'' subreddit. We analyzed substances by frequency, co-occurrences, and network analysis to identify important substances and substance clusters. Results: The named-entity recognition algorithm achieved an F1 score of 0.67. A total of 28,447 substance entities and 5789 word co-occurrence pairs were extracted. ``Histamine antagonists,'' ``famotidine,'' ``magnesium,'' ``vitamins,'' and ``steroids'' were the most frequently mentioned substances. Network analysis revealed three clusters of substances, indicating certain medication patterns. Conclusions: This feasibility study indicates that network analysis can be used to characterize the medication strategies discussed in social media. Comparison with existing literature shows that this approach identifies substances that are promising candidates for drug repurposing, such as antihistamines, steroids, or antidepressants. In the context of a pandemic, the proposed method could be used to support drug repurposing hypothesis development by prioritizing substances that are important to users. ", doi="10.2196/39582", url="https://formative.jmir.org/2022/10/e39582", url="http://www.ncbi.nlm.nih.gov/pubmed/36007131" } @Article{info:doi/10.2196/38070, author="Maragh-Bass, Allysha and Comello, Leonora Maria and Tolley, Ellen Elizabeth and Stevens Jr, Darrell and Wilson, Jade and Toval, Christina and Budhwani, Henna and Hightow-Weidman, Lisa", title="Digital Storytelling Methods to Empower Young Black Adults in COVID-19 Vaccination Decision-Making: Feasibility Study and Demonstration", journal="JMIR Form Res", year="2022", month="Sep", day="26", volume="6", number="9", pages="e38070", keywords="young Black adults", keywords="COVID-19", keywords="vaccine hesitancy", keywords="digital storytelling", keywords="community-based participatory research", keywords="digital health intervention", abstract="Background: Despite high rates of novel COVID-19, acceptance of COVID-19 vaccination is low among Black adults. In response, we developed a digital health intervention (Tough Talks-COVID) that includes digital stories created in a workshop we held with young Black adults. Objective: Our formative research using digital storytelling workshops asked 3 research questions: (1) What issues did participants have in conceptualizing their stories, and what themes emerged from the stories they created? (2) What issues did participants have related to production techniques, and which techniques were utilized in stories? and (3) Overall, how did participants evaluate their workshop experience? Methods: Participants were workshop-eligible if they were vaccine-accepting based on a baseline survey fielded in late 2021. Final participants (N=11) completed a consent process, all 3 workshops, and a media release form for their digital story. The first 2 workshops provided background information and hands-on digital storytelling skills from pre- to postproduction. The third workshop served as a screening and feedback session for participants' final videos. Qualitative and quantitative feedback elements were incorporated into all 3 sessions. Results: Digital stories addressed one or more of 4 broad themes: (1) COVID-19 vulnerability, (2) community connections, (3) addressing vaccine hesitancy, and (4) countering vaccine misinformation. Participants incorporated an array of technical approaches, including unique creative elements such as cartoon images and instant messaging tools to convey social interactions around COVID-19 decision-making. Most (9/11, 82\%) strongly agreed the digital storytelling workshops were delivered as expected; 10 of 11 agreed (n=5) or strongly agreed (n=5) that they had some ideas about what story to tell by the end of the first workshop, and most (8/11, 73\%) strongly agreed they had narrowed down their ideas by workshop two. Of the participants, 9 felt they would very likely (n=6) or likely (n=3) use digital storytelling techniques for personal use in the future, and even more were very likely (n=7) to use the techniques for professional use. Conclusions: Our study is one of the first to incorporate digital storytelling as a central component to a digital health intervention and the only one to do so with exclusive focus on young Black adults. Our emphasis on digital storytelling was shown to be highly acceptable. Similar approaches, including careful consideration of the ethical challenges of community-based participatory approaches, are applicable to other populations experiencing both COVID-19 inequities and marginalization, such as other age demographics and people of color. ", doi="10.2196/38070", url="https://formative.jmir.org/2022/9/e38070", url="http://www.ncbi.nlm.nih.gov/pubmed/36155984" } @Article{info:doi/10.2196/38589, author="Layug, Alyan and Krishnamurthy, Samiksha and McKenzie, Rachel and Feng, Bo", title="The Impacts of Social Media Use and Online Racial Discrimination on Asian American Mental Health: Cross-sectional Survey in the United States During COVID-19", journal="JMIR Form Res", year="2022", month="Sep", day="19", volume="6", number="9", pages="e38589", keywords="Asian Americans", keywords="mental health", keywords="COVID-19 pandemic", keywords="racial discrimination", keywords="social media", keywords="anxiety", keywords="depression", keywords="secondary traumatic stress", keywords="negative affect", keywords="racial/ethnic identification", abstract="Background: During the COVID-19 pandemic, increased social media usage has led to worsened mental health outcomes for many people. Moreover, due to the sociopolitical climate during the pandemic, the prevalence of online racial discrimination has contributed to worsening psychological well-being. With increases in anti-Asian hate, Asian and Asian American social media users may experience the negative effects of online racial discrimination in addition to the reduced psychological well-being resulting from exposure to online COVID-19 content. Objective: This study aims to investigate the impact of COVID-19--related social media use and exposure to online racial discrimination during the pandemic on the mental health outcomes (ie, anxiety, depression, and secondary traumatic stress [STS]) of Asian Americans compared with those of non-Asian Americans. In addition, this study explores the mediating role of negative affect and the moderating role of racial/ethnic identification. Methods: An online survey was conducted through Amazon Mechanical Turk and a university-wide research portal from March 3 to March 15, 2021. A total of 1147 participants took the survey. Participants' social media usage related to COVID-19 and exposure to 2 online forms of racial discrimination (individual and vicarious), mental health outcomes (anxiety, depression, and STS), racial/ethnic identification, negative affect, and demographics were assessed. Results: Our results showed that COVID-19--related social media use, individual discrimination, and vicarious discrimination were predictors of negative mental health outcomes (anxiety, depression, and STS). Asian Americans reported higher vicarious discrimination than Latinx and White Americans, but Asian Americans' mental health outcomes did not differ substantially from those of the other racial/ethnic groups. Racial/ethnic identification moderated the relationship between both types of discrimination and STS, and negative affect served as a mediator between both types of discrimination and all 3 mental health outcomes. Conclusions: These results suggest that social media exposure continues to have a dire effect on mental health during the COVID-19 pandemic. This study helps to contextualize the