@Article{info:doi/10.2196/68811, author="Austad, Bjarne and Vie, {\AA}berge Gunnhild and Hansen, Hegnes Mari and M{\o}rkved, Sandbakken Hanna and Getz, Okkenhaug Linn and Mj{\o}lstad, Prytz Bente", title="Association of Self-Rated Health in Pregnancy With Maternal Childhood Experiences, Socioeconomic Status, Parity, and Choice of Antenatal Care Providers: Cross-Sectional Study", journal="JMIR Form Res", year="2025", month="Jun", day="3", volume="9", pages="e68811", keywords="pregnancy", keywords="antenatal care", keywords="self-rated health", keywords="self-rated mental health", keywords="primary care", abstract="Background: During pregnancy, self-rated health (SRH) and self-rated mental health (SRMH) are key indicators of health status and predictors of future health care needs. The relationship between pregnant women's health perceptions and their choice of antenatal care providers, midwives, or general practitioners (GPs) is not known. Factors like childhood experiences and socioeconomic status are important determinants of health throughout life. Understanding these health determinants can help health care providers better address the diverse needs of pregnant women. Objective: This study aims to assess how SRH and SRMH during pregnancy are associated with maternal childhood experiences, socioeconomic status, parity, and antenatal care provided by midwives or GPs. Methods: An anonymous, web-based cross-sectional survey was conducted from January to March 2022 among pregnant women in Norway, distributed via Facebook and Instagram. The survey included questions on SRH, SRMH, socioeconomic status, childhood perceptions, and antenatal program participation. Pearson's chi-squared test and logistic regression models were used to explore associations and estimate odds ratios for good SRH and SRMH. Results: Among 1402 participants, 94.7\% (1328/1402) reported good or very good health before pregnancy, dropping to 67.8\% (950/1402) during pregnancy (P<.001). Reporting your childhood as good was associated with better SRH compared with those who reported average or difficult childhood (70.2\% [755/1076] vs 64\% [114/178] vs 53.2\% [74/139]; P<.001). This corresponds to 48\% lower odds of good SRH for those reporting a difficult childhood compared to those reporting a good childhood (OR 0.52, 95\% CI 0.36?0.76). Financial security and higher education were associated with better SRH (both P<.001). First-time mothers reported better SRH than those with previous births (73.9\% [533/722] vs 61.4\% [417/680]; P<.001). For SRMH, 89.9\% (1260/1402) reported good or very good SRMH before pregnancy, decreasing to 73.1\% (1024/1401) during pregnancy (P<.001). Women who reported a good childhood, financial security, higher education, and first-time mothers reported better SRMH during pregnancy (P<.001 for all). Nearly all women participated in the antenatal program, regardless of their subjective health, and most expressed satisfaction. Among participants, 55.6\% (753/1354) received shared antenatal care, 38.6\% (520/1354) were seen only by midwives, and 6\% (81/1354) only by GPs. The proportion of women receiving antenatal care solely from a midwife decreased with declining SRH, from 42.6\% (78/183) among those with very good SRH to 27.3\% (15/55) among those with poor SRH. Conclusions: A difficult maternal childhood, low socioeconomic status, and having given birth before were associated with poorer SRH and SRMH during pregnancy. Both midwives and GPs played vital roles in providing antenatal care, though few women received antenatal care exclusively from GPs. The likelihood of physician involvement in care increased slightly with worsening health. ", doi="10.2196/68811", url="https://formative.jmir.org/2025/1/e68811" } @Article{info:doi/10.2196/64630, author="Suzuki, Daichi and Nishimura, Etsuko and Shoki, Rina and Octawijaya, Halim Ishak and Ota, Erika", title="Quality Assessment of Web-Based Information Related to Diet During Pregnancy in Pregnant Women: Cross-Sectional Descriptive Study", journal="JMIR Form Res", year="2025", month="Jun", day="3", volume="9", pages="e64630", keywords="assessment", keywords="availability", keywords="decision-making", keywords="diet", keywords="dietary information", keywords="internet", keywords="internet-based", keywords="misinformation", keywords="nutrition", keywords="nutrition-related", keywords="online health information", keywords="physical harm", keywords="pregnancy", keywords="pregnancy-related guidance", keywords="pregnant women", keywords="prenatal nutrition", keywords="psychological harm", keywords="QUEST", keywords="quality assessment", keywords="tools", keywords="web-based", keywords="web-based information", keywords="website assessment", keywords="women's health", abstract="Background: The widespread availability of health information online, coupled with the ease of access to the internet, has led pregnant women to rely heavily on online sources for pregnancy-related guidance. The internet-based information regarding nutrition enabled positive dietary changes for pregnant women. Although there are some important sources for pregnant women to collect their health information, some information increases maternal anxiety and difficulties based on a lack of information. Moreover, some women become confused due to conflicts on the same topics from different websites. However, concerns about the reliability and impact of this information have surfaced, contributing to heightened anxiety among expectant mothers. The importance of the quality of web-based information is increasingly recognized; however, no studies have evaluated the quality of nutrition-related information for pregnant women. Objective: This study aims to bridge this research gap by assessing the quality of online health information concerning prenatal nutrition tailored to pregnant women. Methods: This cross-sectional descriptive study was conducted through a Google keyword search on February 14, 2023. We used search terms, such as ``pregnancy,'' ``pregnant women,'' ``diet,'' and ``nutrition'' and conducted an exhaustive search on Google. Using the Quality Evaluation Scoring Tool (QUEST), we meticulously evaluated the quality of the retrieved information. Results: The top 20 Google-searched sites were evaluated using the QUEST tool. The average score was 11.7 points, ranging from 6 to 15, with most sites scoring between 11 and 15. Half of the websites lacked clear authorship and most gave weak or no attribution to specific scientific sources. While conflict of interest scored highest overall, with 60\% showing no bias, some sites promoted products or specific interventions. Currency was inconsistent---only half were updated within 5 years. Complementarity received the lowest scores, with 70\% lacking support for patient-physician relationships. The tone was generally positive, with 95\% supporting their claims, though only one site used a balanced, well-reasoned tone. Discrepancies in cited guidelines on nutritional intake and inappropriate expressions about alcohol, weight management, and miscarriage raised concerns about the information's accuracy and appropriateness. Conclusions: Although many websites use cautious language to mitigate commercial influence, deficiencies persist in crucial areas for empowering informed decision-making among pregnant women. From our assessment of the results, it was found that incorrect evidence information is provided at the top of search results, which is easily accessible to users. The inadequacies in attributing authorship, clarifying conflicts of interest, and ensuring the currency of information pose substantial challenges to the reliability and usefulness of online health resources in prenatal nutrition. Since internet-based information is the most accessible, reliable evidence should be provided to protect everyone from misinformation, including shallow health literacy demographics, and from potential physical and psychological harm. ", doi="10.2196/64630", url="https://formative.jmir.org/2025/1/e64630" } @Article{info:doi/10.2196/62886, author="Leung, Man Ka and Shi, Yuchen", title="Impact of a Light Volleyball Intervention Program on Improving Physical Attributes of Older Adults in Hong Kong: Preliminary Study of a Randomized Controlled Trial", journal="JMIR Aging", year="2025", month="May", day="28", volume="8", pages="e62886", keywords="adapted physical activity", keywords="older adults", keywords="gerontology", keywords="geriatrics", keywords="older", keywords="aging", keywords="randomized controlled trial", keywords="volleyball", keywords="light volleyball", keywords="intervention", keywords="sports", keywords="physical activity", keywords="exercise", keywords="physical attributes", keywords="RCT", keywords="controlled trial", abstract="Background: Physical inactivity, which increases the risk of chronic diseases in older adults, is prevalent among older adults in Hong Kong. To address this problem, the Hong Kong government has been proactively promoting active aging. Objective: Following the World Health Organization's strategy to prevent chronic diseases in older adults and aligning with the global goal of active aging, this study evaluated the effects of a 16-week light volleyball (LVB) intervention program on the physical health of older adults in Hong Kong. Methods: A total of 276 participants aged ?60 years were recruited and randomly assigned to 1 of 3 groups: an LVB intervention group, a Taichi control group (ie, with light physical activity), and a control group. Tests on components of fitness were conducted before and after the intervention. Results: Participants from the LVB intervention group exhibited significant improvements in lower body strength (F2,272=\thinspace7.23, P=.001, $\eta$2=.05), agility (F2,272=\thinspace6.05, P=.003, $\eta$2=.043), and dynamic balance (F2,272=\thinspace9.41, P=.001, $\eta$2=.065) when compared with those from the Taichi active control group and control group. Conclusions: To promote active aging among older adults in Hong Kong, the findings of this preliminary study, along with forthcoming follow-up tests, will provide health specialists and practitioners with valuable insights regarding the health benefits of the LVB community program for older adults. Trial Registration: Chinese Clinical Trial Register ChiCTR1900026657; https://www.chictr.org.cn/showprojEN.html?proj=44350 ", doi="10.2196/62886", url="https://aging.jmir.org/2025/1/e62886" } @Article{info:doi/10.2196/66751, author="Farah, Mohamed Alinoor and Abdulahi, Abdifatah and Hussein, Abdulahi and Hussein, Abdikadir Ahmed and Osman, Abdi and Mohamud, Mohamed and Mowlid, Hasan and Hailu, Girum and Alwan, Fathia and Bizuneh, Abebe Ermiyas and Ibrahim, Mohammed Ahmed and Abdulahi, Elyas", title="COVID-19 Perceptions Among Communities Living on Ground Crossings of Somali Region of Ethiopia: Community Cross-Sectional Survey Study", journal="JMIR Form Res", year="2025", month="Apr", day="24", volume="9", pages="e66751", keywords="COVID-19", keywords="perceptions", keywords="border-crossings", keywords="SARS-CoV-2", keywords="coronavirus", keywords="respiratory", keywords="infectious", keywords="pandemic", keywords="Somali", keywords="Ethiopia", keywords="Africa", keywords="community-based", keywords="World Health Organization", keywords="WHO", keywords="cross-sectional study", keywords="multistage sampling technique", keywords="transmission", keywords="cross-border", keywords="community engagement", abstract="Background: The COVID-19 pandemic has profoundly affected the movement of people across borders in Eastern and Southern Africa. The implementation of border closures and restrictive measures has disrupted the region's economic and social dynamics. In areas where national authorities lack full control over official and unofficial land crossings, enforcing public health protocols to mitigate health risks may prove challenging. Objective: This study aimed to assess perceived factors that influence the spread and control of COVID-19 among Somali communities living on and near ground crossings in Tog Wajaale, Somali region, Ethiopia. Methods: A community-based cross-sectional study was conducted using a multistage sampling technique. Beliefs and perceptions of the virus's spread and control were partially adapted from the World Health Organization (WHO) resources, exploring four main perception themes: (1) perceived facilitators for the spread of the virus, (2) perceived inhibitors, (3) risk labeling, and (4) sociodemographic variables. A sample size of 634 was determined using the single proportion formula. Standardized mean scores (0?100) and SDs categorized perception themes, with mean differences by sociodemographic variables analyzed using ANOVA and t tests. Statistical significance was established with a 95\% CI and a P value below .05. The data were analyzed using STATA version 14.1. Results: Factors influencing COVID-19 spread and control include behavioral nonadherence and enabling environments. A total of 81.9\% (439/536) did not comply with social distancing, and 92.2\% (493/536) faced constraints preventing them from staying home and enabling environments. Misconceptions were prevalent, including beliefs about hot weather (358/536, 66.8\%), traditional medicine (36/536, 6.7\%), and religiosity (425/536, 79.3\%). False assurances also contributed, such as feeling safe due to geographic distance from hot spots (76/536, 14.2\%) and perceiving the virus as low-risk or exaggerated (162/536, 30.2\%). Only 25.2\% (135/536) followed standard precautions and 29.9\% (160/536) were vaccinated. Employment, region, income, sex, education, and information sources significantly influenced behavioral nonadherence, myth prevalence, and false assurances. Conclusions: The findings highlight the need for substantial risk communication and community engagement. Only 46.6\% (250/536) of individuals adhered to precautionary measures, there was a high perception of nonadherence, and essential COVID-19 resources were lacking. Additionally, numerous misconceptions and false reassurances were noted. Understanding cross-border community behavior is crucial for developing effective, contextually appropriate strategies to mitigate COVID-19 risk in these regions. ", doi="10.2196/66751", url="https://formative.jmir.org/2025/1/e66751" } @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/10.2196/65767, author="Touali, Rachid and Zerouaoui, Jamal and Chakir, Mahjoub El and Bui, Tien Hung and Leone, Mario and Allisse, Maxime", title="Impact of a Sensorimotor Integration and Hyperstimulation Program on Global Motor Skills in Moroccan Children With Autism Spectrum Disorder: Exploratory Clinical Quasi-Experimental Study", journal="JMIR Form Res", year="2025", month="Mar", day="26", volume="9", pages="e65767", keywords="classical physical education", keywords="children with a neurotypical profile", keywords="children with ASD", keywords="UQAC-UQAM test battery", keywords="University of Qu{\'e}bec in Chicoutimi-University of Qu{\'e}bec in Montr{\'e}al", keywords="sensorimotor integration", keywords="hyperstimulation", keywords="Morocco", keywords="sensorimotor", keywords="integration", keywords="motor skill", keywords="Moroccan children", keywords="Moroccan", keywords="children", keywords="autism spectrum disorder", keywords="ASD", keywords="exploratory study", keywords="autism", keywords="mental health", keywords="young", keywords="youth", keywords="feasibility", abstract="Background: Children with autism spectrum disorders (ASDs) often struggle with processing information, which can impact their coordination, balance, and other motor skills. Studies have demonstrated that intervention programs based on sensory integration can enhance motor performance in these children. Objective: The objective of this study is to evaluate the applicability of a standardized battery of gross motor skill tests for Moroccan children aged 6 to 12 years with ASD. The objective is to assess the potential efficacy of an innovative pedagogical approach focused on sensorimotor integration and hyperstimulation. This approach will be compared to traditional physical education (PE) sessions to determine its feasibility and potential to bridge the developmental gaps in motor skills between children with ASD and those with a neurotypical profile. Methods: A convenience sample of 14 Moroccan children with ASD aged 6 to 12 years participated in this exploratory study. Children with ASD were divided into an experimental group (n=7) and a control group (n=7) based on age, sex, motor performance, and socioeconomic status. The control group followed the standard PE program, while the experimental group underwent a specialized program combining sensorimotor integration and hyperstimulation for a period of 15 weeks. All participants were classified as level 2 (moderate) on the Autism Severity Rating Scale based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria. Gross motor skills were measured at baseline and after 15 weeks of intervention using the UQAC-UQAM (University of Qu{\'e}bec in Chicoutimi-University of Qu{\'e}bec in Montr{\'e}al) test battery protocol, which includes 10 items. Results: At baseline (T1), no significant difference was observed between the control and experimental groups of children with ASD. Following the 15-week intervention, the group participating in traditional PE showed an overall improvement in motor skills of approximately 14.5\%. Conversely, the results of the ASD experimental group suggest a more substantial improvement of 44.5\%. Additionally, the experimental group exhibited significant better performance across all motor skill variables compared to the control group (minimum P values of <.02) with large effect sizes (>0.80). In this regard, a 2-way repeated measures ANOVA confirms the efficiency of the program implemented within the experimental group, demonstrating significant effects associated with both group and time factors as well as a clinically highly significant group{\texttimes}time interaction across all measured variables ($\eta$2p>0.14). Conclusions: The results of this study suggest that the approach that emphasizes sensorimotor integration and management of hyperstimulation was more effective in improving motor skills in this population. However, other more exhaustive studies will need to be carried out in order to be able to more precisely measure the full potential of this approach. ", doi="10.2196/65767", url="https://formative.jmir.org/2025/1/e65767", url="http://www.ncbi.nlm.nih.gov/pubmed/40137439" } @Article{info:doi/10.2196/54803, author="Li, Jiajia and Wang, Zikai and Yu, Longxuan and Liu, Hui and Song, Haitao", title="Synthetic Data-Driven Approaches for Chinese Medical Abstract Sentence Classification: Computational Study", journal="JMIR Form Res", year="2025", month="Mar", day="19", volume="9", pages="e54803", keywords="medical abstract sentence classification", keywords="large language models", keywords="synthetic datasets", keywords="deep learning", keywords="Chinese medical", keywords="dataset", keywords="traditional Chinese medicine", keywords="global medical research", keywords="algorithm", keywords="robustness", keywords="efficiency", keywords="accuracy", abstract="Background: Medical abstract sentence classification is crucial for enhancing medical database searches, literature reviews, and generating new abstracts. However, Chinese medical abstract classification research is hindered by a lack of suitable datasets. Given the vastness of Chinese medical literature and the unique value of traditional Chinese medicine, precise classification of these abstracts is vital for advancing global medical research. Objective: This study aims to address the data scarcity issue by generating a large volume of labeled Chinese abstract sentences without manual annotation, thereby creating new training datasets. Additionally, we seek to develop more accurate text classification algorithms to improve the precision of Chinese medical abstract classification. Methods: We developed 3 training datasets (dataset \#1, dataset \#2, and dataset \#3) and a test dataset to evaluate our model. Dataset \#1 contains 15,000 abstract sentences translated from the PubMed dataset into Chinese. Datasets \#2 and \#3, each with 15,000 sentences, were generated using GPT-3.5 from 40,000 Chinese medical abstracts in the CSL database. Dataset \#2 used titles and keywords for pseudolabeling, while dataset \#3 aligned abstracts with category labels. The test dataset includes 87,000 sentences from 20,000 abstracts. We used SBERT embeddings for deeper semantic analysis and evaluated our model using clustering (SBERT-DocSCAN) and supervised methods (SBERT-MEC). Extensive ablation studies and feature analyses were conducted to validate the model's effectiveness and robustness. Results: Our experiments involved training both clustering and supervised models on the 3 datasets, followed by comprehensive evaluation using the test dataset. The outcomes demonstrated that our models outperformed the baseline metrics. Specifically, when trained on dataset \#1, the SBERT-DocSCAN model registered an impressive accuracy and F1-score of 89.85\% on the test dataset. Concurrently, the SBERT-MEC algorithm exhibited comparable performance with an accuracy of 89.38\% and an identical F1-score. Training on dataset \#2 yielded similarly positive results for the SBERT-DocSCAN model, achieving an accuracy and F1-score of 89.83\%, while the SBERT-MEC algorithm recorded an accuracy of 86.73\% and an F1-score of 86.51\%. Notably, training with dataset \#3 allowed the SBERT-DocSCAN model to attain the best with an accuracy and F1-score of 91.30\%, whereas the SBERT-MEC algorithm also showed robust performance, obtaining an accuracy of 90.39\% and an F1-score of 90.35\%. Ablation analysis highlighted the critical role of integrated features and methodologies in improving classification efficiency. Conclusions: Our approach addresses the challenge of limited datasets for Chinese medical abstract classification by generating novel datasets. The deployment of SBERT-DocSCAN and SBERT-MEC models significantly enhances the precision of classifying Chinese medical abstracts, even when using synthetic datasets with pseudolabels. ", doi="10.2196/54803", url="https://formative.jmir.org/2025/1/e54803" } @Article{info:doi/10.2196/58976, author="Sohail, Maira and Matthews, Lynn and Williams, Audra and Kempf, Mirjam-Colette and Phillips, Desiree and Goymer, Hannah and Johnson,, Bernadette and Mugavero, Michael and Elopre, Latesha", title="Improving Pre-Exposure Prophylaxis Provision as Part of Routine Gynecologic Care Among Black Cisgender Women (Project PrEP4Her): Protocol for the Implementation of an Intervention", journal="JMIR Res Protoc", year="2025", month="Mar", day="14", volume="14", pages="e58976", keywords="Black", keywords="cis-Gender women", keywords="PrEP", keywords="pre-exposure prophylaxis", keywords="South", keywords="HIV", keywords="gynecology", abstract="Background: Although HIV pre-exposure prophylaxis (PrEP) has been proven to be an effective prevention tool in decreasing HIV transmission, achieving adequate PrEP uptake has remained a challenge among Black cisgender women living in the Southern United States. Gynecology clinics, which provide primary health care services for many cisgender women, have the potential to be an ideal setting for the integration of PrEP services. Objective: We designed an intervention, PrEP4Her, which aims to implement PrEP service delivery at gynecology clinics in Alabama, the United States, as part of routine reproductive and sexual health care visits to improve PrEP engagement rates among Black cisgender women. Methods: Guided by the information gathered on (1) factors impacting PrEP implementation at gynecology clinics, including key barriers and facilitators to PrEP implementation and potential strategies to address the identified barriers (in-depth interviews with the gynecology care team), (2) structural barriers and provider-level barriers to PrEP implementation (cross-sectional study among gynecologists), and (3) implementation strategies on how to integrate PrEP services into routine gynecology care (in-depth interviews and focus groups with Black cisgender women), a multicomponent implementation strategy, tailored for Black cisgender women, was developed to integrate PrEP in routine women's health visits (ie, PrEP4Her). To determine the efficacy of the program, we will measure implementation outcomes, reach (increase in the absolute number of Black cisgender women receiving PrEP prescriptions), effectiveness (increase in the proportion of PrEP prescriptions over time), and adoption (proportion of team members willing to implement PrEP4Her) using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. In addition, acceptability (the extent to which providers and Black cisgender women feel PrEP4Her to be acceptable---in-depth interviews); Feasibility (appropriateness of PrEP4Her for a larger, full-scale trial---the Feasibility of Intervention Measure scale); and fidelity (the degree to which PrEP4Her program was implemented as designed---electronic survey with patients) will also be assessed. Results: The qualitative and quantitative data from the gynecology care team and the qualitative data from Black cisgender women were collected from August 9, 2022, to April 19, 2023, and were integrated through joint displays to identify major themes. The combined findings provided a comprehensive understanding of factors that were fundamental in the development and refinement of PrEP4Her implementation. The PrEP4Her was implemented from January 29, 2024, to August 16, 2024. The information gathered is being used to assess PrEP4Her efficacy (based on reach, effectiveness, adoption, acceptability, feasibility, and fidelity). Conclusions: Upon completion of our research, our interdisciplinary team, which includes experts in infectious diseases, implementation science, community-engaged research, and psychology, will be primed to lead a multisite type III implementation trial for PrEP service delivery at gynecology clinics across the Southern United States. International Registered Report Identifier (IRRID): DERR1-10.2196/58976 ", doi="10.2196/58976", url="https://www.researchprotocols.org/2025/1/e58976", url="http://www.ncbi.nlm.nih.gov/pubmed/40085134" } @Article{info:doi/10.2196/67223, author="Almalki, Manal", title="Predictors of the Intention to Stop Using Smart Devices at Bedtime Among University Students in Saudi Arabia: Cross-Sectional Survey", journal="JMIR Form Res", year="2025", month="Mar", day="10", volume="9", pages="e67223", keywords="smart devices", keywords="smartphone", keywords="digital health", keywords="digital technology", keywords="sleep quality", keywords="university student", keywords="bedtime habits", keywords="Saudi Arabia", keywords="path analysis", keywords="sleep disturbances", keywords="well-being", keywords="usage", keywords="intention", keywords="behavior", keywords="mobile phone", abstract="Background: The widespread use of smart devices, particularly among university students, has raised concerns about their impact on sleep quality. Bedtime usage of smart devices is associated with sleep disruptions and poor sleep quality. Objective: This study aimed to explore the behavioral and perceptual factors influencing university students' intention to stop using smart devices at bedtime in Saudi Arabia. Methods: A cross-sectional survey was conducted in June 2024 and distributed via social media platforms to university students (aged ?18 years). The questionnaire collected data on demographics, smart device usage habits, perceived negative effects on sleep, and physical sleep disturbances. The Pittsburgh Sleep Quality Index was used to assess sleep quality. Path analysis was performed to evaluate relationships between the outcome variables, intended to stop using smart device usage, and 3 latent variables: sleep quality smartphone usage, sleep quality perceived negative effects, and sleep quality during the past month. Model fit was assessed using chi-square, comparative fit index, and root mean square error of approximation. Results: Of the 774 participants, 90.43\% (700/774) reported using their smart devices every night and 72.48\% (561/774) believed bedtime device use negatively affected them the next morning. The most frequently reported next-morning symptoms were fatigue or drowsiness (480/774, 62.01\%). Common purposes for bedtime device use were staying in touch with friends or family (432/774, 55.81\%), entertainment (355/774, 45.86\%), and filling up spare time (345/774, 44.57\%). Overall, 58.26\% (451/774) expressed an intention to stop bedtime device use within the next 3 months. Path analysis demonstrated that frequent nightly use (path coefficient=0.36) and after-lights-off usage (0.49) were positively associated with the intention to stop, whereas spending ?3 hours on devices (--0.35) and engaging in multiple activities (--0.18) had negative associations. The strongest predictors of the intention to stop were perceived negative effects on next-morning well-being (0.71) and difficulty breathing comfortably during sleep (0.64). Model fit was excellent (comparative fit index=0.845 and root mean square error of approximation=0.039). Conclusions: Perceived negative effects on sleep quality and physical sleep disturbances are strong predictors of the intention to stop using smart devices at bedtime among university students in Saudi Arabia. Interventions aimed at improving sleep hygiene should focus on raising awareness about the impact of smart device use on well-being and addressing behaviors such as late-night usage and heavy screen time. Public health strategies should target both psychological and physiological aspects of bedtime smart device use to improve sleep quality in this population. ", doi="10.2196/67223", url="https://formative.jmir.org/2025/1/e67223", url="http://www.ncbi.nlm.nih.gov/pubmed/40063070" } @Article{info:doi/10.2196/57398, author="Cheng, G. Hui and Noggle, Brendan and Vansickel, R. Andrea and Largo, G. Edward and Magnani, Pierpaolo", title="Tobacco Use, Risk Perceptions, and Characteristics of Adults Who Used a Heated Tobacco Product (IQOS) in the United States: Cross-Sectional Survey Study", journal="JMIR Form Res", year="2025", month="Feb", day="7", volume="9", pages="e57398", keywords="United States Food and Drug Administration", keywords="FDA", keywords="IQOS", keywords="Tobacco Heating System", keywords="THS", keywords="heated tobacco products", keywords="modified risk tobacco products", keywords="MRTP", keywords="tobacco", keywords="nicotine", keywords="smokers", keywords="tobacco harm reduction", keywords="cross-sectional surveys", keywords="cigarettes", abstract="Background: The Tobacco Heating System (THS; commercialized as IQOS) is a smoke-free heated tobacco product introduced in the United States in 2019 and authorized by the US Food and Drug Administration as a modified risk tobacco product (MRTP) in 2020. THS consists of a holder and specially designed tobacco sticks that are heated instead of burned to produce a nicotine-containing aerosol. THS was available in Atlanta, Georgia; Richmond, Virginia; Charlotte, North Carolina; the Northern Virginia region; and South Carolina before its market removal in November 2021. Objective: This study aims to describe selected sociodemographic characteristics and self-reported health history of adults who used IQOS (AUIs), their tobacco use patterns (eg, tobacco use history, exclusive and dual-use, and switching from cigarette smoking), their risk perceptions of the product, and their understanding of MRTP messages. Methods: The IQOS Cross-Sectional Postmarket Adult Consumer Study was a study of AUIs aged 21 years or older who were recruited from a consumer database via direct postal mail and emails. Participants completed the online survey between September and November 2021. Results: The survey was completed by 645 current and 43 former AUIs who had used at least 100 tobacco sticks (considered established THS use) before the assessment. Of the 688 participants, 424 (61.6\%) were male, 502 (73.0\%) were non--Hispanic White, and the mean age was 45 years. The vast majority (680/688, 98.8\%) of AUIs had ever smoked combusted cigarettes before first trying THS and 628 (91.3\%) had smoked cigarettes in the 30 days before first using THS. At the time of assessment, 161 (23.4\%) reported using e-cigarettes (vs 229, 33.3\%, before THS use), 92 (13.4\%) reported smoking cigars (vs 114, 16.6\%, before THS use), and 338 (49.1\%) were still smoking after an average of 1 year of THS use. Among those currently using THS who were still smoking (n=298), 249 (83.6\%) smoked fewer cigarettes compared with before first trying THS; 362 of 688 (52.6\%) AUIs reported having no physical health conditions evaluated in this study and almost three-quarters reported having no mental health conditions. Among all AUIs, over 563 (81.8\%) had never used a cessation treatment or had not used it in the past 12 months, and 555 (80.7\%) AUIs demonstrated a correct understanding of the MRTP message and AUIs perceived THS as having a lower risk than cigarettes (43.8 vs 64.4 on a 100-point composite score scale). Conclusions: This study provides evidence that THS can help adult smokers in the United States completely switch away from cigarettes or reduce smoking. ", doi="10.2196/57398", url="https://formative.jmir.org/2025/1/e57398" } @Article{info:doi/10.2196/63556, author="Luo, Yang and Li, Sisi and Feng, Lijuan and Zheng, Junyi and Peng, Chunfen and Bao, Lihong", title="Impact of Psychological Resilience on the Fear of Pain and Activity Recovery in Postsurgical Patients: Observational Cohort Study", journal="JMIR Form Res", year="2025", month="Feb", day="7", volume="9", pages="e63556", keywords="psychological resilience", keywords="fear of pain", keywords="postsurgical recovery", keywords="fear avoidance belief", keywords="pain management", keywords="activity recovery", abstract="Background: The fear of pain (FOP) and fear avoidance belief (FAB) play a crucial role in the occurrence and development of chronic pain. However, the dynamics of these factors in postsurgical pain appear to differ, with the FOP often learned from others rather than directly caused by painful experiences. Psychological resilience refers to an individual's capacity to adapt effectively to adversity, challenges, and threats, and may play a significant role in overcoming the FOP and avoidance behavior. Objective: The aim of this study was to investigate the role of psychological resilience in overcoming the FOP and avoidance behavior among surgical patients undergoing lung surgery. Methods: Participants were recruited at the Wuhan Union Hospital. Psychological resilience was measured using the Connor-Davidson Resilience Scale. The FOP was assessed using the simplified Chinese version of the Fear of Pain-9 items. The FAB was measured using the Physical Activity subscale of the Fear-Avoidance Beliefs Questionnaire. Activity recovery was assessed through questions related to social activities and household responsibilities. The adaptive least absolute shrinkage and selection operator (Lasso) regression analysis under nested cross-validation was used to identify key factors affecting postoperative FOP and activity recovery. Results: A total of 144 participants were included in the final analysis. The results showed that preoperative FOP (coefficient=8.620) and FAB (coefficient=8.560) were mainly positively correlated with postoperative FOP, while psychological resilience (coefficient=?5.822) and age (coefficient=?2.853) were negatively correlated with it. These average R2 of these models was 73\% (SD 6\%). Psychological resilience was the most important factor in predicting activity recovery, and these models obtained an average accuracy of 0.820 (SD 0.024) and an average area under the curve of 0.926 (SD 0.044). Conclusions: Psychological resilience was negatively associated with the postoperative FOP and positively with activity recovery in patients who underwent lung surgery. Patients with higher resilience are more likely to cope effectively with postsurgical pain and recover activities sooner. These findings highlight the importance of assessing and potentially enhancing psychological resilience in the perioperative period to improve postoperative outcomes. ", doi="10.2196/63556", url="https://formative.jmir.org/2025/1/e63556" } @Article{info:doi/10.2196/68371, author="Rose, Christian and Shearer, Emily and Woller, Isabela and Foster, Ashley and Ashenburg, Nicholas and Kim, Ireh and Newberry, Jennifer", title="Identifying High-Priority Ethical Challenges for Precision Emergency Medicine: Nominal Group Study", journal="JMIR Form Res", year="2025", month="Feb", day="6", volume="9", pages="e68371", keywords="precision medicine", keywords="emergency medicine", keywords="ethical considerations", keywords="nominal group study", keywords="consensus framework", abstract="Background: Precision medicine promises to revolutionize health care by providing the right care to the right patient at the right time. However, the emergency department's unique mandate to treat ``anyone, anywhere, anytime'' creates critical tensions with precision medicine's requirements for comprehensive patient data and computational analysis. As emergency departments serve as health care's safety net and provide a growing proportion of acute care in America, identifying and addressing the ethical challenges of implementing precision medicine in this setting is crucial to prevent exacerbation of existing health care disparities. The rapid advancement of precision medicine technologies makes it imperative to understand these challenges before widespread implementation in emergency care settings. Objective: This study aimed to identify high priority ethical concerns facing the implementation of precision medicine in the emergency department. Methods: We conducted a qualitative study using a modified nominal group technique (NGT) with emergency physicians who had previous knowledge of precision medicine concepts. The NGT process consisted of four phases: (1) silent generation of ideas, (2) round-robin sharing of ideas, (3) structured discussion and clarification, and (4) thematic grouping of priorities. Participants represented diverse practice settings (county hospital, community hospital, academic center, and integrated managed care consortium) and subspecialties (education, ethics, pediatrics, diversity, equity, inclusion, and informatics) across various career stages from residents to late-career physicians. Results: A total of 12 emergency physicians identified 82 initial challenges during individual ideation, which were consolidated to 48 unique challenges after removing duplicates and combining related items. The average participant contributed 6.8 (SD 2.9) challenges. These challenges were organized into a framework with 3 themes: values, privacy, and justice. The framework identified the need to address these themes across 3 time points of the precision medicine process: acquisition of data, actualization in the care setting, and the after effects of its use. This systematic organization revealed interrelated concerns spanning from data collection and bias to implementation challenges and long-term consequences for health care equity. Conclusions: Our study developed a novel framework that maps critical ethical challenges across 3 domains (values, privacy, and justice) and 3 temporal stages of precision medicine implementation. This framework identifies high-priority areas for future research and policy development, particularly around data representation, privacy protection, and equitable access. Successfully addressing these challenges is essential to realize precision medicine's potential while preserving emergency medicine's core mission as health care's safety net. ", doi="10.2196/68371", url="https://formative.jmir.org/2025/1/e68371" } @Article{info:doi/10.2196/50458, author="Borhany, Hojjat", title="Converting Organic Municipal Solid Waste Into Volatile Fatty Acids and Biogas: Experimental Pilot and Batch Studies With Statistical Analysis", journal="JMIRx Med", year="2025", month="Feb", day="4", volume="6", pages="e50458", keywords="multistep fermentation", keywords="specific methane production", keywords="anaerobic digestion", keywords="kinetics study", keywords="biochar", keywords="first-order", keywords="modified Gompertz", keywords="mass balance", keywords="waste management", keywords="environment sustainability", abstract="Background: Italy can augment its profit from biorefinery products by altering the operation of digesters or different designs to obtain more precious bioproducts like volatile fatty acids (VFAs) than biogas from organic municipal solid waste. In this context, recognizing the process stability and outputs through operational interventions and its technical and economic feasibility is a critical issue. Hence, this study involves an anaerobic digester in Treviso in northern Italy. Objective: This research compares a novel line, consisting of pretreatment, acidogenic fermentation, and anaerobic digestion, with single-step anaerobic digestion regarding financial profit and surplus energy. Therefore, a mass flow model was created and refined based on the outputs from the experimental and numerical studies. These studies examine the influence of hydraulic retention time (HRT), pretreatment, biochar addition, and fine-tuned feedstock/inoculum (FS/IN) ratio on bioproducts and operational parameters. Methods: VFA concentration, VFA weight ratio distribution, and biogas yield were quantified by gas chromatography. A t test was then conducted to analyze the significance of dissimilar HRTs in changing the VFA content. Further, a feasible biochar dosage was identified for an assumed FS/IN ratio with an adequately long HRT