rise of anti-Asian American hate and its impact on mental health outcomes in the United States. ", doi="10.2196/38589", url="https://formative.jmir.org/2022/9/e38589", url="http://www.ncbi.nlm.nih.gov/pubmed/36121698" } @Article{info:doi/10.2196/37775, author="Yousef, Murooj and Dietrich, Timo and Rundle-Thiele, Sharyn", title="Actions Speak Louder Than Words: Sentiment and Topic Analysis of COVID-19 Vaccination on Twitter and Vaccine Uptake", journal="JMIR Form Res", year="2022", month="Sep", day="15", volume="6", number="9", pages="e37775", keywords="COVID-19", keywords="COVID-19 vaccination", keywords="sentiment analysis", keywords="public health campaigns", keywords="vaccine uptake", keywords="Twitter", keywords="social media", keywords="vaccines", abstract="Background: The lack of trust in vaccines is a major contributor to vaccine hesitancy. To overcome vaccine hesitancy for the COVID-19 vaccine, the Australian government launched multiple public health campaigns to encourage vaccine uptake. This sentiment analysis examines the effect of public health campaigns and COVID-19--related events on sentiment and vaccine uptake. Objective: This study aims to examine the relationship between sentiment and COVID-19 vaccine uptake and government actions that impacted public sentiment about the vaccine. Methods: Using machine learning methods, we collected 137,523 publicly available English language tweets published in Australia between February and October 2021 that contained COVID-19 vaccine--related keywords. Machine learning methods were used to extract topics and sentiments relating to COVID-19 vaccination. The relationship between public vaccination sentiment on Twitter and vaccine uptake was examined. Results: The majority of collected tweets expressed negative (n=91,052, 66\%) rather than positive (n=21,686, 16\%) or neutral (n=24,785, 18\%) sentiments. Topics discussed within the study time frame included the role of the government in the vaccination rollout, availability and accessibility of the vaccine, and vaccine efficacy. There was a significant positive correlation between negative sentiment and the number of vaccine doses administered daily (r267=.15, P<.05), with positive sentiment showing the inverse effect. Public health campaigns, lockdowns, and antivaccination protests were associated with increased negative sentiment, while vaccination mandates had no significant effect on sentiment. Conclusions: The study findings demonstrate that negative sentiment was more prevalent on Twitter during the Australian vaccination rollout but vaccine uptake remained high. Australians expressed anger at the slow rollout and limited availability of the vaccine during the study period. Public health campaigns, lockdowns, and antivaccination rallies increased negative sentiment. In contrast, news of increased vaccine availability for the public and government acquisition of more doses were key government actions that reduced negative sentiment. These findings can be used to inform government communication planning. ", doi="10.2196/37775", url="https://formative.jmir.org/2022/9/e37775", url="http://www.ncbi.nlm.nih.gov/pubmed/36007136" } @Article{info:doi/10.2196/35718, author="Rauer, Thomas and Scherer, Julian and St{\"a}ubli, Pascal and Gerber, Jonas and Pape, Hans-Christoph and Heining, Sandro-Michael", title="Satisfaction With Telemedicine in Patients With Orthopedic Trauma During the COVID-19 Lockdown: Interview Study", journal="JMIR Form Res", year="2022", month="Sep", day="12", volume="6", number="9", pages="e35718", keywords="COVID-19", keywords="digital", keywords="survey", keywords="telehealth", keywords="follow-up", keywords="orthopedic trauma", keywords="trauma", keywords="attitude", abstract="Background: Telemedicine can take many forms, from telephone-only consultations to video consultations via a smartphone or personal computer, depending on the goals of the treatment. One of the advantages of videoconferencing is the direct visual contact between patients and therapists even over long distances. Although some telemedicine models require specially designed add-on devices, others get by with off-the-shelf equipment and software and achieve similarly successful successful results. This depends, among other things, on the nature of the injury, the desired outcome of therapy, and the medical consultation. In the last decade, the science and practice of telemedicine have grown exponentially and even more so during the COVID-19 pandemic. Depending on the traumatic lesion, posttraumatic and postoperative treatment and care of patients who experience trauma may require medical or physical therapy consultations in a clinic or office. However, due to the COVID-19 lockdown, direct physical follow-up was more difficult, and therefore, telemedicine solutions were sought and implemented. Objective: The aim of this study was to assess satisfaction with telemedical aftercare in patients with orthopedic trauma. Methods: Between March and July 2020, a standardized interview using a standardized questionnaire---Freiburg Index of Patient Satisfaction (FIPS)---among patients with orthopedic trauma who received telemedical postsurgical or physiotherapeutic care was conducted. The FIPS is composed of 5 questions regarding treatment and 1 question on the overall treatment satisfaction. Furthermore, we assessed patients' demographics and their telemedical use. Subgroup analysis was performed for age groups (<65 years vs ?65 years), the used device, and gender. Results: In total, we assessed 25 patients with a mean age of 43 (SD 24.31) years (14 female). The majority of patients (n=19, 76\%) used their smartphone for consultations. The mean overall FIPS score assessed was 2.14 (SD 0.87). The mean FIPS score for younger patients was 2.23 (SD 0.90) vs 1.91 (SD 0.82) for older patients. The vast majority of the surveyed patients (n=20, 80\%) were absolutely confident with their smartphone or tablet use. Conclusions: Most patients surveyed stated a high satisfaction with the telemedical follow-up. Older patients showed a higher satisfaction rate than their younger counterparts. It seems that telemedical postsurgical or physiotherapeutic care is a viable option, especially in times of reduced contact, like the current COVID-19 pandemic. Thus, telemedicine offers the opportunity to ensure access to effective patient care, even over long distances, while maintaining patient satisfaction. ", doi="10.2196/35718", url="https://formative.jmir.org/2022/9/e35718", url="http://www.ncbi.nlm.nih.gov/pubmed/36040961" } @Article{info:doi/10.2196/36003, author="Splinter, Bas and Saadah, H. Nicholas and Chavannes, H. Niels and Kiefte-de Jong, C. Jessica and Aardoom, J. Jiska", title="Optimizing the Acceptability, Adherence, and Inclusiveness of the COVID Radar Surveillance App: Qualitative Study Using Focus Groups, Thematic Content Analysis, and Usability Testing", journal="JMIR Form Res", year="2022", month="Sep", day="9", volume="6", number="9", pages="e36003", keywords="COVID-19", keywords="corona", keywords="eHealth", keywords="self-report", keywords="mobile app", keywords="track-and-trace strategies", keywords="population surveillance", keywords="citizen science", keywords="usability", keywords="mobile phone", abstract="Background: The COVID Radar app was developed as a population-based surveillance instrument to identify at-risk populations and regions in response to the COVID-19 pandemic. The app boasts of >8.5 million completed questionnaires, with >280,000 unique users. Although the COVID Radar app is a valid tool for population-level surveillance, high