using the first-order rate model. Accordingly, the parameters for a mass flow model were adopted for 70,000 population equivalents to determine the payback period and surplus energy for two scenarios. We also explored the effectiveness of amendments in improving the process kinetics. Results: Both HRTs were identical concerning the ratio of VFA/soluble chemical oxygen demand (0.88 kg/kg) and VFA weight ratio distribution: mainly, acetic acid (40\%), butyric acid (24\%), and caproic acid (17\%). However, a significantly higher mean VFA content was confirmed for an HRT of 4.5 days than the quantity for an HRT of 3 days (30.77, SD 2.82 vs 27.66, SD 2.45 g--soluble chemical oxygen demand/L), using a t test (t8=?2.68; P=.03; CI=95\%). In this research, 83\% of the fermented volatile solids were converted into biogas to obtain a specific methane (CH4) production of 0.133 CH4-Nm3/kg--volatile solids. While biochar addition improved only the maximum methane content by 20\% (86\% volumetric basis [v/v]), the FS/IN ratio of 0.3 volatile solid basis with thermal plus fermentative pretreatment improved the hydrolysis rate substantially (0.57 vs 0.07, 1/d). Furthermore, the biochar dosage of 0.12 g-biochar/g--volatile solids with an HRT of 20 days was identified as a feasible solution. Principally, the payback period for our novel line would be almost 2 years with surplus energy of 2251 megajoules [MJ] per day compared to 45 years and 21,567 MJ per day for single-step anaerobic digestion. Conclusions: This research elaborates on the advantage of the refined novel line over the single-step anaerobic digestion and confirms its financial and technical feasibility. Further, changing the HRT and other amendments significantly raised the VFA concentration and the process kinetics and stability. ", doi="10.2196/50458", url="https://xmed.jmir.org/2025/1/e50458" } @Article{info:doi/10.2196/60829, author="Karasek, Deborah and Williams, C. Jazzmin and Taylor, A. Michaela and De La Cruz, M. Monica and Arteaga, Stephanie and Bell, Sabra and Castillo, Esperanza and Chand, A. Maile and Coats, Anjeanette and Hubbard, M. Erin and Love-Goodlett, Latriece and Powell, Breezy and Spellen, Solaire and Malawa, Zea and Gomez, Manchikanti Anu", title="Designing the First Pregnancy Guaranteed Income Program in the United States: Qualitative Needs Assessment and Human-Centered Design to Develop the Abundant Birth Project", journal="JMIR Form Res", year="2025", month="Jan", day="27", volume="9", pages="e60829", keywords="maternal and child health", keywords="economics", keywords="public health", keywords="qualitative research methods", keywords="programs (evaluation and funding)", keywords="community-centered", keywords="pregnancy", keywords="first pregnancy", keywords="behavioral interventions", keywords="racial health", keywords="financial stress", keywords="Abundant Birth Project", keywords="infant health", keywords="infant", keywords="Black", abstract="Background: Racial inequities in pregnancy outcomes persist despite investments in clinical, educational, and behavioral interventions, indicating that a new approach is needed to address the root causes of health disparities. Guaranteed income during pregnancy has the potential to narrow racial health inequities for birthing people and infants by alleviating financial stress. Objective: We describe community-driven formative research to design the first pregnancy-guaranteed income program in the United States---the Abundant Birth Project (ABP). Informed by birth equity and social determinants of health perspectives, ABP targets upstream structural factors to improve racial disparities in maternal and infant health. Methods: The research team included community researchers, community members with lived experience as Black or Pacific Islander pregnant, and parenting people in the San Francisco Bay Area. The team conducted needs assessment interviews and facilitated focus groups with participants using human-centered design methods. Needs assessment participants later served as co-designers of the ABP program and research, sharing their experiences with financial hardships and government benefits programs and providing recommendations on key program elements, including fund disbursement, eligibility, and amount. Results: Housing affordability and the high cost of living in San Francisco emerged as significant sources of stress in pregnancy. Participants reported prohibitively low income eligibility thresholds and burdensome enrollment processes as challenges or barriers to existing social services. These insights guided the design of prototypes of ABP's program components, which were used in a design sprint to determine the final components. Based on this design process, the ABP program offered US \$1000/month for 12 months to pregnant Black and Pacific Islander people, selected through a lottery called an abundance drawing. Conclusions: The formative design process maximized community input and shared decision-making to co-design a guaranteed income program for Black and Pacific Islander women and people. Our upstream approach and community research model can inform the development of public health and social service programs. ", doi="10.2196/60829", url="https://formative.jmir.org/2025/1/e60829" } @Article{info:doi/10.2196/65561, author="Iyer, S. Maya and Moe, Aubrey and Massick, Susan and Davis, Jessica and Ballinger, Megan and Townsend, Kristy", title="Development of the Big Ten Academic Alliance Collaborative for Women in Medicine and Biomedical Science: ``We Built the Airplane While Flying It''", journal="JMIR Form Res", year="2025", month="Jan", day="23", volume="9", pages="e65561", keywords="collaborative", keywords="gender equity", keywords="women in medicine", keywords="women in science", keywords="biomedical science", keywords="women", keywords="women+", keywords="gender", keywords="medicine", keywords="university", keywords="faculty", keywords="accessibility", keywords="career", keywords="equity", keywords="networking", keywords="opportunity", keywords="retaining", keywords="programming", keywords="Big Ten Academic Alliance", keywords="BTAA", keywords="academic alliance", doi="10.2196/65561", url="https://formative.jmir.org/2025/1/e65561" } @Article{info:doi/10.2196/59203, author="M{\"o}llmann, Louise Henriette and Alhammadi, Eman and Boulghoudan, Soufian and Kuhlmann, Julian and Mevissen, Anica and Olbrich, Philipp and Rahm, Louisa and Frohnhofen, Helmut", title="Assessment of Geriatric Problems and Risk Factors for Delirium in Surgical Medicine: Protocol for Multidisciplinary Prospective Clinical Study", journal="JMIR Res Protoc", year="2025", month="Jan", day="22", volume="14", pages="e59203", keywords="delirium", keywords="older patients", keywords="perioperative assessment", keywords="age-related surgical risk factors", keywords="geriatric assessment", keywords="gerontology", keywords="aging", keywords="surgical medicine", keywords="surgical care", keywords="surgery", keywords="multidisciplinary", keywords="prospective study", keywords="perioperative", keywords="screening", keywords="palliative care", keywords="health informatics", abstract="Background: An aging population in combination with more gentle and less stressful surgical procedures leads to an increased number of operations on older patients. This collectively raises novel challenges due to higher age heavily impacting treatment. A major problem, emerging in up to 50\% of cases, is perioperative delirium. It is thus vital to understand whether and which existing geriatric assessments are capable of reliably identifying risk factors, how high the incidence of delirium is, and whether the resulting management of these risk factors might lead to a reduced incidence of delirium. Objective: This study aimed to determine the frequency and severity of geriatric medical problems in elective patients of the Clinics of Oral and Maxillofacial Surgery, Vascular Surgery, and Orthopedics, General Surgery, and Trauma Surgery, revealing associations with the incidence of perioperative delirium regarding potential risk factors, and recording the long-term effects of geriatric problems and any perioperative delirium that might have developed later the patient's life. Methods: We performed both pre- and postoperative assessments in patients of 4 different surgical departments who are older than 70 years. Patient-validated screening instruments will be used to identify risk factors. A geriatric assessment with the content of basal and instrumental activities of daily living (basal activities of daily living [Katz index], instrumental activities of daily living [Lawton and Brody score], cognition [6-item screener and clock drawing test], mobility [de Morton Mobility Index and Sit-to-Stand test], sleep [Pittsburgh Sleep Quality Index and Insomnia Severity Index/STOP-BANG], drug therapy [polypharmacy and quality of medication, Fit For The Aged classification, and anticholinergic burden score], and pain assessment and delirium risk (Delirium Risk Assessment Tool) will be performed. Any medical problems detected will be treated according to current standards, and no intervention is planned as part of the study. In addition, a telephone follow-up will be performed 3, 6, and 12 months after discharge. Results: Recruitment started in August 2022, with 421 patients already recruited at the time of submission. Initial analyses of the data are to be published at the end of 2024 or the beginning of 2025. Conclusions: In the current study, we investigate whether the risk factors addressed in the assessment are associated with an increase in the delirium rate. The aim is then to reduce this comprehensive assessment to the central aspects to be able to conduct targeted and efficient risk screening. Trial Registration: German Clinical Trials Registry DRKS00028614; https://www.drks.de/search/de/trial/DRKS00028614 International Registered Report Identifier (IRRID): DERR1-10.2196/59203 ", doi="10.2196/59203", url="https://www.researchprotocols.org/2025/1/e59203", url="http://www.ncbi.nlm.nih.gov/pubmed/39841510" } @Article{info:doi/10.2196/64258, author="Lopez, M. Cristina and Moreland, D. Angela and Amaya, Stephanie and Bisca, Erin and Mujica, Christin and Wilson, Tayler and Baker, Nathaniel and Richey, Lauren and Eckard, Ross Allison and Resick, A. Patricia and Safren, A. Steven and Danielson, Kmett Carla", title="Assessment, Decision, Adaptation, Production, Topical Experts-Integration, Training, and Testing (ADAPT-ITT) Framework to Tailor Evidence-Based Posttraumatic Stress Disorder Treatment for People With HIV to Enhance Engagement and Adherence: Qualitative Results from a Feasibility Randomized Controlled Trial", journal="JMIR Form Res", year="2025", month="Jan", day="16", volume="9", pages="e64258", keywords="PTSD", keywords="HIV", keywords="adherence", keywords="minoritized populations", keywords="adaptation", keywords="evidence-based", keywords="treatment", keywords="engagement", keywords="posttraumatic stress disorder", keywords="stress", keywords="trauma", keywords="antiretroviral therapy", keywords="therapy", keywords="symptoms", keywords="acceptability", keywords="self-efficacy", abstract="Background: Individuals with co-occurring posttraumatic stress disorder (PTSD) and HIV are at high-risk for negative HIV-related outcomes, including low adherence to antiretroviral therapy, faster disease progression, more hospitalizations, and almost twice the rate of death. Despite high rates of PTSD in persons with HIV (PWH) and poor HIV-related health outcomes associated with PTSD, an effective evidence-based treatment for PTSD symptoms in PWH does not exist. Objective: This study aimed to describe the adaptation and theater testing of an evidence-based intervention designed for people with co-occurring PTSD and HIV. Methods: The Assessment, Decision, Adaptation, Production, Topical experts-integration, Training, and Testing (ADAPT-ITT) framework guided the formative process used to modify an evidence-based PTSD treatment (cognitive processing therapy; CPT) to meet the unique needs of PWH experiencing PTSD. With the integration of Life-Steps for Medication Adherence (Life-Steps), the adapted protocol (CPT-Life-Steps for integration of adherence; CPT-L) targeted HIV-related stigma and HIV medication adherence within a trauma-informed framework. Theater testing was completed with 7 participants to evaluate acceptability of CPT-L for PWH. The qualitative data (N=54 recordings) used to evaluate and adapt CPT-L emerged from individual interviews conducted with participants after each therapy session as well as exit interviews conducted at posttreatment data collection. Results: After challenging stigma-related appraisals, participants expressed feeling less constrained by maladaptive thoughts. These shifts translated to increased self-efficacy with both HIV-related care and mental health. Conclusions: These results indicate that trauma-informed work with PWH should consider the impact of HIV on trauma-related stuck points, intersecting identities (including living with HIV), and challenging internalized stigma. Findings provide evidence that CPT-L is acceptable and effective in addressing internalized HIV stigma that impacts PTSD symptom maintenance and HIV treatment engagement. Trial Registration: ClinicalTrials.gov; NCT05275842; https://clinicaltrials.gov/study/NCT05275842?id=NCT05275842\&rank=1 International Registered Report Identifier (IRRID): RR2-10.1016/j.conctc.2023.101150 ", doi="10.2196/64258", url="https://formative.jmir.org/2025/1/e64258" } @Article{info:doi/10.2196/63217, author="Block Ngaybe, G. Maiya and Azurdia Sierra, Lidia and McNair, Andrew and Gonzalez, Myla and Arora, Mona and Ernst, Kacey and Noriega-Atala, Enrique and Iyengar, Sriram M.", title="Resilience Informatics in Public Health: Qualitative Analysis of Conference Proceedings", journal="JMIR Form Res", year="2025", month="Jan", day="16", volume="9", pages="e63217", keywords="resilience", keywords="public health", keywords="informatics", keywords="mobile phone", keywords="artificial intelligence", keywords="AI", abstract="Background: In recent years, public health has confronted 2 formidable challenges: the devastating COVID-19 pandemic and the enduring threat of climate change. The convergence of these crises underscores the urgent need for resilient solutions. Resilience informatics (RI), an emerging discipline at the intersection of informatics and public health, leverages real-time data integration from health systems, environmental monitoring, and technological tools to develop adaptive responses to multifaceted crises. It offers promising avenues for mitigating and adapting to these challenges by proactively identifying vulnerabilities and fostering adaptive capacity in public health systems. Addressing critical questions regarding target audiences, privacy concerns, and scalability is paramount to fostering resilience in the face of evolving health threats. Objective: The University of Arizona held a workshop, titled Resilience Informatics in Public Health, in November 2023 to serve as a pivotal forum for advancing these discussions and catalyzing collaborative efforts within the field. This paper aims to present a qualitative thematic analysis of the findings from this workshop. Methods: A purposive sampling strategy was used to invite 40 experts by email from diverse fields, including public health, medicine, weather services, informatics, environmental science, and resilience, to participate in the workshop. The event featured presentations from key experts, followed by group discussions facilitated by experts. The attendees engaged in collaborative reflection and discussion on predetermined questions. Discussions were systematically recorded by University of Arizona students, and qualitative analysis was conducted. A detailed thematic analysis was performed using an inductive approach, supported by MAXQDA software to manage and organize data. Two independent researchers coded the transcripts; discrepancies in coding were resolved through consensus, ensuring a rigorous synthesis of the findings. Results: The workshop hosted 27 experts at the University of Arizona, 21 (78\%) of whom were from public health--related fields. Of these 27 experts, 8 (30\%) were from the field of resilience. In addition, participants from governmental agencies, American Indian groups, weather services, and a mobile health organization attended. Qualitative analysis identified major themes, including the potential of RI tools, threats to resilience (eg, health care access, infrastructure, and climate change), challenges with RI tools (eg, usability, funding, and real-time response), and standards for RI tools (eg, technological, logistical, and sociological). The attendees emphasized the importance of equitable access, community engagement, and iterative development in RI projects. Conclusions: The RI workshop emphasized the necessity for accessible, user-friendly tools bridging technical knowledge and community needs. The workshop's conclusions provide a road map for future public health resilience, highlighting the need for scalable, culturally sensitive, community-driven interventions. Future directions include focused discussions to yield concrete outputs such as implementation guidelines and tool designs, reshaping public health strategies in the face of emerging threats. ", doi="10.2196/63217", url="https://formative.jmir.org/2025/1/e63217" } @Article{info:doi/10.2196/64873, author="Antolin Mu{\~n}iz, Marley and McMahan, M. Vanessa and Luna Marti, Xochitl and Brennan, Sarah and Tavasieff, Sophia and Rodda, N. Luke and Knoll, James and Coffin, O. Phillip", title="Identification of Behavioral, Clinical, and Psychological Antecedents of Acute Stimulant Poisoning: Development and Implementation of a Mixed Methods Psychological Autopsy Study", journal="JMIR Form Res", year="2025", month="Jan", day="13", volume="9", pages="e64873", keywords="psychological autopsy", keywords="acute stimulant poisoning", keywords="overdose", keywords="cocaine", keywords="methamphetamine", keywords="fentanyl", abstract="Background: Despite increasing fatal stimulant poisoning in the United States, little is understood about the mechanism of death. The psychological autopsy (PA) has long been used to distinguish the manner of death in equivocal cases, including opioid overdose, but has not been used to explicitly explore stimulant mortality. Objective: We aimed to develop and implement a large PA study to identify antecedents of fatal stimulant poisoning, seeking to maximize data gathering and ethical interactions during the collateral interviews. Methods: We ascertained death records from the California Electronic Death Reporting System (CA-EDRS) and the San Francisco Office of the County Medical Examiner (OCME) from June 2022 through December 2023. We selected deaths determined to be due to acute poisoning from cocaine or methamphetamine, which occurred 3?12 months prior and were not attributed to suicide or homicide. We identified 31 stimulant-fentanyl and 70 stimulant-no-opioid decedents. We sought 2 informants for each decedent, who were able to describe the decedent across their life course. Informants were at least 18 years of age, communicated with the decedent within the year before death, and were aware that the decedent had been using substances during that year. Upon completion of at least one informant interview conducted by staff with bachelor's or master's degrees, we collected OCME, medical record, and substance use disorder treatment data for the decedent. Planned analyses include least absolute shrinkage and selection operator regressions of quantitative data and thematic analyses of qualitative data. Results: We identified and interviewed at least one informant (N=141) for each decedent (N=101). Based on feedback during recruitment, we adapted language to improve rapport, including changing the term ``accidental death'' to ``premature death,'' offering condolences, and providing content warnings. As expected, family members were able to provide more data about the decedent's childhood and adolescence, and nonfamily informants provided more data regarding events proximal to death. We found that the interviews were stressful for both the interviewee and interviewer, especially when participants thought the study was intrusive or experienced significant grief during the interviews. Conclusions: In developing and implementing PA research on fatal stimulant poisoning, we noted the importance of recruitment language regarding cause of death and condolences with collateral informants. Compassion and respect were critical to facilitate the interview process and maintain an ethical framework. We discuss several barriers to success and lessons learned while conducting PA interviews, as well as recommendations for future PA studies. ", doi="10.2196/64873", url="https://formative.jmir.org/2025/1/e64873" } @Article{info:doi/10.2196/64586, author="Gong, Chan-Juan and Zhou, Xiao-Kai and Zhang, Zhen-Feng and Fang, Yin", title="Impact of Preventive Intravenous Amiodarone on Reperfusion Ventricular Fibrillation in Patients With Left Ventricular Hypertrophy Undergoing Open-Heart Surgery: Randomized Controlled Clinical Trial", journal="JMIR Form Res", year="2025", month="Jan", day="13", volume="9", pages="e64586", keywords="amiodarone", keywords="left ventricular hypertrophy", keywords="reperfusion ventricular fibrillation", keywords="open-heart surgery", keywords="randomized controlled trial", keywords="RCT", keywords="clinical trial", keywords="ventricular fibrillation", keywords="vicious arrhythmia", keywords="aortic cross-clamp", keywords="surgery", keywords="effectiveness", keywords="defibrillation", abstract="Background: Ventricular fibrillation (VF) is a vicious arrhythmia usually generated after removal of the aortic cross-clamp (ACC) in patients undergoing open-heart surgery, which could damage cardiomyocytes, especially in patients with left ventricular hypertrophy (LVH). Amiodarone has the prominent properties of converting VF and restoring sinus rhythm. However, few studies concentrated on the effect of amiodarone before ACC release on reducing VF in patients with LVH. Objective: The study was designed to explore the effectiveness of prophylactic intravenous amiodarone in reducing VF after the release of the ACC in patients with LVH. Methods: A total of 54 patients with LVH scheduled for open-heart surgery were enrolled and randomly divided (1:1) into 2 groups---group A (amiodarone group) and group P (placebo-controlled group). Thirty minutes before removal of the ACC, the trial drugs were administered intravenously. In group A, 150 mg of amiodarone was pumped in 15 minutes. In group P, the same volume of normal saline was pumped in 15 minutes. The primary outcome was the incidence of VF 10 minutes after removal of the ACC. Results: The incidence of VF was lower in group A than in group P (30\% vs 70\%, P=.003). The duration of VF, the number of defibrillations, and the defibrillation energy were also lower in group A than in group P (P<.001, P=.002, and P=.002, respectively). After the end of cardiopulmonary bypass, the heart rate and mean arterial pressure were lower in group A, and the mean pulmonary arterial pressure and the dose of vasoactive drugs were higher than those in group P (P<.001, P<.001, P=.04, and P=.02, respectively). However, there were no significant differences in the use of vasoactive-inotropic agents and hemodynamic status between the 2 groups before the end of surgery. Conclusions: In patients with LVH who undergo open-heart surgery, amiodarone can be safely used to reduce the incidence of VF, the duration of VF, the frequency of defibrillation, and the energy of defibrillation after ACC removal. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000035057; https://www.chictr.org.cn/showprojEN.html?proj=57145 ", doi="10.2196/64586", url="https://formative.jmir.org/2025/1/e64586" } @Article{info:doi/10.2196/58650, author="Bierbooms, A. Joyce J. P. and Sluis-Thiescheffer, W. Wouter R. J. and Feijt, Anne Milou and Bongers, B. Inge M.", title="Co-Design of an Escape Room for e-Mental Health Training of Mental Health Care Professionals: Research Through Design Study", journal="JMIR Form Res", year="2025", month="Jan", day="7", volume="9", pages="e58650", keywords="serious gaming", keywords="mental health care professionals", keywords="e-mental health", keywords="skill enhancement", keywords="training", abstract="Background: Many efforts to increase the uptake of e-mental health (eMH) have failed due to a lack of knowledge and skills, particularly among professionals. To train health care professionals in technology, serious gaming concepts such as educational escape rooms are increasingly used, which could also possibly be used in mental health care. However, such serious-game concepts are scarcely available for eMH training for mental health care professionals. Objective: This study aims to co-design an escape room for training mental health care professionals' eMH skills and test the escape room's usability by exploring their experiences with this concept as a training method. Methods: This project used a research through design approach with 3 design stages. In the first stage, the purpose, expectations, and storylines for the escape room were formulated in 2 co-design sessions with mental health care professionals, game designers, innovation staff, and researchers. In the second stage, the results were translated into the first escape room, which was tested in 3 sessions, including one web version of the escape room. In the third stage, the escape room was tested with mental health care professionals outside the co-design team. First, 2 test sessions took place, followed by 3 field study sessions. In the field study sessions, a questionnaire was used in combination with focus groups to assess the usability of the escape room for eMH training in practice. Results: An escape room prototype was iteratively developed and tested by the co-design team, which delivered multiple suggestions for adaptations that were assimilated in each next version of the prototype. The field study showed that the escape room creates a positive mindset toward eMH. The suitability of the escape room to explore the possibilities of eMH was rated 4.7 out of 5 by the professionals who participated in the field study. In addition, it was found to be fun and educational at the same time, scoring 4.7 (SD 0.68) on a 5-point scale. Attention should be paid to the game's complexity, credibility, and flexibility. This is important for the usefulness of the escape room in clinical practice, which was rated an average of 3.8 (SD 0.77) on a 5-point scale. Finally, implementation challenges should be addressed, including organizational policy and stimulation of eMH training. Conclusions: We can conclude that the perceived usability of an escape room for training mental health care professionals in eMH skills is promising. However, it requires additional effort to transfer the learnings into mental health care professionals' clinical practice. A straightforward implementation plan and testing the effectiveness of an escape room on skill enhancement in mental health care professionals are essential next steps to reach sustainable goals. ", doi="10.2196/58650", url="https://formative.jmir.org/2025/1/e58650" } @Article{info:doi/10.2196/57265, author="Guti{\'e}rrez-Salme{\'a}n, Gabriela and Miranda-Alatriste, Vanessa Paola and Ben{\'i}tez-Alday, Patricio and Orozco-Rivera, Enrique Luis and Islas-Vargas, Nurit and Espinosa-Cuevas, {\'A}ngeles and Correa-Rotter, Ricardo and Colin-Ramirez, Eloisa", title="Knowledge, Attitudes, and Behaviors Toward Salt Consumption and Its Association With 24-Hour Urinary Sodium and Potassium Excretion in Adults Living in Mexico City: Cross-Sectional Study", journal="Interact J Med Res", year="2024", month="Nov", day="18", volume="13", pages="e57265", keywords="beliefs", keywords="attitudes", keywords="hypertension", keywords="knowledge", keywords="salt consumption", keywords="sodium intake", keywords="potassium intake", keywords="Mexico", abstract="Background: The World Health Organization recommends a daily sodium intake of less than 2000 mg for adults; however, the Mexican population, like many others globally, consumes more sodium than this recommended amount. Excessive sodium intake is often accompanied by inadequate potassium intake. The association between knowledge, attitudes, and behaviors (KAB) and actual sodium intake has yielded mixed results across various populations. In Mexico, however, salt/sodium-related KAB and its relationship with sodium and potassium intake have not been evaluated. Objective: This study primarily aims to describe salt/sodium-related KAB in a Mexican population and, secondarily, to explore the association between KAB and 24-hour urinary sodium and potassium excretion. Methods: We conducted a cross-sectional study in an adult population from Mexico City and the surrounding metropolitan area. Self-reported KAB related to salt/sodium intake was assessed using a survey developed by the Pan American Health Organization. Anthropometric measurements were taken, and 24-hour urinary sodium and potassium excretion levels were determined. Descriptive statistics were stratified by sex and presented as means (SD) or median (25th-75th percentiles) for continuous variables, and as absolute and relative frequencies for categorical variables. The associations between KAB and sodium and potassium excretion were assessed using analysis of covariance, adjusting for age, sex, BMI, and daily energy intake as covariates, with the {\vS}id{\'a}k correction applied for multiple comparisons. Results: Overall, 232 participants were recruited (women, n=184, 79.3\%). The mean urinary sodium and potassium excretion were estimated to be 2582.5 and 1493.5 mg/day, respectively. A higher proportion of men did not know the amount of sodium they consumed compared with women (12/48, 25\%, vs 15/184, 8.2\%, P=.01). More women reported knowing that there is a recommended amount for daily sodium intake than men (46/184, 25\%, vs 10/48, 20.8\%, P=.02). Additionally, more than half of men (30/48, 62.5\%) reported never or rarely reading food labels, compared with women (96/184, 52.1\%, P=.04). Better salt/sodium-related KAB was associated with higher adjusted mean sodium and potassium excretion. For example, mean sodium excretion was 3011.5 (95\% CI 2640.1-3382.9) mg/day among participants who reported knowing the difference between salt and sodium, compared with 2592.8 (95\% CI 2417.2-2768.3) mg/day in those who reported not knowing this difference (P=.049). Similarly, potassium excretion was 1864.9 (95\% CI 1669.6-2060.3) mg/day for those who knew the difference, compared with 1512.5 (95\% CI 1420.1-1604.8) mg/day for those who did not (P=.002). Additionally, higher urinary sodium excretion was observed among participants who reported consuming too much sodium (3216.0 mg/day, 95\% CI 2867.1-3565.0 mg/day) compared with those who claimed to eat just the right amount (2584.3 mg/day, 95\% CI 2384.9-2783.7 mg/day, P=.01). Conclusions: Salt/sodium-related KAB was poor in this study sample. Moreover, KAB had a greater impact on potassium excretion than on sodium excretion, highlighting the need for more strategies to improve KAB related to salt/sodium intake. Additionally, it is important to consider other strategies aimed at modifying the sodium content of foods. ", doi="10.2196/57265", url="https://www.i-jmr.org/2024/1/e57265", url="http://www.ncbi.nlm.nih.gov/pubmed/39556832" } @Article{info:doi/10.2196/57244, author="Chen, Wanjun and Chen, Lin and Ni, Zhikan and He, Lin and Pan, Xiaohong", title="Role of HIV Serostatus Communication on Frequent HIV Testing and Self-Testing Among Men Who Have Sex With Men Who Seek Sexual Partners on the Internet in Zhejiang, China: Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Nov", day="14", volume="8", pages="e57244", keywords="human immunodeficiency virus", keywords="HIV", keywords="men who have sex with men", keywords="HIV serostatus communication", keywords="HIV testing", keywords="HIV self-testing", abstract="Background: Men who have sex with men (MSM) are increasingly using the internet to meet casual sexual partners. Those who do are at higher risk of sexually transmitted diseases. However, little is known about the rates and associations of frequent HIV testing and self-testing among such MSM. Objective: We aimed to examine HIV serostatus communication and perceptions regarding the HIV infection risk of internet-based partners, along with their associations with frequent HIV testing and self-testing. Methods: A cross-sectional study was conducted between May 2018 and April 2019 in Zhejiang Province, China. The study participants were assigned male at birth, were aged 18 years or older, had had casual sex with another male found through the internet in the last 6 months, and were HIV-negative. Information was obtained on HIV-testing behavior, along with demographic characteristics, HIV-related knowledge, internet-based behaviors, sexual behaviors with male partners, HIV serostatus communication, and perceptions regarding the HIV infection risk of internet-based partners. Uni- and multivariate logistic regression models were used to measure the associations of HIV testing and self-testing. Results: The study recruited 281 individuals who had sought casual sexual partners through the internet during the previous 6 months. Of the participants, 61.9\% (174/281) reported frequent HIV testing (twice or more frequently) and 50.9\% (119/234; 47 with missing values) reported frequent HIV self-testing. MSM who always or usually communicated about the HIV serostatus of internet-based partners in the previous 6 months had 3.12 (95\% CI 1.76-5.52) and 2.45 (95\% CI 1.42-4.22) times higher odds of being frequently tested or self-tested for HIV, respectively, compared with those who communicated about this issue minimally or not at all. Conclusions: There remains a need to improve the frequency of HIV testing and self-testing among internet-based MSM. HIV serostatus communication should be improved within the context of social networking applications to promote frequent HIV testing among internet-based MSM, especially for those who communicated about this issue minimally or not at all. ", doi="10.2196/57244", url="https://formative.jmir.org/2024/1/e57244" } @Article{info:doi/10.2196/64575, author="Brooks Carthon, Margo J. and Brom, Heather and Amenyedor, Eyram Kelvin and Harhay, O. Michael and Grantham-Murillo, Marsha and Nikpour, Jacqueline and Lasater, B. Karen and Golinelli, Daniela and Cacchione, Z. Pamela and Bettencourt, P. Amanda", title="Transitional Care Support for Medicaid-Insured Patients With Serious Mental Illness: Protocol for a Type I Hybrid Effectiveness-Implementation Stepped-Wedge Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Nov", day="12", volume="13", pages="e64575", keywords="serious mental illness", keywords="health care disparities", keywords="Medicaid", keywords="evidence-based practice", keywords="implementation science", keywords="socioeconomic disparities in health", abstract="Background: People diagnosed with a co-occurring serious mental illness (SMI; ie, major depressive disorder, bipolar disorder, or schizophrenia) but hospitalized for a nonpsychiatric condition experience higher rates of readmissions and other adverse outcomes, in part due to poorly coordinated care transitions. Current hospital-to-home transitional care programs lack a focus on the integrated social, medical, and mental health needs of these patients. The Thrive clinical pathway provides transitional care support for patients insured by Medicaid with multiple chronic conditions by focusing on posthospitalization medical concerns and the social determinants of health. This study seeks to evaluate an adapted version of Thrive that also meets the needs of patients with co-occurring SMI discharged from a nonpsychiatric hospitalization. Objective: This study aimed to (1) engage staff and community advisors in participatory implementation processes to adapt the Thrive clinical pathway for all Medicaid-insured patients, including those with SMI; (2) examine utilization outcomes (ie, Thrive referral, readmission, emergency department [ED], primary, and specialty care visits) for Medicaid-insured individuals with and without SMI who receive Thrive compared with usual care; and (3) evaluate the acceptability, appropriateness, feasibility, and cost-benefit of an adapted Thrive clinical pathway that is tailored for Medicaid-insured patients with co-occurring SMI. Methods: This study will use a prospective, type I hybrid effectiveness-implementation, stepped-wedge, cluster randomized controlled trial design. We will randomize the initiation of Thrive referrals at the unit level. Data collection will occur over 24 months. Inclusion criteria for Thrive referral include individuals who (1) are Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) reside in Philadelphia; (3) are admitted for a medical diagnosis for over 24 hours at the study hospital; (4) are planned for discharge to home; (5) agree to receive home care services; and (6) are aged ?18 years. Primary analyses will use a mixed-effects negative binomial regression model to evaluate readmission and ED utilization, comparing those with and without SMI who receive Thrive to those with and without SMI who receive usual care. Using a convergent parallel mixed methods design, analyses will be conducted simultaneously for the survey and interview data of patients, clinicians, and health care system leaders. The cost of Thrive will be calculated from budget monitoring data for the research budget, the cost of staff time, and average Medicaid facility fee payments. Results: This research project was funded in October 2023. Data collection will occur from April 2024 through December 2025. Results are anticipated to be published in 2025-2027. Conclusions: We anticipate that patients with and without co-occurring SMI will benefit from the adapted Thrive clinical pathway. We also anticipate the adapted version of Thrive to be deemed feasible, acceptable, and appropriate by patients, clinicians, and health system leaders. Trial Registration: ClinicalTrials.gov NCT06203509; https://clinicaltrials.gov/ct2/show/NCT06203509 International Registered Report Identifier (IRRID): DERR1-10.2196/64575 ", doi="10.2196/64575", url="https://www.researchprotocols.org/2024/1/e64575" } @Article{info:doi/10.2196/55643, author="Meyer, B. Kathe and Rohde, Gudrun and Frivold, Gro", title="Relatives' and Intensive Care Unit Personnel's Perspectives of Care in Organ Donation: Protocol for a Multiple Methods Study", journal="JMIR Res Protoc", year="2024", month="Nov", day="11", volume="13", pages="e55643", keywords="organ procurement", keywords="qualitative research", keywords="public health", keywords="patient-reported outcome", keywords="organ donation", keywords="organ care", keywords="perspectives", keywords="donors", keywords="intensive care personnel", keywords="Scandinavia", keywords="donor relatives", keywords="family satisfaction", keywords="descriptive analysis", keywords="comparative analysis", keywords="organ harvesting", abstract="Background: In organ donation from deceased donors, the interaction between the donor's relatives and intensive care personnel is an important factor. The organ donation (OD) process is complex, and patients' relatives play a vital role. Intensive care professionals need knowledge about how relatives perceive and experience the process to create a caring environment and support them throughout. Therefore, this collaborative project aims to explore both relatives' and intensive care personnel's perspectives of care in deceased organ donation in Scandinavia. Objective: This study aims to (1) investigate donor relatives' satisfaction and ICU personnel's perception of their own professional competence and (2) explore donor relatives' and ICU personnel's experiences in the OD process to design for care and support in OD. Methods: This protocol outlines a Scandinavian (Norway, Sweden, and Denmark) project, including 4 work packages. Work package 1 started in 2023 with the translation and validation of the Family Satisfaction in the Intensive Care Unit questionnaire into a Danish version and the translation of the Professional Competence in Organ Donation Questionnaire into a Swedish and Danish version. A cross-sectional survey measuring Scandinavian relatives' perception of support in and satisfaction with the organ donation process and a cross-sectional survey measuring Scandinavian intensive care personnel's competence in organ donation are the foundation for work package 2 (2024). The data from both surveys will be analyzed using descriptive and comparative analysis. The results will inform the interview guides in qualitative studies (work packages 3 and 4). Participants in the quantitative study will be invited to participate in in-depth interviews. In work package 3, in-depth interviews will be conducted to illuminate relatives' experiences in the organ donation process. The interviews will be analyzed using thematic analysis, according to Braun and Clarke. In work package 4 (2025-2026), 1 qualitative design study will be conducted to illuminate ICU personnel's experiences. Furthermore, the results from work packages 2 and 3 will inform the development of specific programs for care, support, and communication in the organ donation process. Results: The project was funded by the Norwegian Organ Donor Foundation in 2022 and Scandiatransplant in 2023. The Norwegian Nurses Organisation supports the project by funding a PhD student. The PhD student was employed by the University in Agder in May 2024. Conclusions: This project will provide new knowledge that will assist us in designing and