user engagement is critical to the success of the COVID Radar app in maintaining validity. Objective: This study aimed to identify optimization targets of the COVID Radar app to improve its acceptability, adherence, and inclusiveness. Methods: The main component of the COVID Radar app is a self-report questionnaire that assesses COVID-19 symptoms and social distancing behaviors. A total of 3 qualitative substudies were conducted. First, 3 semistructured focus group interviews with end users (N=14) of the app were conducted to gather information on user experiences. The output was transcribed and thematically coded using the framework method. Second, a similar qualitative thematic analysis was conducted on 1080 end-user emails. Third, usability testing was conducted in one-on-one sessions with 4 individuals with low literacy levels. Results: All 3 substudies identified optimization targets in terms of design and content. The results of substudy 1 showed that the participants generally evaluated the app positively. They reported the app to be user-friendly and were satisfied with its design and functionalities. Participants' main motivation to use the app was to contribute to science. Participants suggested adding motivational tools to stimulate user engagement. A larger national publicity campaign for the app was considered potentially helpful for increasing the user population. In-app updates informing users about the project and its outputs motivated users to continue using the app. Feedback on the self-report questionnaire, stemming from substudies 1 and 2, mostly concerned the content and phrasing of the questions. Furthermore, the section of the app allowing users to compare their symptoms and behaviors to those of their peers was found to be suboptimal because of difficulties in interpreting the figures presented in the app. Finally, the output of substudy 3 resulted in recommendations primarily related to simplification of the text to render it more accessible and comprehensible for individuals with low literacy levels. Conclusions: The convenience of app use, enabling personal adjustments of the app experience, and considering motivational factors for continued app use (ie, altruism and collectivism) were found to be crucial to procuring and maintaining a population of active users of the COVID Radar app. Further, there seems to be a need to increase the accessibility of public health tools for individuals with low literacy levels. These results can be used to improve the this and future public health apps and improve the representativeness of their user populations and user engagement, ultimately increasing the validity of the tools. ", doi="10.2196/36003", url="https://formative.jmir.org/2022/9/e36003", url="http://www.ncbi.nlm.nih.gov/pubmed/35781492" } @Article{info:doi/10.2196/37509, author="Seifarth, Jack and Pinaire, Megan and Zicker, John and Singh, Inder and Bloch, Danielle", title="Circulating Illness and Changes in Thermometer Use Behavior: Series of Cross-sectional Analyses", journal="JMIR Form Res", year="2022", month="Sep", day="8", volume="6", number="9", pages="e37509", keywords="thermometer", keywords="health behavior", keywords="influenza", keywords="COVID-19", keywords="fever", keywords="surveillance", keywords="perceived risk", keywords="percent positivity", keywords="smart technology", keywords="smart thermometer", keywords="population demography", keywords="older adult", keywords="elderly population", keywords="health monitoring", abstract="Background: Temperature-taking behaviors vary with levels of circulating infectious illness; however, little is known about how these behaviors differ by demographic characteristics. Populations with higher perceived risks of illness are more likely to adopt protective health behaviors. Objective: We investigated differences in temperature-taking frequency and the proportion of readings that were feverish among demographic groups (age, gender, urban/rural status) over influenza offseason; influenza season; and waves 1, 2, and 3 of the COVID-19 pandemic. Methods: Using data from smart thermometers collected from May 1, 2019, to February 28, 2021, across the United States, we calculated the frequency of temperature-taking and the proportion of temperature readings that were feverish. Mixed-effects negative binomial and mixed-effects logistic regression analyses were performed to identify demographic characteristics associated with temperature-taking frequency and the proportion of feverish readings, respectively. Separate models were fit over five study periods: influenza offseason (n=122,480), influenza season (n=174,191), wave 1 of COVID-19 (n=350,385), wave 2 (n=366,489), and wave 3 (n=391,578). Results: Both temperature-taking frequency and the proportion of feverish readings differed by study period (ANOVA P<.001) and were the highest during influenza season. During all periods, children aged 2-5 years and 6-11 years had significantly higher frequencies of temperature-taking than users aged 19-30 years, and children had the highest proportion of feverish readings of all age groups, after adjusting for covariates. During wave 1 of COVID-19, users over the age of 60 years had 1.79 times (95\% CI 1.76-1.83) the rate of temperature-taking as users aged 19-30 years and 74\% lower odds (95\% CI 72\%-75\%) of a reading being feverish. Across all periods, men had significantly lower temperature-taking frequency and significantly higher odds of having a feverish reading compared to women. Users living in urban areas had significantly higher frequencies of temperature-taking than rural users during all periods, except wave 2 of COVID-19, and urban users had higher odds of a reading being feverish in all study periods except wave 1 of COVID-19. Conclusions: Temperature-taking behavior and the proportion of readings that were feverish are associated with both population disease levels and individual demographic characteristics. Differences in the health behavior of temperature-taking may reflect changes in both perceived and actual illness risk. Specifically, older adults may have experienced an increase in perceived risk during the first three waves of COVID-19, leading to increased rates of temperature monitoring, even when their odds of fever were lower than those of younger adults. Men's perceived risk of circulating infectious illnesses such as influenza and COVID-19 may be lower than that of women, since men took their temperature less frequently and each temperature had a higher odds of being feverish across all study periods. Infectious disease surveillance should recognize and incorporate how behavior impacts illness monitoring and testing. ", doi="10.2196/37509", url="https://formative.jmir.org/2022/9/e37509", url="http://www.ncbi.nlm.nih.gov/pubmed/35998174" } @Article{info:doi/10.2196/34212, author="Oyibo, Kiemute and Morita, Pelegrini Plinio", title="The Effect of Persuasive Design on the Adoption of Exposure Notification Apps: Quantitative Study Based on COVID Alert", journal="JMIR Form Res", year="2022", month="Sep", day="6", volume="6", number="9", pages="e34212", keywords="contact tracing app", keywords="exposure notification app", keywords="COVID Alert", keywords="COVID-19", keywords="persuasive technology", keywords="behavior change", keywords="exposure", keywords="behavior", keywords="effect", keywords="design", keywords="adoption", keywords="use", keywords="case study", keywords="effectiveness", keywords="user interface", keywords="mobile phone", abstract="Background: The adoption of contact tracing apps worldwide has been low. Although considerable research has been conducted on technology acceptance, little has been done to show the benefit of incorporating persuasive principles. Objective: This research aimed to investigate the effect of persuasive features in the COVID Alert app, created by Health Canada, by focusing on the no-exposure status, exposure status, and diagnosis report interfaces. Methods: We conducted a study among 181 Canadian residents, including 65 adopters and 116 nonadopters. This study was based on screenshots of the 3 interfaces, of which each comprised a persuasive design and a control design. The persuasive versions of the first two interfaces supported self-monitoring (of exposure levels), and that of the third interface supported social learning (about how many other users have reported their diagnosis). The 6 screenshots were randomly assigned to 6 groups of participants to provide feedback on perceived persuasiveness and adoption willingness. Results: A multivariate repeated-measure ANOVA showed that there is an interaction among interface, app design, and adoption status regarding the perceived persuasiveness of the interfaces. This resulted in a 2-way ANOVA for each interface. For the no-exposure interface, there was an interaction between adoption status and app design. Among adopters, there was no significant difference P=.31 between the persuasive design (mean 5.36, SD 1.63) and the control design (mean 5.87, SD 1.20). However, among nonadopters, there was an effect of app design (P<.001), with participants being more motivated by the persuasive design (mean 5.37, SD 1.30) than by the control design (mean 4.57, SD 1.19). For the exposure interface, adoption status had a main effect (P<.001), with adopters (mean 5.91, SD 1.01) being more motivated by the designs than nonadopters (mean 4.96, SD 1.43). For the diagnosis report interface, there was an interaction between adoption status and app design. Among nonadopters, there was no significant difference P=.99 between the persuasive design (mean 4.61, SD 1.84) and the control design (mean 4.77, SD 1.21). However, among adopters, there was an effect of app design (P=.006), with participants being more likely to report their diagnosis using the persuasive design (mean 6.00, SD 0.97) than using the control design (mean 5.03, SD 1.22). Finally, with regard to willingness to download the app, pairwise comparisons showed that nonadopters were more likely to adopt the app after viewing the persuasive version of the no-exposure interface (13/21, 62\% said yes) and the diagnosis report interface (12/17, 71\% said yes) than after viewing the control versions (3/17, 18\% and 7/16, 44\%, respectively, said yes). Conclusions: Exposure notification apps are more likely to be effective if equipped with persuasive features. Incorporating self-monitoring into the no-exposure status interface and social learning into the diagnosis report interface can increase adoption by >30\%. ", doi="10.2196/34212", url="https://formative.jmir.org/2022/9/e34212", url="http://www.ncbi.nlm.nih.gov/pubmed/35580138" } @Article{info:doi/10.2196/39144, author="Stoner, CD Marie and Browne, N. Erica and Tweedy, David and Pettifor, E. Audrey and Maragh-Bass, C. Allysha and Toval, Christina and Tolley, E. Elizabeth and Comello, G. Maria Leonora and Muessig, E. Kathryn and Budhwani, Henna and Hightow-Weidman, B. Lisa", title="Exploring Motivations for COVID-19 Vaccination Among Black Young Adults in 3 Southern US States: Cross-sectional Study", journal="JMIR Form Res", year="2022", month="Sep", day="2", volume="6", number="9", pages="e39144", keywords="COVID-19", keywords="COVID-19 vaccination", keywords="young people", keywords="vaccination motivations", keywords="vaccination beliefs", keywords="online survey", keywords="health disparity", keywords="minority population", keywords="vaccine hesitancy", keywords="misinformation", keywords="vaccine safety", abstract="Background: Few studies have focused on attitudes toward COVID-19 vaccination among Black or African American young adults (BYA) in the Southern United States, despite high levels of infection in this population. Objective: To understand this gap, we conducted an online survey to explore beliefs and experiences related to COVID-19 vaccination among BYA (aged 18-29 years) in 3 southern states. Methods: We recruited 150 BYA to participate in an online survey as formative research for an intervention to address vaccine hesitancy in Alabama, Georgia, and North Carolina from September 22, 2021, to November 18, 2021. Participants were recruited through social media ads on Facebook, Twitter, Instagram, and YouTube. Additionally, we distributed information about the survey through organizations working with BYA in Alabama, Georgia, and North Carolina; our community partners; and network collaborations. We used measures that had been used and were previously validated in prior surveys, adapting them to the context of this study. Results: Roughly 28 (19\%) of the participants had not received any doses of the COVID-19 vaccine. Half of the unvaccinated respondents (n=14, 50\%) reported they wanted to wait longer before getting vaccinated. Motivators to get vaccinated were similar between unvaccinated and vaccinated respondents (eg, if required, to protect the health of others), but the main motivator for those vaccinated was to protect one's own health. Among unvaccinated individuals, reasons for not receiving the COVID-19 vaccine included concern about vaccine side effects (n=15, 54\%) and mistrust of vaccine safety (n=13, 46\%), of effectiveness (n=12, 43\%), and of the government's involvement with vaccines (n=12, 43\%). Experiences of discrimination (n=60, 40\%) and mistrust of vaccines (n=54, 36\%) were common overall. Among all respondents, those who said they would be motivated to get vaccinated if it was required for school, work, or travel were more likely to endorse negative beliefs about vaccines compared to those motivated for other reasons. Conclusions: Mistrust in COVID-19 vaccine safety and efficacy is common among BYA in the Southern United States, irrespective of vaccination status. Other motivators, such as safety of family and community and vaccination requirements, may be able to tip the scales toward a decision to be vaccinated among those who are initially hesitant. However, it is unclear how vaccine requirements among BYA in the South affect trust in the government or health care in the long term. Interventions that include BYA in vaccination messaging and programs may more proactively build feelings of trust and combat misinformation. ", doi="10.2196/39144", url="https://formative.jmir.org/2022/9/e39144", url="http://www.ncbi.nlm.nih.gov/pubmed/35969516" } @Article{info:doi/10.2196/39772, author="Williams, D. Kimberly and Jurkovitz, T. Claudine and Papas, A. Mia and Muther, Kathryn Ann and Anderson, L. Sharon and Anderson, L. Tammy", title="Feasibility of a Novel COVID-19 Telehealth Care Management Program Among Individuals Receiving Treatment for Opioid Use Disorder: Analysis of a Pilot Program", journal="JMIR Form Res", year="2022", month="Aug", day="30", volume="6", number="8", pages="e39772", keywords="opioid use disorder", keywords="substance use", keywords="drug addiction", keywords="opioid treatment program", keywords="COVID-19", keywords="telehealth", keywords="telemedicine", keywords="eHealth", keywords="Short Message Service", keywords="SMS", keywords="text messaging", keywords="text message", keywords="opioid use", keywords="opioid", keywords="care management", keywords="patient care management", keywords="health intervention", keywords="telehealth