establishing programs for care, support, and donor relatives' involvement in OD processes. International Registered Report Identifier (IRRID): PRR1-10.2196/55643 ", doi="10.2196/55643", url="https://www.researchprotocols.org/2024/1/e55643" } @Article{info:doi/10.2196/54792, author="Knowlden, P. Adam and Winchester, J. Lee and MacDonald, V. Hayley and Geyer, D. James and Higginbotham, C. John", title="Associations Among Cardiometabolic Risk Factors, Sleep Duration, and Obstructive Sleep Apnea in a Southeastern US Rural Community: Cross-Sectional Analysis From the SLUMBRx-PONS Study", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e54792", keywords="obstructive sleep apnea", keywords="obesity", keywords="adiposity", keywords="cardiometabolic", keywords="cardiometabolic disease", keywords="risk factors", keywords="sleep", keywords="sleep duration", keywords="sleep apnea", keywords="Short Sleep Undermines Cardiometabolic Health-Public Health Observational study", keywords="SLUMBRx study", abstract="Background: Short sleep and obstructive sleep apnea are underrecognized strains on the public health infrastructure. In the United States, over 35\% of adults report short sleep and more than 80\% of individuals with obstructive sleep apnea remain undiagnosed. The associations between inadequate sleep and cardiometabolic disease risk factors have garnered increased attention. However, challenges persist in modeling sleep-associated cardiometabolic disease risk factors. Objective: This study aimed to report early findings from the Short Sleep Undermines Cardiometabolic Health-Public Health Observational study (SLUMBRx-PONS). Methods: Data for the SLUMBRx-PONS study were collected cross-sectionally and longitudinally from a nonclinical, rural community sample (n=47) in the southeast United States. Measures included 7 consecutive nights of wrist-based actigraphy (eg, mean of 7 consecutive nights of total sleep time [TST7N]), 1 night of sleep apnea home testing (eg, apnea-hypopnea index [AHI]), and a cross-sectional clinical sample of anthropometric (eg, BMI), cardiovascular (eg, blood pressure), and blood-based biomarkers (eg, triglycerides and glucose). Correlational analyses and regression models assessed the relationships between the cardiometabolic disease risk factors and the sleep indices (eg, TST7N and AHI). Linear regression models were constructed to examine associations between significant cardiometabolic indices of TST7N (model 1) and AHI (model 2). Results: Correlational assessment in model 1 identified significant associations between TST7N and AHI (r=--0.45, P=.004), BMI (r=--0.38, P=.02), systolic blood pressure (r=0.40, P=.01), and diastolic blood pressure (r=0.32, P=.049). Pertaining to model 1, composite measures of AHI, BMI, systolic blood pressure, and diastolic blood pressure accounted for 25.1\% of the variance in TST7N (R2adjusted=0.25; F2,38=7.37; P=.002). Correlational analyses in model 2 revealed significant relationships between AHI and TST7N (r=--0.45, P<.001), BMI (r=0.71, P<.001), triglycerides (r=0.36, P=.03), and glucose (r=0.34, P=.04). Results from model 2 found that TST7N, triglycerides, and glucose accounted for 37.6\% of the variance in the composite measure of AHI and BMI (R2adjusted=0.38; F3,38=8.63; P<.001). Conclusions: Results from the SLUMBRx-PONS study highlight the complex interplay between sleep-associated risk factors for cardiometabolic disease. Early findings underscore the need for further investigations incorporating the collection of clinical, epidemiological, and ambulatory measures to inform public health, health promotion, and health education interventions addressing the cardiometabolic consequences of inadequate sleep. International Registered Report Identifier (IRRID): RR2-10.2196/27139 ", doi="10.2196/54792", url="https://formative.jmir.org/2024/1/e54792" } @Article{info:doi/10.2196/49761, author="Woolard, Alix and Paciente, Rigel and Munro, Emily and Wickens, Nicole and Wells, Gabriella and Ta, Daniel and Mandzufas, Joelie and Lombardi, Karen", title="\#TraumaTok---TikTok Videos Relating to Trauma: Content Analysis", journal="JMIR Form Res", year="2024", month="Nov", day="7", volume="8", pages="e49761", keywords="trauma", keywords="traumatic events", keywords="traumatic stress", keywords="TikTok", keywords="public health", keywords="social media", keywords="content analysis", abstract="Background: Experiencing a traumatic event can significantly impact mental and emotional well-being. Social media platforms offer spaces for sharing stories, seeking support, and accessing psychoeducation. TikTok (ByteDance), a rapidly growing social media platform, is increasingly used for advice, validation, and information, although the content of this requires further study. Research is particularly needed to better understand TikTok content relating to trauma and the potential implications for young viewers, considering the distressing nature of the subject and the possibility of users experiencing vicarious trauma through exposure to these videos. Objective: This study aims to explore the content of trauma-related videos on TikTok, focusing on hashtags related to trauma. Specifically, this study analyzes how TikTok videos present information, advice, stories, and support relating to trauma. Methods: A quantitative cross-sectional descriptive content analysis was performed on TikTok in December 2022. A total of 5 hashtags related to trauma were selected: \#trauma, \#traumatized, \#traumatok, \#traumatic, and \#traumabond, with the top 50 videos from each hashtag analyzed (total N=250 videos). A standardized codebook was developed inductively to analyze the content of the videos, while an existing generic codebook was used to collect the video features (eg, age of people in the video) and metadata (likes, comments, and shares) for each video. Results: A total of 2 major content themes were identified, which were instructional videos (54/250, 21.6\%) and videos disclosing personal stories (168/250, 67.3\%). The videos garnered significant engagement, with a total of 296.6 million likes, 2.3 million comments, and 4.6 million shares, indicating that users find this content engaging and useful. Alarmingly, only 3.7\% (9/250) of videos included a trigger warning, despite many featuring highly distressing stories that young people and those with trauma may be exposed to. Conclusions: The study highlights the potential risks of vicarious trauma due to trauma dumping without trigger warnings on TikTok, and the need for further research to assess the accuracy of advice and information in these videos. However, it also underscores the platform's potential to foster social connections, provide validation, and reduce stigma around mental health issues. Public health professionals should leverage social media to disseminate accurate mental health information, while promoting user education and content moderation to mitigate potential harms. People often use social media, such as TikTok to share advice, stories, and support around mental health, including their experiences with trauma. Out of 250 videos, most were either giving advice (54/250, 21.6\%) or sharing personal experiences (168/250, 67.3\%). The study found many videos lacked warnings about upsetting content, which could potentially harm young viewers or people suffering from trauma. While TikTok can help people feel connected and reduce the stigma around mental health, it is important to seek support from professionals when needed. ", doi="10.2196/49761", url="https://formative.jmir.org/2024/1/e49761" } @Article{info:doi/10.2196/60370, author="Hernandez, Christopher and Rowe, Christopher and Ikeda, Janet and Arenander, Justine and Santos, Glenn-Milo", title="Interest in the Use of Herbal Supplements to Close the Treatment Gap for Hazardous Alcohol Use Among Men Who Have Sex With Men: Secondary Analysis of a Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Oct", day="29", volume="8", pages="e60370", keywords="alcohol use disorder", keywords="herbal supplements", keywords="HIV", keywords="herbal", keywords="supplement", keywords="alcohol", keywords="alcoholic", keywords="alcohol use", keywords="alcohol consumption", keywords="cross-sectional study", keywords="California", keywords="USA: binge drinking", keywords="alcohol dependence", keywords="men", keywords="social", keywords="clinical", keywords="logistic regression", keywords="drinking", abstract="Background: Hazardous alcohol consumption is highly prevalent for men who have sex with men (MSM). The 4 treatments currently approved by the Food and Drug Administration for alcohol use are reaching an alarmingly low percentage of people who would benefit from a reduction in their alcohol use. There is increasing interest in alternative methods of treatment, such as herbal supplements, to address hazardous drinking. However, research on the acceptability of alternative pharmacotherapies among MSM remains limited. Objective: We examined the prevalence and correlates of expressing interest in using herbal supplements for alcohol treatment among MSM with hazardous alcohol consumption. Methods: We conducted a secondary data analysis from a cross-sectional study of MSM who use alcohol, conducted from March 2015 to July 2017 in San Francisco, California, to assess the overall prevalence of interest in using herbal supplements to help reduce alcohol consumption. Associations between expressing interest in herbal supplements and demographic, social, and clinical characteristics were examined using bivariate and multivariable logistic regression models. Results: One-third (66/200, 33\%) of the participants expressed interest in an herbal supplement for reducing alcohol consumption. In the multivariable analyses, weekly binge drinking (adjusted odds ratio [aOR] 2.85, 95\% CI 1.17-6.93), interest in abstaining from alcohol use (aOR 5.04, 95\% CI 1.46-17.40), higher severity of alcohol dependence score (aOR 1.22, 95\% CI 1.04-1.41), and interest in naltrexone (aOR 3.22, 95\% CI 2.12-4.91) were independently associated with higher odds of being interested in using an herbal supplement to reduce alcohol consumption, adjusting for age, race or ethnicity, and education. Conclusions: We found that MSM who have hazardous drinking habits, more severe alcohol dependence, and interest in pharmacotherapy were more likely to express interest in using an herbal supplement for reducing alcohol consumption. To our knowledge, this is the first study that has evaluated correlates of interest in herbal supplements for alcohol use among MSM. As researchers implement novel alcohol treatment studies, they should focus on recruitment efforts among MSM with a motivation to reduce their alcohol use patterns. ", doi="10.2196/60370", url="https://formative.jmir.org/2024/1/e60370" } @Article{info:doi/10.2196/58658, author="Stenov, Vibeke and Cleal, Bryan and Willaing, Ingrid and Christensen, Normann Jette and Jensen, Gaden Christian and Mouritsen, Drotner Julie and Due-Christensen, Mette", title="An Evidence-Based Nurse-Led Intervention to Reduce Diabetes Distress Among Adults With Type 1 Diabetes and Diabetes Distress (REDUCE): Development of a Complex Intervention Using Qualitative Methods Informed by the Medical Research Council Framework", journal="JMIR Form Res", year="2024", month="Oct", day="18", volume="8", pages="e58658", keywords="diabetes mellitus", keywords="mental health", keywords="diabetes distress", keywords="qualitative research", keywords="co-design study", keywords="complex intervention", keywords="Medical Research Council framework", abstract="Background: Diabetes distress refers to the negative emotional reaction to living with the demands of diabetes; it occurs in >40\% of adults with type 1 diabetes (T1D). However, no interventions to reduce diabetes distress are specifically designed to be an integral part of diabetes care. Objective: This study aims to modify and adapt existing evidence-based methods into a nurse-led group intervention to reduce diabetes distress among adults with T1D and moderate to severe diabetes distress. Methods: The overall framework of this study was informed by the initial phase of the Medical Research Council's complex intervention framework that focused on undertaking intervention identification and development to guide the adaptation of the intervention. This study took place at 2 specialized diabetes centers in Denmark from November 2019 to June 2021. A total of 36 adults with T1D participated in 10 parallel workshops. A total of 12 diabetes-specialized nurses were interviewed and participated in 1 cocreation workshop; 12 multidisciplinary specialists, including psychologists, educational specialists, and researchers, participated in 4 cocreation workshops and 14 feedback meetings. Data were analyzed by applying a deductive analytic approach. Results: The intervention included 5 biweekly 2.5-hour small group sessions involving adults with T1D and diabetes distress. Guided by a detailed step-by-step manual, the intervention was delivered by 2 trained diabetes specialist nurses. The intervention material included visual conversation tools covering seven diabetes-specific sources derived from the 28-item Type 1 Diabetes Distress Scale for measuring diabetes distress: (1) powerlessness, (2) self-management, (3) fear of hypoglycemia, (4) food and eating, (5) friends and family, (6) negative social perception, and (7) physician distress. The tools are designed to kick-start awareness and sharing of diabetes-specific challenges and strengths, individual reflections, as well as plenary and peer-to-peer discussions about strategies to manage diabetes distress, providing new perspectives on diabetes worries and strategies to overcome negative emotions. Diabetes specialist nurses expressed a need for a manual with descriptions of methods and detailed guidelines for using the tools. To deliver the intervention, nurses need increased knowledge about diabetes distress, how to support diabetes distress reduction, and training and supervision to improve skills. Conclusions: This co-design study describes the adaptation of a complex intervention with a strong evidence base, including detailed reporting of the theoretical underpinnings and core mechanisms. ", doi="10.2196/58658", url="https://formative.jmir.org/2024/1/e58658", url="http://www.ncbi.nlm.nih.gov/pubmed/39239797" } @Article{info:doi/10.2196/64085, author="Rajamani, Sripriya and Austin, Robin and Richwine, Chelsea and Britt-Lalich, Malin and Thakur, Madhur and Odowa, Yasmin and Jantraporn, Ratchada and Marquard, Jenna", title="Understanding Patient Portal Uses and Needs: Cross-Sectional Study in a State Fair Setting", journal="JMIR Form Res", year="2024", month="Oct", day="11", volume="8", pages="e64085", keywords="patient portals", keywords="patient engagement", keywords="health information technology", keywords="consumer health informatics", keywords="health informatics", keywords="use", keywords="online access", keywords="medical records", keywords="data access", keywords="functionality", doi="10.2196/64085", url="https://formative.jmir.org/2024/1/e64085" } @Article{info:doi/10.2196/50028, author="Thomson, D. Maria and Shahab, H. Guleer and Cooper-McGill, A. Chelsey and Sheppard, B. Vanessa and Hill, S. Sherrick and Preston, Michael and Keen II, Larry", title="Increasing Colorectal Cancer Screening Among Black Men in Virginia: Development of an mHealth Intervention", journal="JMIR Form Res", year="2024", month="Oct", day="10", volume="8", pages="e50028", keywords="colorectal cancer", keywords="cancer screening", keywords="mHealth", keywords="screening", keywords="Black men", keywords="early detection", keywords="health disparities", keywords="design thinking", abstract="Background: In the United States, colorectal cancer (CRC) is the third leading cause of cancer death among Black men. Compared to men of all other races or ethnicities, Black men have the lowest rates of CRC screening participation, which contributes to later-stage diagnoses and greater mortality. Despite CRC screening being a critical component of early detection and increased survival, few interventions have been tailored for Black men. Objective: This study aims to report on the multistep process used to translate formative research including prior experiences implementing a national CRC education program, community advisory, and preliminary survey results into a culturally tailored mobile health (mHealth) intervention. Methods: A theoretically and empirically informed translational science public health intervention was developed using the Behavioral Design Thinking approach. Data to inform how content should be tailored were collected from the empirical literature and a community advisory board of Black men (n=7) and reinforced by the preliminary results of 98 survey respondents. Results: A community advisory board identified changes for delivery that were private, self-paced, and easily accessible and content that addressed medical mistrust, access delays for referrals and appointments, lack of local information, misinformation, and the role of families. Empirical literature and survey results identified the need for local health clinic involvement as critical to screening uptake, leading to a partnership with local Federally Qualified Health Centers to connect participants directly to clinical care. Men surveyed (n=98) who live or work in the study area were an average of 59 (SD 7.9) years old and held high levels of mistrust of health care institutions. In the last 12 months, 25\% (24/98) of them did not see a doctor and 16.3\% (16/98) of them did not have a regular doctor. Regarding CRC, 27\% (26/98) and 38\% (37/98) of them had never had a colonoscopy or blood stool test, respectively. Conclusions: Working with a third-party developer, a prototype mHealth app that is downloadable, optimized for iPhone and Android users, and uses familiar sharing, video, and text messaging modalities was created. Guided by our results, we created 4 short videos (1:30-2 min) including a survivor vignette, animated videos about CRC and the type of screening tests, and a message from a community clinic partner. Men also receive tailored feedback and direct navigation to local Federally Qualified Health Center partners including via school-based family clinics. These content and delivery elements of the mHealth intervention were the direct result of the multipronged, theoretically informed approach to translate an existing but generalized CRC knowledge--based intervention into a digital, self-paced, tailored intervention with links to local community clinics. Trial Registration: ClinicalTrials.gov NCT05980182; https://clinicaltrials.gov/study/NCT05980182 ", doi="10.2196/50028", url="https://formative.jmir.org/2024/1/e50028" } @Article{info:doi/10.2196/60858, author="Chandrashekar, BS and Lobo, Clement Oliver and Fusco, Irene and Madeddu, Francesca and Zingoni, Tiziano", title="Effectiveness of 675-nm Wavelength Laser Therapy in the Treatment of Androgenetic Alopecia Among Indian Patients: Clinical Experimental Study", journal="JMIR Dermatol", year="2024", month="Sep", day="23", volume="7", pages="e60858", keywords="androgenetic alopecia", keywords="AGA", keywords="675-nm laser", keywords="Indian patients", keywords="hair restoration", keywords="effectiveness", keywords="laser therapy", keywords="therapy", keywords="treatment", keywords="Indian", keywords="patients", keywords="patient", keywords="India", keywords="hair loss", keywords="hair", keywords="laser stimulation", keywords="hair density", abstract="Background: Androgenetic alopecia (AGA) is the most prevalent cause of hair loss around the world. Objective: The purpose of this study was to evaluate the efficacy of laser stimulation with a 675-nm wavelength for the treatment of AGA in male and female Indian patients. Methods: A total of 20 Indian healthy patients aged 23-57 years who presented a grade of alopecia stage I to stage V underwent one single pass with a 675-nm laser to the scalp area twice a week for a total of 8 sessions, followed by once a week for 4 sessions and once in 2 weeks for 2 sessions. There are 14 laser treatments in total. Macro- and dermatoscopic images have been acquired at T0 (baseline) and T1 (4 months). The vertex, frontal, and parietal areas of the scalp were evaluated. Many parameters were analyzed including hair count and hair density of terminal; mean thickness; vellus follicles; total follicular units; units with 1 hair, 2 hairs, 3 hairs, 4 hairs, and >4 hairs; unit density; and average hair/unit. Results: The macroimages and dermatoscopic evaluations showed good improvement over the entire treated area, with a clear increase in the number of hairs and hair thickness. General parameters such as hair count and hair density showed a percentage increase of around 17\%. The hair mean thickness parameters showed a significant (P<.001) percentage increase of 13.91\%. Similar results were obtained for terminal and vellus hair: terminal hair count and hair density significantly (P=.04 and P=.01, respectively) increased by 17.45\%, vellus hair count increased by 16.67\% (P=.06), and the density of vellus hair increased by 16.61\% (P=.06). Conclusions: The study findings demonstrate that the 675-nm laser system improved AGA in Indian patients, facilitating the anagen phase and improving hair density and other positive hair parameters. ", doi="10.2196/60858", url="https://derma.jmir.org/2024/1/e60858" } @Article{info:doi/10.2196/57384, author="Aggarwal, Sumit and Simmy, Simmy and Mahajan, Nupur and Nigam, Kuldeep", title="Challenges Experienced by Health Care Workers During Service Delivery in the Geographically Challenging Terrains of North-East India: Study Involving a Thematic Analysis", journal="JMIR Form Res", year="2024", month="Sep", day="10", volume="8", pages="e57384", keywords="challenges", keywords="thematic analysis", keywords="infrastructure", keywords="communication", keywords="supply distribution", keywords="resilience", keywords="adaptability", keywords="vaccination awareness", keywords="innovative solutions", abstract="Background: The public health landscape in North-East India is marked by the foundational principle of equitable health care provision, a critical endeavor considering the region's intricate geography and proximity to international borders. Health care workers grapple with challenges, such as treacherous routes, limited infrastructure, and diverse cultural nuances, when delivering essential medical services. Despite improvements since the National Rural Health Mission in 2005, challenges persist, prompting a study to identify health care workers' challenges and alternative strategies in Manipur and Nagaland. Objective: This study aims to document the challenges experienced by health care workers during service delivery in the geographically challenging terrains of North-East India. Methods: This study is part of the i-DRONE (Indian Council of Medical Research's Drone Response and Outreach for North East) project, which aims to assess the feasibility of drone-mediated vaccine and medical delivery. This study addresses the secondary objective of the i-DRONE project. In-depth interviews of 29 health care workers were conducted using semistructured questionnaires in 5 districts (Mokokchung and Tuensang in Nagaland, and Imphal West, Bishnupur, and Churachandpur in Manipur). Nineteen health facilities, including primary health care centers, community health centers, and district hospitals, were selected. The study considered all levels of health care professionals who were in active employment for the past 6 months without a significant vacation and those who were engaged in ground-level implementation, policy, and maintenance activities. Data were recorded, transcribed, and translated, and subsequently, codes, themes, and subthemes were developed using NVivo 14 (QSR International) for thematic analysis. Results: Five themes were generated from the data: (1) general challenges (challenges due to being an international borderline district, human resource constraints, logistical challenges for medical supply, infrastructural issues, and transportation challenges); (2) challenges during the COVID-19 pandemic (increased workload, lack of diagnostic centers, mental health challenges and family issues, routine health care facilities affected, stigma and fear of infection, and vaccine hesitancy and misinformation); (3) perception and awareness regarding COVID-19 vaccination; (4) alternative actions or strategies adopted by health care workers to address the challenges; and (5) suggestions provided by health care workers. Health care workers demonstrated adaptability by overcoming these challenges and provided suggestions for addressing these challenges in the future. Conclusions: Health care workers in Manipur and Nagaland have shown remarkable resilience in the face of numerous challenges exacerbated by the pandemic. Despite infrastructural limitations, communication barriers, and inadequate medical supply distribution in remote areas, they have demonstrated adaptability through innovative solutions like efficient data management, vaccination awareness campaigns, and leveraging technology for improved care delivery. The findings are pertinent for not only health care practitioners and policymakers but also the broader scientific and public health communities. However, the findings may have limited generalizability beyond Manipur and Nagaland. ", doi="10.2196/57384", url="https://formative.jmir.org/2024/1/e57384", url="http://www.ncbi.nlm.nih.gov/pubmed/39255009" } @Article{info:doi/10.2196/56402, author="Darnell, Doyanne and Pierson, Andria and Tanana, J. Michael and Dorsey, Shannon and Boudreaux, D. Edwin and Are{\'a}n, A. Patricia and Comtois, Anne Katherine", title="Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospital Patients: Formative Acceptability Evaluation of an eLearning Continuing Education Training", journal="JMIR Form Res", year="2024", month="Sep", day="6", volume="8", pages="e56402", keywords="suicide prevention", keywords="hospital", keywords="training", keywords="e-learning", keywords="artificial intelligence", keywords="AI", keywords="task-shifting", keywords="quality assessment", keywords="fidelity", keywords="acceptability", keywords="feasibility", keywords="eLearning", keywords="suicide", keywords="quality", keywords="innovative", keywords="nurse", keywords="education training", keywords="safety planning", keywords="pilot study", keywords="virtual patient", keywords="web-based", keywords="role-play", keywords="microcounseling skills", keywords="United States", abstract="Background: Suicide is the 12th leading cause of death in the United States. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill building are resource intensive and difficult to implement. Novel computer technologies harnessing artificial intelligence are now available, which hold promise for increasing the feasibility of providing trainees opportunities across a range of continuing education contexts to engage in skills practice with constructive feedback on performance. Objective: This pilot study aims to evaluate the feasibility and acceptability of an eLearning training in suicide safety planning among nurses serving patients admitted to a US level 1 trauma center for acute or intensive care. The training included a didactic portion with demonstration, practice of microcounseling skills with a web-based virtual patient (Client Bot Emily), role-play with a patient actor, and automated coding and feedback on general counseling skills based on the role-play via a web-based platform (Lyssn Advisor). Secondarily, we examined learning outcomes of knowledge, confidence, and skills in suicide safety planning descriptively. Methods: Acute and intensive care nurses were recruited between November 1, 2021, and May 31, 2022, to participate in a formative evaluation using pretraining, posttraining, and 6-month follow-up surveys, as well as observation of the nurses' performance in delivering suicide safety planning via standardized patient role-plays over 6 months and rated using the Safety Plan Intervention Rating Scale. Nurses completed the System Usability Scale after interacting with Client Bot Emily and reviewing general counseling scores based on their role-play via Lyssn Advisor. Results: A total of 18 nurses participated in the study; the majority identified as female (n=17, 94\%) and White (n=13, 72\%). Of the 17 nurses who started the training, 82\% (n=14) completed it. On average, the System Usability Scale score for Client Bot Emily was 70.3 (SD 19.7) and for Lyssn Advisor was 65.4 (SD 16.3). On average, nurses endorsed a good bit of knowledge (mean 3.1, SD 0.5) and confidence (mean 2.9, SD 0.5) after the training. After completing the training, none of the nurses scored above the expert-derived cutoff for proficiency on the Safety Plan Intervention Rating Scale (?14); however, on average, nurses were above the cutoffs for general counseling skills per Lyssn Advisor (empathy: mean 4.1, SD 0.6; collaboration: mean 3.6, SD 0.7). Conclusions: Findings suggest the completion of the training activities and use of novel technologies within this context are feasible. Technologic modifications may enhance the training acceptability and utility, such as increasing the virtual patient conversational abilities and adding automated coding capability for specific suicide safety planning skills. International Registered Report Identifier (IRRID): RR2-10.2196/33695 ", doi="10.2196/56402", url="https://formative.jmir.org/2024/1/e56402" } @Article{info:doi/10.2196/55797, author="Vargas Meza, Xanat and Oikawa, Masanori", title="Japanese Perception of Organ Donation and Implications for New Medical Technologies: Quantitative and Qualitative Social Media Analyses", journal="JMIR Form Res", year="2024", month="Jul", day="19", volume="8", pages="e55797", keywords="Japan", keywords="organ donation", keywords="social media", keywords="multidimensional analysis", keywords="Twitter/X", keywords="YouTube", abstract="Background: The Rapid Autopsy Program (RAP) is a valuable procedure for studying human biology and diseases such as cancer. However, implementing the RAP in Japan necessitates a thorough understanding of concepts such as good death and the integration of sociocultural aspects. By revising perceptions of organ donation on social media, we bring attention to the challenges associated with implementing new medical research procedures such as the RAP. Objective: This study aims to examine YouTube and Twitter/X to identify stakeholders, evaluate the quality of organ donation communication, and analyze sociocultural aspects associated with organ donation. Based on our findings, we propose recommendations for the implementation of new medical research procedures. Methods: Using the term ``????'' (organ donation), we collected data from YouTube and Twitter/X, categorizing them into 5 dimensions: time, individuality, place, activity, and relationships. We utilized a scale to evaluate the quality of organ donation information and categorized YouTube videos into 3 groups to analyze their differences using statistical methods. Additionally, we conducted a text-based analysis to explore narratives associated with organ donation. Results: Most YouTube videos were uploaded in 2021 (189/638, 29.6\%) and 2022 (165/638, 25.9\%), while tweets about organ donation peaked between 2019 and 2022. Citizens (184/770, 23.9\%), media (170/770, 22.0\%), and unknown actors (121/770, 15.7\%) were the primary uploaders of videos on organ donation. In a sample of average retweeted and liked tweets, citizens accounted for the majority of identified users (64/91, 70\%, and 65/95, 68\%, respectively). Regarding Japanese regions, there were numerous information videos about organ donation in Hokkaido (F2.46,147.74=--5.28, P=.005) and Kyushu and Okinawa (F2.46,147.74=--5.28, P=.005). On Twitter/X, Japan and China were the most frequently mentioned countries in relation to organ donation discussions. Information videos often focused on themes such as borrowed life and calls to register as donors, whereas videos categorized as no information and misinformation frequently included accusations of organ trafficking, often propagated by Chinese-American media. Tweets primarily centered around statements of donation intention and discussions about family consent. The majority of video hyperlinks directed users to YouTube and Twitter/X platforms, while Twitter/X hyperlinks predominantly led to news reports from Japanese media outlets. Conclusions: There is significant potential to implement new medical research procedures such as the RAP in Japan. Recommendations include conceptualizing research data as borrowed data, implementing horizontally diversified management of donation programs, and addressing issues related to science misinformation and popular culture trends. ", doi="10.2196/55797", url="https://formative.jmir.org/2024/1/e55797", url="http://www.ncbi.nlm.nih.gov/pubmed/39028549" } @Article{info:doi/10.2196/48434, author="Bray, Riina and Wang, Yifan and Argiropoulos, Nikolas and Robins, Stephanie and Molot, John and Pigeon, Marie-Andr{\'e}e and Gaudet, Michel and Auger, Pierre and B{\'e}langer, Emilie and Peris, Rohini", title="The Impact of COVID-19 Health Measures on Adults With Multiple Chemical Sensitivity: Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Jul", day="17", volume="8", pages="e48434", keywords="COVID-19", keywords="multiple chemical sensitivity", keywords="Canada", keywords="accessibility", keywords="social isolation", keywords="physical environment", keywords="health care", keywords="air pollution", keywords="pollution", keywords="air quality", keywords="isolation", keywords="social network", keywords="social interaction", keywords="lived experience", keywords="sensitivity", keywords="environment", keywords="environmental", abstract="Background: Multiple chemical sensitivity (MCS) develops in response to repeated small-level chemical exposures or a major exposure in a subset of people, who then experience symptoms that can range from mild to debilitating when exposed to chemicals. The arrival of the COVID-19 pandemic and the stringent health measures put in place may have increased the burden for those living with MCS, as it became more challenging to avoid chemicals that trigger their condition. Objective: This study aimed to better understand the lived experience of Canadians living with MCS during the first year of the COVID-19 pandemic. Methods: An online questionnaire was created to ask participants to compare daily living during the pandemic to before March 11, 2020. Data were collected in January and February 2021. Three areas were investigated: (1) environmental exposures to chemical triggers from ambient air (pollution from industry, farming, and traffic) and indoor air (the smell of cleaning products, cooking odors, and smoke); (2) access to, and satisfaction with, health care visits; and (3) how people experiencing MCS rated contact with their social network. Results: In all, 119 Canadians who had lived with MCS for more than a year completed the questionnaire. The participant sample was mostly female (86.6\%, n=103) and highly educated, with 57.1\% (n=68) having a university degree. Slightly more than half (57.1\%, n=68) were older than 55 years. McNemar chi-square and Wilcoxon signed rank tests were used to evaluate if there were statistically significant changes before (``prepandemic period'') and after (``postpandemic period'') March 11, 2020. Perceived exposure to pollution from a highway or a road was significantly decreased from the prepandemic to postpandemic period (z=--3.347; P<.001). Analysis of industry or power plants also suggested a significant decrease in the perceived exposure from the prepandemic to postpandemic period (z=--2.152; P=.04). Participants reported an increase in exposure to odors from disinfectants or sanitizers that entered their living environment (P<.001). There was a significant decrease between prepandemic and postpandemic levels of satisfaction when attending in-person meetings with a physician (z=--2.048; P=.04), yet there were no significant differences between prepandemic and postpandemic levels of satisfaction for online or telephone meetings with a physician. Although people with MCS experienced increased social isolation (P<.001), they also reported an increase in understanding from family (P=.03) and a decrease in stigma for wearing personal protective equipment (P<.001). Conclusions: During the first year of the COVID-19 pandemic, people with MCS were impacted by inaccessibility, loss of social support, and barriers to accessing health care. This study highlights unique challenges and possible benefits associated with the COVID-19 pandemic public health measures for individuals living with MCS. These findings can guide decision makers to improve policies on accessibility through appropriate accommodation measures. ", doi="10.2196/48434", url="https://formative.jmir.org/2024/1/e48434" } @Article{info:doi/10.2196/56716, author="Belanger, Christopher and Peixoto, Cayden and Francoeur, Sara and Bjerre, M. Lise", title="Patient and Provider Satisfaction With a Geomapping Tool for Finding Community Family Physicians in Ontario, Canada: Cross-Sectional Online Survey Study", journal="JMIR Form Res", year="2024", month="Jul", day="9", volume="8", pages="e56716", keywords="primary care", keywords="language-concordant care", keywords="web-based maps", keywords="maps", keywords="physicians", keywords="experience", keywords="language", keywords="access", keywords="accessibility", abstract="Background: Language-concordant health care, or health care in a patient's language of choice, is an important element of health accessibility that improves patient safety and comfort and facilitates an increased quality of care. However, prior research has found that linguistic minorities often face higher travel burdens to access language-concordant care compared to the general population. Objective: This study intended to assess patient experiences and satisfaction with an online interactive physician map that allows patients to find family physicians who speak their preferred language in and around Ottawa, Ontario, Canada, as a means of identifying areas of improvement. Methods: This study used an online survey with questions related to user satisfaction. Responses to Likert-scale questions were compiled as summary statistics and short-answer responses underwent thematic analysis. The study setting was Ottawa and Renfrew County, Ontario, and the surrounding region, including the province of Quebec. Results: A total of 93 respondents completed the survey and self-identified as living in Ontario or Quebec. Overall, 57 (61\%) respondents were ``very satisfied'' or ``somewhat satisfied'' with the map, 16 (17\%) were ``neither satisfied nor dissatisfied,'' and 20 (22\%) were ``very dissatisfied'' or ``somewhat dissatisfied.'' We found no significant differences in satisfaction by preferred language, age group, physician attachment, or intended beneficiary. A total of 56 respondents provided short-answer responses to an open-ended question about map improvements. The most common specific suggestion was to show which physicians are accepting new patients (n=20). Other suggestions included data refreshes (n=6), user interface adjustments (n=23), and additional languages (n=2). Some participants also provided positive feedback (n=5) or expressed concern with their inability to find a family physician (n=5). Several comments included multiple suggestions. Conclusions: While most patients were satisfied with the online map, a significant minority expressed dissatisfaction that the map did not show which family physicians were accepting new patients. This suggests that there may be public interest in an accessible database of which family physicians in Ontario are currently accepting new patients. ", doi="10.2196/56716", url="https://formative.jmir.org/2024/1/e56716", url="http://www.ncbi.nlm.nih.gov/pubmed/38980717" } @Article{info:doi/10.2196/46570, author="Krarup, Bygum Kasper and Riis, Johannes and M{\o}rk, Morten and Nguyen, Thu Hien Thi and S{\o}kilde Pedersen, Inge and Risom Kristensen, S{\o}ren and Handberg, Aase and Krarup, Bygum Henrik", title="Biochemical Changes in Adult Male Gamers During Prolonged Gaming: Pilot Study", journal="Interact J Med Res", year="2024", month="Jul", day="8", volume="13", pages="e46570", keywords="long gaming sessions", keywords="local area network party", keywords="biochemistry", keywords="cortisol", keywords="glucose", keywords="gaming", keywords="biochemical", keywords="blood sample", keywords="hematology", keywords="hematological", keywords="games", keywords="gamers", keywords="hemoglobin", keywords="adults", keywords="males", keywords="men", keywords="blood", abstract="Background: Gaming has become an integrated part of life for children and adults worldwide. Previous studies on the impact of gaming on biochemical parameters have primarily addressed the acute effects of gaming. The literature is limited, and the study designs are very diverse. The parameters that have been investigated most thoroughly are blood glucose and cortisol. Objective: This exploratory study is the first to investigate the effects of long gaming sessions on the biochemical parameters of healthy male adults. The extensive testing allowed us to observe short-term changes (within 6 hours), long-term changes during the duration of the gaming sessions, and follow-up after 1 week to determine whether any changes were longer lasting. Methods: In total, 9 experienced gamers completed 2 back-to-back 18-hour gaming sessions interspersed with a 6-hour rest period. All participants adhered to a structured sleep pattern due to daytime employment or attending university. Blood, saliva, and urine samples were collected from the