intervention", abstract="Background: The emergence of COVID-19 exacerbated the existing epidemic of opioid use disorder (OUD) across the United States due to the disruption of in-person treatment and support services. Increased use of technology including telehealth and the development of new partnerships may facilitate coordinated treatment interventions that comprehensively address the health and well-being of individuals with OUD. Objective: The analysis of this pilot program aimed to determine the feasibility of delivering a COVID-19 telehealth care management program using SMS text messages for patients receiving OUD treatment. Methods: Eligible individuals were identified from a statewide opioid treatment program (OTP) network. Those who screened positive for COVID-19 symptoms were invited to connect to care management through a secure SMS text message that was compliant with Health Insurance Portability and Accountability Act standards. Care management monitoring for COVID-19 was provided for a period of up to 14 days. Monitoring services consisted of daily SMS text messages from the care manager inquiring about the participant's physical health in relation to COVID-19 symptoms by confirming their temperature, if the participant was feeling worse since the prior day, and if the participant was experiencing symptoms such as coughing or shortness of breath. If COVID-19 symptoms worsened during this observation period, the care manager was instructed to refer participants to the hospital for acute care services. The feasibility of the telehealth care management intervention was assessed by the rates of adoption in terms of program enrollment, engagement as measured by the number of SMS text message responses per participant, and retention in terms of the number of days participants remained in the program. Results: Between January and April 2021, OTP staff members referred 21 patients with COVID-19 symptoms, and 18 (82\%) agreed to be contacted by a care manager. Participants ranged in age from 27 to 65 years and primarily identified as female (n=12, 67\%) and White (n=15, 83\%). The majority of participants were Medicaid recipients (n=14, 78\%). There were no statistically significant differences in the demographic characteristics between those enrolled and not enrolled in the program. A total of 12 (67\%) patients were enrolled in the program, with 2 (11\%) opting out of SMS text message communication and choosing instead to speak with a care manager verbally by telephone. The remaining 10 participants answered a median of 7 (IQR 4-10) SMS text messages and were enrolled in the program for a median of 9 (IQR 7.5-12) days. No participants were referred for acute care services or hospitalized during program enrollment. Conclusions: These results demonstrate the feasibility of a novel telehealth intervention to monitor COVID-19 symptoms among OTP patients in treatment for OUD. Further research is needed to determine the applicability of this intervention to monitor patients with comorbid chronic conditions in addition to the acceptability among patients and providers using the SMS text messaging modality. ", doi="10.2196/39772", url="https://formative.jmir.org/2022/8/e39772", url="http://www.ncbi.nlm.nih.gov/pubmed/35973033" } @Article{info:doi/10.2196/38370, author="Wiciak, Teresa Michelle and Shazley, Omar and Santhosh, Daphne", title="An Observational Report of Screen Time Use Among Young Adults (Ages 18-28 Years) During the COVID-19 Pandemic and Correlations With Mental Health and Wellness: International, Online, Cross-sectional Study", journal="JMIR Form Res", year="2022", month="Aug", day="24", volume="6", number="8", pages="e38370", keywords="coronavirus", keywords="COVID-19", keywords="pandemic", keywords="mental health", keywords="depression", keywords="anxiety", keywords="screen-time usage", keywords="young adults", keywords="students", keywords="international study", keywords="observational study", keywords="cross-sectional study", keywords="smoking", abstract="Background: Screen time (ST) drastically increased during the COVID-19 pandemic, but there is little research on the specific type of ST use, degree of change from before COVID-19, and possible associations with other factors. Young adults are a particular interest since previous studies have shown the detriment ST has on a young person's health. With the combination of a life-changing pandemic, there are unreached depths regarding ST and young adults. This study aims to provide insight into these unknowns. Objective: This study aims to assess ST in 3 domains (entertainment, social media [SM], and educational/professional) in young adults early in the COVID-19 pandemic; identify trends; and identify any correlations with demographics, mental health, substance abuse, and overall wellness. Methods: An online, cross-sectional observational study was performed from September 2020 to January 2021 with 183 eligible respondents. Data were collected on ST, trauma from COVID-19, anxiety, depression, substance use, BMI, and sleep. Results: The average total ST during COVID-19 was 23.26 hours/week, entertainment ST was 7.98 hours/week, SM ST was 6.79 hours/week, and ST for educational or professional purposes was 8.49 hours/week. For all categories, the average ST during COVID-19 was higher than before COVID-19 (P<.001). We found ST differences between genders, student status, and continent of location. Increased well-being scores during COVID-19 were correlated with greater change in total ST (P=.01). Poorer sleep quality (P=.01) and longer sleep duration (P=.03) were associated with a greater change in entertainment ST (P=.01).?More severe depression and more severe anxiety was associated with the amount of entertainment ST (P=.047, P=.03, respectively) and greater percent change in SM (P=.007, P=.002, respectively). Greater stress from COVID-19 was associated with the amount of ST for educational/professional purposes (P=.05), change in total ST (P=.006), change in entertainment ST (P=.01), and change in ST for educational/professional purposes (P=.02). Higher Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) tobacco scores were associated with greater change in total ST (P=.004), and higher pack-years were associated with greater change in SM ST (P=.003). Higher alcohol scores (P=.004) and servings of alcohol per week (P=.003) were associated with greater change in entertainment ST. Quarantining did not negatively impact these variables. Conclusions: There is no doubt ST and worsening mental health increased during COVID-19 in young adults. However, these findings indicate there are many significant associations between ST use and mental health. These associations are more complex than originally thought, especially since we found quarantining is not associated with mental health. Although other factors need to be further investigated, this study emphasizes different types of ST and degree of change in ST affect various groups of people in discrete ways. Acknowledging these findings can help young adults optimize their mental health during pandemics. ", doi="10.2196/38370", url="https://formative.jmir.org/2022/8/e38370", url="http://www.ncbi.nlm.nih.gov/pubmed/35878157" } @Article{info:doi/10.2196/37821, author="Delanerolle, Gayathri and Williams, Robert and Stipancic, Ana and Byford, Rachel and Forbes, Anna and Tsang, M. Ruby S. and Anand, N. Sneha and Bradley, Declan and Murphy, Siobh{\'a}n and Akbari, Ashley and Bedston, Stuart and Lyons, A. Ronan and Owen, Rhiannon and Torabi, Fatemeh and Beggs, Jillian and Chuter, Antony and Balharry, Dominique and