participants every 6 hours. Linear mixed-effect models were used to analyze the repeated-measures data accumulated during the study. A total of 51 biochemical parameters were investigated. Results: In total, 12 of the 51 biochemical parameters significantly changed during the study: alkaline phosphatase, aspartate aminotransferase, bilirubin, chloride, creatinine, glucose, hemoglobin, immature reticulocyte fraction, lactate, methemoglobin, sodium, and thrombocytes. All changes were within the normal range. The mean glucose level of the participants was 4.39 (SD 0.07) mmol/L at baseline, which increased significantly by 0.24 (SD 0.07) mmol/L per 6 hours during the first period and by 0.38 (SD 0.07) mmol/L per 6 hours in the second period (P<.001). The glucose levels during the second session increased even though the participants had little energy intake. Cortisol levels did not change significantly, although the cortisol pattern deviated from the typical circadian rhythm. During both gaming sessions, we observed increasing cortisol levels from 6 AM until noon. The participants were relatively dehydrated at the start of the study. The patients were asked to fast before the first blood sampling. Within the first 6 hours of the study, the participants rehydrated, followed by relative dehydration during the remainder of the study. This pattern was identified using the following parameters: albumin, creatinine, hemoglobin, erythrocytes, potassium, and platelets. Conclusions: This study is the first of its kind, and many of the analyses in the study yielded novel results. The study was designed to emulate the behavior of gamers during the weekend and other long gaming sessions. At this point, we are not able to determine the difference between the effects of gaming and behavior during gaming. Regardless, the results of this study suggest that healthy gamers can partake in long gaming sessions, with ample amounts of unhealthy foods and little rest, without acute impacts on health. ", doi="10.2196/46570", url="https://www.i-jmr.org/2024/1/e46570", url="http://www.ncbi.nlm.nih.gov/pubmed/38976326" } @Article{info:doi/10.2196/52779, author="Polfuss, Michele and Smith, Kathryn and Hopson, Betsy and Moosreiner, Andrea and Huang, Chiang-Ching and Ravelli, N. Michele and Ding, Dan and Huang, Zijian and Rocque, G. Brandon and White-Traut, Rosemary and Van Speybroeck, Alexander and Sawin, J. Kathleen", title="Body Composition and Energy Expenditure in Youth With Spina Bifida: Protocol for a Multisite, Cross-Sectional Study", journal="JMIR Res Protoc", year="2024", month="Jul", day="2", volume="13", pages="e52779", keywords="obesity", keywords="overweight", keywords="body composition", keywords="energy expenditure", keywords="doubly labeled water", keywords="spina bifida", keywords="children", keywords="adolescents", keywords="wearable device", abstract="Background: Obesity prevalence in youth with spina bifida is higher than in their typically developing peers. Obesity is associated with lifelong medical, psychological, and economic burdens. Successful prevention or treatment of obesity in individuals with spina bifida is compromised by (1) the lack of valid and reliable methods to identify body fat in a clinical setting and (2) limited data on energy expenditure that are necessary to provide daily caloric recommendations. Objective: The objectives of this study will be to develop 2 algorithms for use in youth with spina bifida in a clinical setting, one to model body fat and one to predict total daily energy expenditure. In addition, physical activity and dietary intake will be described for the sample. Methods: This multisite, prospective, national clinical study will enroll 232 youth with myelomeningocele aged 5 to 18 years (stratified by age and mobility). Participants will be enrolled for 1 week. Data obtained include 4 measures of body composition, up to 5 height measures, a ramped activity protocol, and a nutrition and physical activity screener. Participants will wear an accelerometer for the week. On the final study day, 2 samples of urine or saliva, which complete the doubly labeled water protocol, will be obtained. The analysis will include descriptive statistics, Bland-Altman plots, concordance correlation, and regression analysis. Results: The study received extramural federal funding in July 2019. Data collection was initiated in March 2020. As of April 2024, a total of 143 (female participants: n=76, 53.1\%; male participants: n=67, 46.9\%) out of 232 participants have been enrolled. Data collection is expected to continue throughout 2024. A no-cost extension until November 2025 will be requested for data analysis and dissemination of findings. Conclusions: This study furthers previous pilot work that confirmed the acceptability and feasibility of obtaining alternate height, body composition, and energy expenditure measures. The findings from this study will enhance screening, prevention, and treatment of abnormal weight status by facilitating the accurate identification of youths' weight status category and recommendations of daily caloric needs for this population that is at higher risk of obesity. Furthermore, the findings have the potential to impact outcomes for youth diagnosed with disabilities other than spina bifida who experience similar challenges related to alterations in body composition or fat distribution or measurement challenges secondary to mobility issues or musculoskeletal problems. International Registered Report Identifier (IRRID): DERR1-10.2196/52779 ", doi="10.2196/52779", url="https://www.researchprotocols.org/2024/1/e52779" } @Article{info:doi/10.2196/13642, author="Dogaru, Emanuel Dumitru and Rosu, Serban and Barattini, Franco Dionisio and Guadagna, Simone and Barattini, Luca and Andor, Bogdan", title="Assessment of the Feasibility of Objective Parameters as Primary End Points for Patients Affected by Knee Osteoarthritis: Protocol for a Pilot, Open Noncontrolled Trial (:SMILE:)", journal="JMIR Res Protoc", year="2024", month="Jun", day="28", volume="13", pages="e13642", keywords="pilot trial", keywords="feasibility study", keywords="knee osteoarthritis", keywords="hyaluronic acid", keywords="outcome assessment", keywords="osteoarthritis", keywords="ultrasonography", keywords="knee", keywords="pain", abstract="Background: Osteoarthritis (OA) is a disabling condition that affects more than one-third of people older than 65 years. Currently, 80\% of these patients report movement limitations, 20\% are unable to perform major activities of daily living, and approximately 11\% require personal care. In 2014, the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) recommended, as the first step in the pharmacological treatment of knee osteoarthritis, a background therapy with chronic symptomatic slow-acting osteoarthritic drugs such as glucosamine sulfate, chondroitin sulfate, and hyaluronic acid. The latter has been extensively evaluated in clinical trials as intra-articular and oral administration. Recent reviews have shown that studies on oral hyaluronic acid generally measure symptoms using only subjective parameters, such as visual analog scales or quality of life questionnaires. As a result, objective measures are lacking, and data validity is generally impaired. Objective: The main goal of this pilot study with oral hyaluronic acid is to evaluate the feasibility of using objective tools as outcomes to evaluate improvements in knee mobility. We propose ultrasound and range of motion measurements with a goniometer that could objectively correlate changes in joint mobility with pain reduction, as assessed by the visual analog scale. The secondary objective is to collect data to estimate the time and budget for the main double-blind study randomized trial. These data may be quantitative (such as enrollment rate per month, number of screening failures, and new potential outcomes) and qualitative (such as site logistical issues, patient reluctance to enroll, and interpersonal difficulties for investigators). Methods: This open-label pilot and feasibility study is conducted in an orthopedic clinic (Timisoara, Romania). The study includes male and female participants, aged 50-70 years, who have been diagnosed with symptomatic knee OA and have experienced mild joint discomfort for at least 6 months. Eight patients must be enrolled and treated with Syalox 300 Plus (River Pharma) for 8 weeks. It is a dietary supplement containing high-molecular-weight hyaluronic acid, which has already been marketed in several European countries. Assessments are made at the baseline and final visits. Results: Recruitment and treatment of the 8 patients began on February 15, 2018, and was completed on May 25, 2018. Data analysis was planned to be completed by the end of 2018. The study was funded in February 2019. We expect the results to be published in a peer-reviewed clinical journal in the last quarter of 2024. Conclusions: The data from this pilot study will be used to assess the feasibility of a future randomized clinical trial in OA. In particular, the planned outcomes (eg, ultrasound and range of motion), safety, and quantitative and qualitative data must be evaluated to estimate in advance the time and budget required for the future main study. Finally, the pilot study should provide preliminary information on the efficacy of the investigational product. Trial Registration: ClinicalTrials.gov NCT03421054; https://clinicaltrials.gov/study/NCT03421054 International Registered Report Identifier (IRRID): RR1-10.2196/13642 ", doi="10.2196/13642", url="https://www.researchprotocols.org/2024/1/e13642" } @Article{info:doi/10.2196/54970, author="Mahanani, Srinalesti and Kertia, Nyoman and Madyaningrum, Ema", title="Combination of Curcuminoids and Acupressure for Inflammation and Pain in Older People with Osteoarthritis Genu: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Jun", day="24", volume="13", pages="e54970", keywords="osteoarthritis", keywords="acupressure", keywords="curcuminoids", keywords="endorphins", keywords="biomarkers", keywords="genu", keywords="older people", keywords="randomized controlled trial", abstract="Background: Curcuminoids and acupressure have beneficial effects in reducing pain and inflammation in patients with osteoarthritis. However, only a few clinical trials are investigating biomarkers to prove this objectively. Objective: This study aims to investigate the effect of acupressure and curcuminoids on inflammatory markers and pain in older people with osteoarthritis genu. Methods: A randomized controlled trial (RCT) was conducted among older people with osteoarthritis. All participants were randomized to a group that received 30 mg of curcuminoids in turmeric extract capsules and acupressure (group 1) or a group that received a placebo and sham acupressure (group 2) for 3 weeks. Results: The study was approved by the research ethics board; ClinicalTrials.gov reviewed this protocol. The extracts were manufactured from May 2023 to June 2023. Participant recruitment was conducted in September and October 2023; a total of 72 participants aged 60 years or older participated, of whom 75\% (n=54) were female. Data were analyzed in April 2024, and dissemination of results is expected by the end of 2024. Conclusions: Primary outcomes were assessed at baseline and after the intervention. Relationships were assessed with inflammatory markers, endorphin hormones, and blood level of cycloxygenase-2 hormone. Additionally, secondary outcomes included pain, ability to perform activities of daily living, and quality of life. The beneficial effects that may be found in this trial may be exceptionally relevant in clinical practice, justifying this scientific inquiry. The benefits of herbs and acupressure can be helpful as additional options in treating inflammation and pain in patients with osteoarthritis. Trial Registration: ClinicalTrials.gov NCT06105840; https://clinicaltrials.gov/study/NCT06105840 International Registered Report Identifier (IRRID): DERR1-10.2196/54970 ", doi="10.2196/54970", url="https://www.researchprotocols.org/2024/1/e54970", url="http://www.ncbi.nlm.nih.gov/pubmed/38771152" } @Article{info:doi/10.2196/56484, author="Wu, Mingli and Chen, Lulu and Wang, Yamin and Li, Yunpeng and An, Yuqi and Wu, Ruonan and Zhang, Yuhan and Gao, Jing and Su, Kaiqi and Feng, Xiaodong", title="The Effect of Acupuncture on Brain Iron Deposition and Body Iron Metabolism in Vascular Cognitive Impairment: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Jun", day="17", volume="13", pages="e56484", keywords="acupuncture", keywords="vascular cognitive impairment", keywords="iron metabolism", keywords="mechanisms explored", keywords="clinical trial", keywords="needling technique", keywords="dry needling", keywords="acupunctures", keywords="activities of daily living", keywords="iron", keywords="prevalence", keywords="cerebrovascular diseases", keywords="vascular dementia", keywords="vascular", keywords="traditional Chinese method", keywords="Chinese methods", abstract="Background: Vascular cognitive impairment (VCI) persistently impairs cognition and the ability to perform activities of daily living, seriously compromising patients' quality of life. Previous studies have reported that disorders of serum iron metabolism and iron deposition in the brain can lead to inflammation, abnormal protein aggregation and degeneration, and massive neuronal apoptosis in the central nervous system, which in turn leads to a progressive decline in cognitive processes. Our previous clinical studies have found acupuncture to be a safe and effective intervention for treating VCI, but the specific mechanisms require further exploration. Objective: The objective of the trial is to evaluate the clinical efficacy of Tongdu Xingshen acupuncture and to investigate whether it can improve VCI by regulating brain iron deposition and body iron metabolism. Methods: In total, 42 patients with VCI and 21 healthy individuals will participate in this clinical trial. The 42 patients with VCI will be randomized into acupuncture and control groups, while the 21 healthy individuals will be in the healthy control group. Both the control and acupuncture groups will receive conventional medical treatment and cognitive rehabilitation training. In addition, the acupuncture group will receive electroacupuncture treatment with Tongdu Xingshen for 30 minutes each time, 6 times a week for 4 weeks. Meanwhile, the healthy control group will not receive any intervention. All 3 groups will undergo baseline assessments of brain iron deposition, serum iron metabolism, and neuropsychological tests after enrollment. The acupuncture and control groups will be evaluated again at the end of 4 weeks of treatment, as described earlier. By comparing neuropsychological test scores between groups, we will examine the efficacy of Tongdu Xingshen acupuncture in treating VCI. Additionally, we will test the correlations between neuropsychological test scores, brain iron deposition, and body iron metabolism indexes to explore the possible mechanisms of Tongdu Xingshen acupuncture in treating VCI. Results: Participants are currently being recruited. The first participant was enrolled in June 2023, which marked the official start of the experiment. As of the submission of the paper, there were 23 participants. The recruitment process is expected to continue until June 2025, at which point the processing and analysis of data will begin. As of May 15, 2024, up to 30 people have been enrolled in this clinical trial. Conclusions: This study will provide data on the effects of Tongdu Xingshen acupuncture on cerebral iron deposition as well as somatic iron metabolism in patients with VCI. These results will help to prove whether Tongdu Xingshen acupuncture can improve VCI by regulating brain iron deposition and body iron metabolism, which will provide the clinical and theoretical basis for the wide application of acupuncture therapy in VCI rehabilitation. Trial Registration: China Clinical Registration Agency ChiCTR2300072188; https://tinyurl.com/5fcydtkv International Registered Report Identifier (IRRID): PRR1-10.2196/56484 ", doi="10.2196/56484", url="https://www.researchprotocols.org/2024/1/e56484", url="http://www.ncbi.nlm.nih.gov/pubmed/38885500" } TY - JOUR AU - Wijekoon, Ashan AU - Gamage Dona, Dilanthi AU - Jayawardana, Subashini AU - Beane, Abigail PY - 2024/6/13 TI - Quality of Life, Physical Activity Participation, and Perceptions of Physical Rehabilitation Among Community-Reintegrated Veterans With Lower Limb Amputation in Sri Lanka: Convergent Parallel Mixed Methods Study JO - JMIR Rehabil Assist Technol SP - e52811 VL - 11 KW - amputation KW - community-based rehabilitation KW - lower limb KW - military KW - physical activity KW - quality of life N2 - Background: Lower limb amputation (LLA) impacts physical activity (PA) participation and quality of life (QoL). To minimize the effects of these challenges, LLA survivors need to have opportunities to engage in appropriately tailored rehabilitation throughout their lives. However, in Sri Lanka, where a 3-decade civil war resulted in trauma-related LLA among young male soldiers, access to rehabilitation was limited to the immediate postinjury period. Developing rehabilitation interventions for these veterans requires an understanding of their current health status and rehabilitation perceptions. Objective: This study was conducted to evaluate the QoL and PA participation of veterans with LLA and explore perceptions of factors influencing their PA participation and expectations for a future community-based physical rehabilitation (CBPR) intervention. Methods: This mixed methods study combined a comparative cross-sectional quantitative survey with qualitative semistructured interviews in 5 districts of Sri Lanka. QoL and PA participation were assessed among community-reintegrated veterans with LLA (n=85) and compared with a matched able-bodied cohort (control; n=85) using Mann-Whitney U and Chi-square tests. PA was assessed in terms of metabolic equivalent of task (MET) minutes per week and was computed for walking, moderate-intensity, and vigorous-intensity activities. PA was classified as sufficiently active, low, or sedentary. The design of interview questions was guided by the Theoretical Domains Framework and followed a phenomenological approach. Interviews were conducted with 25 veterans and were analyzed thematically, and the perceptions regarding PA participation and CBPR were codified using the Consolidated Framework for Implementation Research (CFIR). Results: Based on the quantitative survey findings, scores for both physical (P<.001) and psychological (P<.001) well-being and participation in walking (P=.004) and vigorous-intensity activities (P<.001) were significantly lower among veterans than among controls. A ?sedentary? classification was made for 43% (34/79) of veterans and 12% (10/82) of controls. Veterans mostly engaged in moderate-intensity PA inside the house (49/79, 62%) and in the yard (30/79, 38%). Qualitative interviews revealed that barriers to PA exist at individual (eg, comorbidity burden), primary care (eg, absence of community rehabilitation services), and policy levels (eg, limited resources) and facilitators exist primarily at societal (eg, inclusive community) and individual levels (eg, preinjury activity baseline and positive attitudes toward exercise). Expectations regarding CBPR included individualized rehabilitation parameters; functional exercises; and involvement of peers, amputee societies, and community health care providers. The nonresponse rate for interviews was 7% (2/27). Conclusions: The findings of reduced PA participation, poor QoL, and physical and psychological impairments among relatively young veterans reveal the long-term impacts of living with LLA in the absence of long-term rehabilitation. Policy-level changes need to be implemented along with behavior-change strategies to promote PA participation and minimize physical inactivity?induced health issues. Veterans? perceptions regarding future CBPR programs were positive and centered on holistic, individualized, and peer-led activities. UR - https://rehab.jmir.org/2024/1/e52811 UR - http://dx.doi.org/10.2196/52811 UR - http://www.ncbi.nlm.nih.gov/pubmed/38869933 ID - info:doi/10.2196/52811 ER - ", url="http://www.ncbi.nlm.nih.gov/pubmed/38869933" } @Article{info:doi/10.2196/54666, author="Fujii, Yusaku", title="An Engineering Alternative to Lockdown During COVID-19 and Other Airborne Infectious Disease Pandemics: Feasibility Study", journal="JMIR Biomed Eng", year="2024", month="May", day="14", volume="9", pages="e54666", keywords="COVID-19", keywords="airborne infectious diseases", keywords="lockdown", keywords="powered air purifying respirator (PAPR)", keywords="infectious dose", keywords="airborne transmission", keywords="emergency evacuation", keywords="herd immunity", keywords="pandemic", keywords="aerosol", keywords="air", keywords="quality", keywords="infection