Joy, Mark and Sheikh, Aziz and Hobbs, Richard F. D. and de Lusignan, Simon", title="Methodological Issues in Using a Common Data Model of COVID-19 Vaccine Uptake and Important Adverse Events of Interest: Feasibility Study of Data and Connectivity COVID-19 Vaccines Pharmacovigilance in the United Kingdom", journal="JMIR Form Res", year="2022", month="Aug", day="22", volume="6", number="8", pages="e37821", keywords="Systematized Nomenclature of Medicine", keywords="COVID-19 vaccines", keywords="COVID-19", keywords="sinus thrombosis", keywords="anaphylaxis", keywords="pharmacovigilance", keywords="vaccine uptake", keywords="medical outcome", keywords="clinical coding system", keywords="health database", keywords="health information", keywords="clinical outcome", keywords="vaccine effect", keywords="data model", abstract="Background: The Data and Connectivity COVID-19 Vaccines Pharmacovigilance (DaC-VaP) UK-wide collaboration was created to monitor vaccine uptake and effectiveness and provide pharmacovigilance using routine clinical and administrative data. To monitor these, pooled analyses may be needed. However, variation in terminologies present a barrier as England uses the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), while the rest of the United Kingdom uses the Read v2 terminology in primary care. The availability of data sources is not uniform across the United Kingdom. Objective: This study aims to use the concept mappings in the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) to identify common concepts recorded and to report these in a repeated cross-sectional study. We planned to do this for vaccine coverage and 2 adverse events of interest (AEIs), cerebral venous sinus thrombosis (CVST) and anaphylaxis. We identified concept mappings to SNOMED CT, Read v2, the World Health Organization's International Classification of Disease Tenth Revision (ICD-10) terminology, and the UK Dictionary of Medicines and Devices (dm+d). Methods: Exposures and outcomes of interest to DaC-VaP for pharmacovigilance studies were selected. Mappings of these variables to different terminologies used across the United Kingdom's devolved nations' health services were identified from the Observational Health Data Sciences and Informatics (OHDSI) Automated Terminology Harmonization, Extraction, and Normalization for Analytics (ATHENA) online browser. Lead analysts from each nation then confirmed or added to the mappings identified. These mappings were then used to report AEIs in a common format. We reported rates for windows of 0-2 and 3-28 days postvaccine every 28 days. Results: We listed the mappings between Read v2, SNOMED CT, ICD-10, and dm+d. For vaccine exposure, we found clear mapping from OMOP to our clinical terminologies, though dm+d had codes not listed by OMOP at the time of searching. We found a list of CVST and anaphylaxis codes. For CVST, we had to use a broader cerebral venous thrombosis conceptual approach to include Read v2. We identified 56 SNOMED CT codes, of which we selected 47 (84\%), and 15 Read v2 codes. For anaphylaxis, our refined search identified 60 SNOMED CT codes and 9 Read v2 codes, of which we selected 10 (17\%) and 4 (44\%), respectively, to include in our repeated cross-sectional studies. Conclusions: This approach enables the use of mappings to different terminologies within the OMOP CDM without the need to catalogue an entire database. However, Read v2 has less granular concepts than some terminologies, such as SNOMED CT. Additionally, the OMOP CDM cannot compensate for limitations in the clinical coding system. Neither Read v2 nor ICD-10 is sufficiently granular to enable CVST to be specifically flagged. Hence, any pooled analysis will have to be at the less specific level of cerebrovascular venous thrombosis. Overall, the mappings within this CDM are useful, and our method could be used for rapid collaborations where there are only a limited number of concepts to pool. ", doi="10.2196/37821", url="https://formative.jmir.org/2022/8/e37821", url="http://www.ncbi.nlm.nih.gov/pubmed/35786634" } @Article{info:doi/10.2196/38916, author="Selick, Avra and Durbin, Janet and Hamdani, Yani and Rayner, Jennifer and Lunsky, Yona", title="Accessibility of Virtual Primary Care for Adults With Intellectual and Developmental Disabilities During the COVID-19 Pandemic: Qualitative Study", journal="JMIR Form Res", year="2022", month="Aug", day="22", volume="6", number="8", pages="e38916", keywords="COVID-19", keywords="intellectual disability", keywords="developmental disability", keywords="qualitative", keywords="telemedicine", keywords="virtual care", keywords="primary care", abstract="Background: The COVID-19 pandemic has led to an unprecedented increase in the delivery of virtual primary care. Adults with intellectual and developmental disabilities (IDDs) have complex health care needs, and little is known about the value and appropriateness of virtual care for this patient population. Objective: The aim of this study was to explore the accessibility of virtual primary care for patients with IDDs during the pandemic. Methods: We conducted semistructured interviews with 38 participants in Ontario, Canada between March and November 2021. A maximum variation sampling strategy was used to achieve a diverse sample including 11 adults with IDDs, 13 family caregivers, 5 IDD support staff members, and 9 primary care physicians. An iterative mixed inductive and deductive thematic analysis approach was used to code the data and synthesize higher-level themes. The analysis was informed by the Levesque Patient-Centered Access to Health Care Framework. Results: We identified themes related to 4 of 5 access-to-care dimensions that highlighted both the benefits and challenges of virtual care for adults with IDDs. The benefits included saving time spent traveling and waiting; avoiding anxiety and challenging behavior for patients who struggle to attend in-person visits; allowing caregivers who live far away from their loved ones to participate; reducing illness transmission; and allowing health care providers to see patients in their home environments. The challenges included lack of access to necessary technology, lack of comfort or skill using technology, and lack of nonverbal communication; difficulty engaging and establishing rapport; patient exclusion from the health care encounter; and concerns about privacy and confidentiality. An overarching theme was that ``one size does not fit all,'' and the accessibility of virtual care was dependent on the interaction between the following 5 categories of factors: patient characteristics, patient context, caregiver characteristics, service context, and reason for a particular primary care visit. Though virtual care was not always appropriate, in some cases, it dramatically improved patients' abilities to access necessary health care. Conclusions: This study suggests that a flexible patient-centered system including multiple delivery modalities is needed to ensure all patients have access to primary care. Implementing this system will require improved virtual care platforms, access to technology for patients and caregivers, training for primary care providers, and appropriately aligned primary care funding models. ", doi="10.2196/38916", url="https://formative.jmir.org/2022/8/e38916", url="http://www.ncbi.nlm.nih.gov/pubmed/35951444" } @Article{info:doi/10.2196/37059, author="Rush, L. Kathy and Seaton, L. Cherisse and Corman, Kendra and Hawe, Nicole and Li, Hung Eric Ping and Dow-Fleisner, J. Sarah and Hasan, Khalad Mohammad and Oelke, D. Nelly and Currie, M. Leanne and Pesut, Barbara", title="Virtual Care Prior to and During COVID-19: Cross-sectional Survey of Rural and Urban Adults", journal="JMIR Form Res", year="2022", month="Aug", day="22", volume="6", number="8", pages="e37059", keywords="virtual care", keywords="rural", keywords="urban", keywords="COVID-19", keywords="digital literacy", keywords="unmet needs", abstract="Background: To reduce person-to-person contact, the COVID-19 pandemic has driven a massive shift to virtual care. Defined as the use of technology (synchronous or asynchronous) to support communication between health care providers and patients, rural-urban differences in virtual care are relatively unexplored. Objective: The 2-fold purpose of this study was to examine rural and urban virtual care access, use, and satisfaction during the pandemic and to identify any unmet needs. Methods: This study was a cross-sectional online survey exploring virtual care among rural and urban adults in summer 2021 using a combination of fixed and open-ended response options. Quantitative data were analyzed using both descriptive and inferential statistics, and qualitative data were analyzed using inductive thematic content analysis. Results: Overall, 501 (373, 74.4\% female; age range 19-86 years; 237, 47.3\% rural-living) Western Canadians completed the survey. Virtual care use was high among both rural (171/237, 72.2\%) and urban (188/264, 71.2\%) participants, with over one-half (279/501, 55.7\%) reporting having only started to use virtual care since the pandemic. The self-reported need for mental health programs and services increased during the pandemic, compared with prior for both rural and urban participants. Among virtual care users, interest in its continuation was high. Our analysis also shows that internet quality (all P<.05) and eHealth literacy (all P<.001) were positively associated with participants' perceptions of virtual care usefulness, ease of use, and satisfaction, with no rural-urban differences. Rural participants were less likely to have used video in communicating with doctors or health care providers, compared with urban participants (P<.001). When describing unmet needs, participants described a (1) lack of access to care, (2) limited health promotion and prevention options, and (3) lack of mental health service options. Conclusions: The increased demand for and use of virtual care may reflect increased availability and a lack of alternatives due to limited in-person services during the COVID-19 pandemic, so a balance between virtual care and in-person care is important to consider postpandemic. Further, ensuring availability of high-speed internet and education to support patients will be important for providing accessible and effective virtual care, especially for rural residents. ", doi="10.2196/37059", url="https://formative.jmir.org/2022/8/e37059", url="http://www.ncbi.nlm.nih.gov/pubmed/35849794" } @Article{info:doi/10.2196/36444, author="Bari, Sumra and Vike, L. Nicole and Stetsiv, Khrystyna and Woodward, Sean and Lalvani, Shamal and Stefanopoulos, Leandros and Kim, Woo Byoung and Maglaveras, Nicos and Breiter, C. Hans and Katsaggelos, K. Aggelos", title="The Prevalence of Psychotic Symptoms, Violent Ideation, and Disruptive Behavior in a Population With SARS-CoV-2 Infection: Preliminary Study", journal="JMIR Form Res", year="2022", month="Aug", day="16", volume="6", number="8", pages="e36444", keywords="COVID-19", keywords="paranoia", keywords="delusions", keywords="disruptive behavior", keywords="violent ideation", keywords="psychotic symptoms", keywords="pandemic", keywords="mental health", keywords="distress", keywords="stress", keywords="psychological health", keywords="psychosis", keywords="risk", keywords="machine learning", abstract="Background: The COVID-19 disease results from infection by the SARS-CoV-2 virus to produce a range of mild to severe physical, neurological, and mental health symptoms. The COVID-19 pandemic has indirectly caused significant emotional distress, triggering the emergence of mental health symptoms in individuals who were not previously affected or exacerbating symptoms in those with existing mental health conditions. Emotional distress and certain mental health conditions can lead to violent ideation and disruptive behavior, including aggression, threatening acts, deliberate harm toward other people or animals, and inattention to or noncompliance with education or workplace rules. Of the many mental health conditions that can be associated with violent ideation and disruptive behavior, psychosis can evidence greater vulnerability to unpredictable changes and being at a greater risk for them. Individuals with psychosis can also be more susceptible to contracting COVID-19 disease. Objective: This study aimed to investigate whether violent ideation, disruptive behavior, or psychotic symptoms were more prevalent in a population with COVID-19 and did not precede the pandemic. Methods: In this preliminary study, we analyzed questionnaire responses from a population sample (N=366), received between the end of February 2021 and the start of March 2021 (1 year into the COVID-19 pandemic), regarding COVID-19 illness, violent ideation, disruptive behavior, and psychotic symptoms. Using the Wilcoxon rank sum test followed by multiple comparisons correction, we compared the self-reported frequency of these variables for 3 time windows related to the past 1 month, past 1 month to 1 year, and >1 year ago among the distributions of people who answered whether they tested positive or were diagnosed with COVID-19 by a clinician. We also used multivariable logistic regression with iterative resampling to investigate the relationship between these variables occurring >1 year ago (ie, before the pandemic) and the likelihood of contracting COVID-19. Results: We observed a significantly higher frequency of self-reported violent ideation, disruptive behavior, and psychotic symptoms, for all 3 time windows of people who tested positive or were diagnosed with COVID-19 by a clinician. Using multivariable logistic regression, we observed 72\% to 94\% model accuracy for an increased incidence of COVID-19 in participants who reported violent ideation, disruptive behavior, or psychotic symptoms >1 year ago. Conclusions: This preliminary study found that people who reported a test or clinician diagnosis of COVID-19 also reported higher frequencies of violent ideation, disruptive behavior, or psychotic symptoms across multiple time windows, indicating that they were not likely to be the result of COVID-19. In parallel, participants who reported these behaviors >1 year ago (ie, before the pandemic) were more likely to be diagnosed with COVID-19, suggesting that violent ideation, disruptive behavior, in addition to psychotic symptoms, were associated with COVID-19 with an approximately 70\% to 90\% likelihood. ", doi="10.2196/36444", url="https://formative.jmir.org/2022/8/e36444", url="http://www.ncbi.nlm.nih.gov/pubmed/35763758" } @Article{info:doi/10.2196/38247, author="Bachina, Preetham and Lippincott, Kirk Christopher and Perry, Allison and Munk, Elizabeth and Maltas, Gina and Bohr, Rebecca and Rock, Bryan Robert and Shah, Maunank", title="Programmatic Adoption and Implementation of Video-Observed Therapy in Minnesota: Prospective Observational Cohort Study", journal="JMIR Form Res", year="2022", month="Aug", day="5", volume="6", number="8", pages="e38247", keywords="video directly observed therapy", keywords="vDOT", keywords="mobile health", keywords="mHealth", keywords="tuberculosis", keywords="medication adherence", keywords="telemedicine", keywords="treatment", keywords="telehealth", keywords="observed therapy", keywords="COVID-19", keywords="primary outcome", keywords="treatment adherence", keywords="technology adoption", keywords="virtual health", abstract="Background: In-person directly observed therapy (DOT) is standard of care for tuberculosis (TB) treatment adherence monitoring in the US, with increasing use of video-DOT (vDOT). In Minneapolis, vDOT became available in 2019. Objective: In this paper, we aimed to evaluate the use and effectiveness of vDOT in a program setting, including comparison of verified adherence among those receiving vDOT and in-person DOT. We also sought to understand the impact of COVID-19 on TB treatment adherence and technology adoption. Methods: We abstracted routinely collected data on individuals receiving therapy for TB in Minneapolis, MN, between September 2019 and June 2021. Our primary outcomes were to assess vDOT use and treatment adherence, defined as the proportion of prescribed doses (7 days per week) verified by observation (in person versus video-DOT), and to compare individuals receiving therapy in the pre--COVID-19 (before March 2020), and post--COVID-19 (after March 2020) periods; within the post--COVID-19 period, we evaluated early COVID-19 (March-August 2020), and intra--COVID-19 (after August 2020) periods. Results: Among 49 patients with TB (mean age 41, SD 19; n=27, 55\% female and n=47, 96\% non--US born), 18 (36.7\%) received treatment during the post--COVID-19 period. Overall, verified adherence (proportion of observed doses) was significantly higher when using vDOT (mean 81\%, SD 17.4) compared to in-person DOT (mean 54.5\%, SD 10.9; P=.001). The adoption of vDOT increased significantly from 35\% (11/31) of patients with TB in the pre--COVID-19 period to 67\% (12/18) in the post--COVID-19 period (P=.04). Consequently, overall verified (ie, observed) adherence among all patients with TB in the clinic improved across the study periods (56\%, 67\%, and 79\%, P=.001 for the pre--, early, and intra--COVID-19 periods, respectively). Conclusions: vDOT use increased after the COVID-19 period, was more effective than in-person DOT at verifying ingestion of prescribed treatment, and led to overall increased verified adherence in the clinic despite the onset of the COVID-19 pandemic. ", doi="10.2196/38247", url="https://formative.jmir.org/2022/8/e38247", url="http://www.ncbi.nlm.nih.gov/pubmed/35834671" } @Article{info:doi/10.2196/33964, author="Mousavi, Avah Zahra and Lai, Jocelyn and Simon, Katharine and Rivera, P. Alexander and Yunusova, Asal and Hu, Sirui and Labbaf, Sina and Jafarlou, Salar and Dutt, D. Nikil and Jain, C. Ramesh and Rahmani, M. Amir and Borelli, L. Jessica", title="Sleep Patterns and Affect Dynamics Among College Students During the COVID-19 Pandemic: Intensive Longitudinal Study", journal="JMIR Form Res", year="2022", month="Aug", day="5", volume="6", number="8", pages="e33964", keywords="sleep", keywords="objective sleep outcomes", keywords="COVID-19", keywords="affect variability", keywords="affect dynamics", abstract="Background: Sleep disturbance is a transdiagnostic risk factor that is so prevalent among young adults that it is considered a public health epidemic, which has been exacerbated by the COVID-19 pandemic. Sleep may contribute to mental health via affect dynamics. Prior literature on the contribution of sleep to affect is largely based on correlational studies or experiments that do not generalize to the daily lives of young adults. Furthermore, the literature examining the associations between sleep variability and affect dynamics remains scant. Objective: In an ecologically valid context, using an intensive longitudinal design, we aimed to assess the daily and long-term associations between sleep patterns and affect dynamics among young adults during the COVID-19 pandemic. Methods: College student participants (N=20; female: 13/20, 65\%) wore an Oura ring (?ura Health Ltd) continuously for 3 months to measure sleep patterns, such as average and variability in total sleep time (TST), wake after sleep onset (WASO), sleep efficiency, and sleep onset latency (SOL), resulting in 1173 unique observations. We administered a daily ecological momentary assessment by using a mobile health app to evaluate positive affect (PA), negative affect (NA), and COVID-19 worry once per day. Results: Participants with a higher sleep onset latency (b=?1.09, SE 0.36; P=.006) and TST (b=?0.15, SE 0.05; P=.008) on the prior day had lower PA on the next day. Further, higher average TST across the 3-month period predicted lower average PA (b=?0.36, SE 0.12; P=.009). TST variability predicted higher affect variability across all affect domains. Specifically, higher variability in TST was associated higher PA variability (b=0.09, SE 0.03; P=.007), higher negative affect variability (b=0.12, SE 0.05; P=.03), and higher COVID-19 worry variability (b=0.16, SE 0.07; P=.04). Conclusions: Fluctuating sleep patterns are associated with affect dynamics at the daily and long-term scales. Low PA and affect variability may be potential pathways through which sleep has implications for mental health. ", doi="10.2196/33964", url="https://formative.jmir.org/2022/8/e33964", url="http://www.ncbi.nlm.nih.gov/pubmed/35816447" } @Article{info:doi/10.2196/38351, author="Mehta, N. Shivani and Burger, C. Zoe and Meyers-Pantele, A. Stephanie and Garfein, S. Richard and Ortiz, O. Dayanna and Mudhar, K. Pavan and Kothari, B. Smit and Kothari, Jigna and Meka, Meena and Rodwell, Timothy", title="Knowledge, Attitude, Practices, and Vaccine Hesitancy Among the Latinx Community in Southern California Early in the COVID-19 Pandemic: Cross-sectional Survey", journal="JMIR Form Res", year="2022", month="Aug", day="4", volume="6", number="8", pages="e38351", keywords="COVID-19", keywords="knowledge", keywords="attitude", keywords="practices", keywords="KAP survey", keywords="vaccine hesitancy", keywords="Latinx", keywords="Latinx cohort", keywords="minority population", keywords="primary care", keywords="sociodemographic characteristic", keywords="public health", keywords="vulnerable population", keywords="epidemiology", abstract="Background: The Latinx population in the United States has experienced high rates of infection, hospitalization, and death since the beginning of the COVID-19 pandemic. There is little data on the knowledge, attitude, and practices (KAP) specifically in Latinx communities in the United States. Objective: We aimed to assess COVID-19 KAP and vaccine hesitancy among a Latinx cohort in the early stages of the COVID-19 pandemic (from July 2020 to October 2020), at a unique time when a vaccine was not available.? Methods: Participants aged ?18 years were recruited at a primary care clinic in Southern California and asked to self-report sociodemographic characteristics, KAP, and vaccine hesitancy. A subset of the participants answered the vaccine hesitancy assessment as it was added after the start of data collection. KAP items were summed to create composite scores, with higher scores reflecting increased COVID-19 knowledge, positive attitudes toward the COVID-19 pandemic, and disease prevention practices. Bivariate and multivariable regression models were fitted to test associations between sociodemographic characteristics and KAP scores. For our analysis, we only included patients who self-identified as Latinx. Results: Our final data set included 265 participants. The participants had a mean age of 49 (IQR 38.5-59) years, and 72.1\% (n=191) were female, 77\% (n=204) had at most a high school degree, 34.7\% (n=92) had an annual income