control", keywords="infectious", keywords="respiratory", keywords="purifier", keywords="purifiers", keywords="purifying", keywords="respirator", keywords="respirators", keywords="device", keywords="devices", keywords="airborne", abstract="Background: Now and in the future, airborne diseases such as COVID-19 could become uncontrollable and lead the world into lockdowns. Finding alternatives to lockdowns, which limit individual freedoms and cause enormous economic losses, is critical. Objective: The purpose of this study was to assess the feasibility of achieving a society or a nation that does not require lockdown during a pandemic due to airborne infectious diseases through the mass production and distribution of high-performance, low-cost, and comfortable powered air purifying respirators (PAPRs). Methods: The feasibility of a social system using PAPR as an alternative to lockdown was examined from the following perspectives: first, what PAPRs can do as an alternative to lockdown; second, how to operate a social system utilizing PAPR; third, directions of improvement of PAPR as an alternative to lockdown; and finally, balancing between efficiency of infection control and personal freedom through the use of Internet of Things (IoT). Results: PAPR was shown to be a possible alternative to lockdown through the reduction of airborne and droplet transmissions and through a temporary reduction of infection probability per contact. A social system in which individual constraints imposed by lockdown are replaced by PAPRs was proposed, and an example of its operation is presented in this paper. For example, the government determines the type and intensity of the lockdown and activates it. At that time, the government will also indicate how PAPR can be substituted for the different activity and movement restrictions imposed during a lockdown, for example, a curfew order may be replaced with the permission to go outside if wearing a PAPR. The following 7 points were raised as directions for improvement of PAPR as an alternative method to lockdown: flow optimization, precise differential pressure control, design improvement, maintenance method, variation development such as booth type, information terminal function, and performance evaluation method. In order to achieve the effectiveness and efficiency in controlling the spread of infection and the individual freedom at a high level in a social system that uses PAPRs as an alternative to lockdown, it was considered effective to develop a PAPR wearing rate network management system utilizing IoT. Conclusions: This study shows that using PAPR with infection control ability and with less economic and social damage as an alternative to nationwide lockdown is possible during a pandemic due to airborne infectious diseases. Further, the efficiency of the government's infection control and each citizen's freedom can be balanced by using the PAPR wearing rate network management system utilizing an IoT system. ", doi="10.2196/54666", url="https://biomedeng.jmir.org/2024/1/e54666", url="http://www.ncbi.nlm.nih.gov/pubmed/38875692" } @Article{info:doi/10.2196/54026, author="Tang, Haiyang and Tian, Yijia and Fang, Jing and Yuan, Xiaoying and Yao, Minli and Wang, Yujia and Feng, Yan and Shu, Jia and Ni, Yan and Yu, Ying and Wang, Yuanhe and Liang, Ping and Li, Xingmin and Bai, Xiaoxia", title="Detection of Urinary Misfolded Proteins for Imminent Prediction of Preeclampsia in Pregnant Women With Suspected Cases: Protocol for a Prospective Noninterventional Study", journal="JMIR Res Protoc", year="2024", month="Apr", day="26", volume="13", pages="e54026", keywords="preeclampsia", keywords="misfolded protein", keywords="congophilia", keywords="noninvasive", keywords="prospective", abstract="Background: Preeclampsia (PE) is one of the most common hypertensive diseases, affecting 2\%-8\% of all pregnancies. The high maternal and fetal mortality rates of PE are due to a lack of early identification of affected pregnant women that would have led to closer monitoring and care. Recent data suggest that misfolded proteins might be a promising biomarker for PE prediction, which can be detected in urine samples of pregnant women according to their congophilia (aggregated) characteristic. Objective: The main purpose of this trial is to evaluate the value of the urine congophilia-based detection of misfolded proteins for the imminent prediction of PE in women presenting with suspected PE. The secondary objectives are to demonstrate that the presence of urine misfolded proteins correlates with PE-related maternal or neonatal adverse outcomes, and to establish an accurate PE prediction model by combining misfolded proteins with multiple indicators. Methods: At least 300 pregnant women with clinical suspicion of PE will be enrolled in this prospective cohort study. Participants should meet the following inclusion criteria in addition to a suspicion of PE: ?18 years old, gestational week between 20+0 and 33+6, and single pregnancy. Consecutive urine samples will be collected, blinded, and tested for misfolded proteins and other PE-related biomarkers at enrollment and at 4 follow-up visits. Clinical assessments of PE status and related complications for all participants will be performed at regular intervals using strict diagnostic criteria. Investigators and participants will remain blinded to the results. Follow-up will be performed until 42 days postpartum. Data from medical records, including maternal and fetal outcomes, will be collected. The performance of urine misfolded proteins alone and combined with other biomarkers or clinical variables for the prediction of PE will be statistically analyzed. Results: Enrollment started in July 2023 and was still open upon manuscript submission. As of March 2024, a total of 251 eligible women have been enrolled in the study and enrollment is expected to continue until August 2024. Results analysis is scheduled to start after all participants reach the follow-up endpoint and complete clinical data are collected. Conclusions: Upon completion of the study, we expect to derive an accurate PE prediction model, which will allow for proactive management of pregnant women with clinical suspicion of PE and possibly reduce the associated adverse pregnancy outcomes. The additional prognostic value of misfolded proteins is also expected to be confirmed. Trial Registration: Chinese Clinical Trials Registry ChiCTR2300074878; https://www.chictr.org.cn/showproj.html?proj=202096 International Registered Report Identifier (IRRID): PRR1-10.2196/54026 ", doi="10.2196/54026", url="https://www.researchprotocols.org/2024/1/e54026", url="http://www.ncbi.nlm.nih.gov/pubmed/38669061" } @Article{info:doi/10.2196/49815, author="Hasan, Zahid Md and Rabbani, Golam Md and Akter, Orin and Mehdi, Golam Gazi and Ahmed, Wahid Mohammad and Ahmed, Sayem and Chowdhury, Elahi Mahbub", title="Patient Satisfaction With the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Apr", day="24", volume="8", pages="e49815", keywords="Shasthyo Surokhsha Karmasuchi", keywords="health care services", keywords="health care utilization", keywords="satisfaction", keywords="below poverty line", keywords="Bangladesh", keywords="patient satisfaction", keywords="physician behavior", abstract="Background: Since 2016, the government of Bangladesh has been piloting a health protection scheme known as Shasthyo Surokhsha Karmasuchi (SSK), which specifically targets households living below the poverty line. This noncontributory scheme provides enrolled households access to inpatient health care services for 78 disease groups. Understanding patients' experiences with health care utilization from the pilot SSK scheme is important for enhancing the quality of health care service delivery during the national-level scale-up of the scheme. Objective: We aimed to evaluate patient satisfaction with the health care services provided under the pilot health protection scheme in Bangladesh. Methods: A cross-sectional survey was conducted with the users of the SSK scheme from August to November 2019. Patients who had spent a minimum of 2 nights at health care facilities were selected for face-to-face exit interviews. During these interviews, we collected information on patients' socioeconomic characteristics, care-seeking experiences, and level of satisfaction with various aspects of health care service delivery. To measure satisfaction, we employed a 5-point Likert scale (very satisfied, 5; satisfied, 4; neither satisfied nor dissatisfied, 3; dissatisfied, 2; very dissatisfied, 1). Descriptive statistics, statistical inferential tests (t-test and 1-way ANOVA), and linear regression analyses were performed. Results: We found that 55.1\% (241/438) of users were either very satisfied or satisfied with the health care services of the SSK scheme. The most satisfactory indicators were related to privacy maintained during diagnostic tests (mean 3.91, SD 0.64), physicians' behaviors (mean 3.86, SD 0.77), services provided at the registration booth (mean 3.86, SD 0.62), confidentiality maintained regarding diseases (mean 3.78, SD 0.72), and nurses' behaviors (mean 3.60, SD 0.83). Poor satisfaction was identified in the interaction of patients with providers about illness-related information (mean 2.14, SD 1.40), availability of drinking water (mean 1.46, SD 0.76), cleanliness of toilets (mean 2.85, SD 1.04), and cleanliness of the waiting room (mean 2.92, SD 1.09). Patient satisfaction significantly decreased by 0.20 points for registration times of 16-30 minutes and by 0.32 points for registration times of >30 minutes compared with registration times of ?15 minutes. Similarly, patient satisfaction significantly decreased with an increase in the waiting time to obtain services. However, the satisfaction of users significantly increased if they received a complete course of medicines and all prescribed diagnostic services. Conclusions: More than half of the users were satisfied with the services provided under the SSK scheme. However, there is scope for improving user satisfaction. To improve the satisfaction level, the SSK scheme implementation authorities should pay attention to reducing the registration time and waiting time to obtain services and improving the availability of drugs and prescribed diagnostic services. The authorities should also ensure the supply of drinking water and enhance the cleanliness of the facility. ", doi="10.2196/49815", url="https://formative.jmir.org/2024/1/e49815", url="http://www.ncbi.nlm.nih.gov/pubmed/38656783" } @Article{info:doi/10.2196/50032, author="Kim, J. Jacqueline H. and Kagawa Singer, Marjorie and Bang, Lisa and Ko, Amy and Nguyen, Becky and Chen Stokes, Sandy and Lu, Qian and Stanton, L. Annette", title="Supportive Care Needs in Chinese, Vietnamese, and Korean Americans With Metastatic Cancer: Mixed Methods Protocol for the DAWN Study", journal="JMIR Res Protoc", year="2024", month="Apr", day="22", volume="13", pages="e50032", keywords="Asian American", keywords="disparities", keywords="metastatic cancer", keywords="psychosocial", keywords="supportive care", keywords="unmet needs", keywords="well-being", abstract="Background: Asian Americans with metastatic cancer are an understudied population. The Describing Asian American Well-Being and Needs in Cancer (DAWN) Study was designed to understand the supportive care needs of Chinese-, Vietnamese-, and Korean-descent (CVK) patients with metastatic cancer. Objective: This study aims to present the DAWN Study protocol involving a primarily qualitative, convergent, mixed methods study from multiple perspectives (patients or survivors, caregivers, and health care professionals). Methods: CVK Americans diagnosed with solid-tumor metastatic cancer and their caregivers were recruited nationwide through various means (registries, community outreach newsletters, newspapers, radio advertisements, etc). Potentially eligible individuals were screened and consented on the web or through a phone interview. The study survey and interview for patients or survivors and caregivers were provided in English, traditional/simplified Chinese and Cantonese/Mandarin, Vietnamese, and Korean, and examined factors related to facing metastatic cancer, including quality of life, cultural values, coping, and cancer-related symptoms. Community-based organizations assisted in recruiting participants, developing and translating study materials, and connecting the team to individuals for conducting interviews in Asian languages. Health care professionals who have experience working with CVK patients or survivors with metastatic solid cancer were recruited through referrals from the DAWN Study community advisory board and were interviewed to understand unmet supportive care needs. Results: Recruitment began in November 2020; data collection was completed in October 2022. A total of 66 patients or survivors, 13 caregivers, and 15 health care professionals completed all portions of the study. We completed data management in December 2023 and will submit results for patients or survivors and caregivers to publication outlets in 2024. Conclusions: Future findings related to this protocol will describe and understand the supportive care needs of CVK patients or survivors with metastatic cancer and will help develop culturally appropriate psychosocial interventions that target known predictors of unmet supportive care needs in Chinese, Vietnamese, and Korean Americans with metastatic cancer. International Registered Report Identifier (IRRID): DERR1-10.2196/50032 ", doi="10.2196/50032", url="https://www.researchprotocols.org/2024/1/e50032", url="http://www.ncbi.nlm.nih.gov/pubmed/38648633" } @Article{info:doi/10.2196/51542, author="Abdullah, Rifham Shazana and Wan Mohd Zin, Mona Ruziana and Azizul, Hayati Nur and Sulaiman, Suffia Nur and Khalid, Mustafa Norhayati and Mohd Salim Mullahi Jahn, Jahn Roshan and Khalil, Nazrin Muhamad Khairul and Abu Seman, Norhashimah and Zainal Abidin, Azlin Nur and Ali, Azizan and Tan, Zhuan You and Omar, Azahadi and Seman, Zamtira and Yahya, Abqariyah and Md Noh, Fairulnizal Mohd", title="The Effect of a Combined Intermittent Fasting Healthy Plate Intervention on Anthropometric Outcomes and Body Composition Among Adults With Overweight and Obesity: Nonrandomized Controlled Trial", journal="JMIR Form Res", year="2024", month="Apr", day="10", volume="8", pages="e51542", keywords="intermittent fasting", keywords="dry fasting", keywords="healthy plate", keywords="obesity", keywords="overweight", abstract="Background: Adult obesity and overweight pose a substantial risk to global public health and are associated with various noncommunicable diseases. Although intermittent fasting (IF) is increasingly used as a relatively new dietary strategy for weight loss, the effectiveness of 2 days per week of dry fasting remains unknown. Objective: This study aims to evaluate the effectiveness of a combined dry IF and healthy plate (IFHP) and healthy plate (HP) intervention in improving anthropometric outcomes and body composition. Methods: This nonrandomized controlled trial involved 177 adults who were overweight and obese. Among them, 91 (51.4\%) were allocated to the IFHP group and 86 (48.6\%) were allocated to the HP group. The overall study duration was 6 months (October 2020 to March 2021). The intervention was divided into 2 phases: supervised (3 months) and unsupervised (3 months). The data were collected at baseline, after the supervised phase (month 3), and after the unsupervised phase (month 6). Anthropometric (weight, height, waist circumference, and hip circumference) and body composition (body fat percentage, body fat mass, skeletal muscle mass, and visceral fat area) data were measured at all 3 data collection points. Sociodemographic data were obtained using a questionnaire at baseline. Results: Most participants were female (147/177, 83.1\%) and Malay (141/177, 79.7\%). After 3 months, there were significant reductions in weight (difference ?1.68; P<.001), BMI (difference ?0.62; P<.001), body fat percentage (difference ?0.921; P<.001), body fat mass (difference ?1.28; P<.001), and visceral fat area (difference ?4.227; P=.008) in the IFHP group, whereas no significant changes were observed in the HP group. Compared to baseline, participants in the IFHP group showed a significant decrease in weight (difference ?1.428; P=.003), BMI (difference ?0.522; P=.005), body fat percentage (difference ?1.591; P<.001), body fat mass (difference ?1.501; P<.001), visceral fat area (difference ?7.130; P<.001), waist circumference (difference ?2.304; P=.001), and hip circumference (difference ?1.908; P=.002) at month 6. During the unsupervised phase, waist (IFHP difference ?3.206; P<.001, HP difference ?2.675; P=.004) and hip (IFHP difference ?2.443; P<.001; HP difference ?2.896; P<.001) circumferences were significantly reduced in both groups (P<.01), whereas skeletal muscle mass (difference 0.208; P=.04) and visceral fat area (difference ?2.903; P=.003) were significantly improved in the IFHP group only. No significant difference in the between-group comparison was detected throughout the intervention (all P>.05). Conclusions: A combined IFHP intervention was effective in improving anthropometric outcomes and body composition in adults with overweight and obesity. International Registered Report Identifier (IRRID): RR2-10.2196/33801. ", doi="10.2196/51542", url="https://formative.jmir.org/2024/1/e51542", url="http://www.ncbi.nlm.nih.gov/pubmed/38598283" } @Article{info:doi/10.2196/51848, author="Yoon, Sungwon and Tan, Min Chao and Phang, Kie Jie and Liu, Xi Venice and Tan, Boon Wee and Kwan, Heng Yu and Low, Leng Lian", title="Exploring the Implementation of Shared Decision-Making Involving Health Coaches for Diabetes and Hypertension Self-Management: Qualitative Study", journal="JMIR Form Res", year="2024", month="Apr", day="4", volume="8", pages="e51848", keywords="decision-making", keywords="diabetes", keywords="health coach", keywords="health coaching", keywords="healthcare professional", keywords="hypertension", keywords="patient", keywords="patient-centered care", keywords="person-centered care", keywords="qualitative research", keywords="self-management", keywords="shared decision-making", abstract="Background: An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension. Objective: This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs. Methods: We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care. The main topics discussed included the roles of health coaches and HCPs in self-management, views toward health coaching and SDM, and factors that should be considered for optimal implementation of SDM that involves health coaches. All focus group discussions were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Participants agreed that the main responsibility of HCPs should be identifying the patient's stage of change and medication education, while health coaches should focus on lifestyle education, monitoring, and motivational conversation. The health coach was seen to be more effective in engaging patients in lifestyle education and designing goal management plans as health coaches have more time available to spend with patients. The importance of a health coach's personal attributes (eg, sufficient knowledge of both medical and psychosocial management of disease conditions) and credentials (eg, openness, patience, and empathy) was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: (1) target population (newly diagnosed and less stable patients), (2) commitment of all stakeholders (discrepancy on targeted times and modality), (3) continuity of care (familiar faces), (4) philosophy of care (person-centered communication), and (5) faces of legitimacy (physician as the ultimate authority). Conclusions: The findings shed light on the appropriate roles of health coaches vis-{\`a}-vis HCPs in SDM as perceived by patients and HCPs. Findings from this study also contribute to the understanding of SDM on self-management strategies for patients with diabetes and hypertension and highlight potential opportunities for integrating health coaches into the routine care process. ", doi="10.2196/51848", url="https://formative.jmir.org/2024/1/e51848", url="http://www.ncbi.nlm.nih.gov/pubmed/38573763" } @Article{info:doi/10.2196/51084, author="Russo, Sara and Caruso, Rosario and Conte, Gianluca and Magon, Arianna and Vangone, Ida and Bascape', Barbara and Maga, Giulia and Pasek, Malgorzata and Arrigoni, Cristina", title="Development of a Core Outcome Set for Family and Community Nursing: Protocol for a Delphi Study", journal="JMIR Res Protoc", year="2024", month="Mar", day="29", volume="13", pages="e51084", keywords="clinical knowledge", keywords="core outcomes set", keywords="Delphi survey", keywords="family and community nurse", keywords="health interventions", keywords="health promotion", keywords="primary care", keywords="stakeholder engagement", abstract="Background: Family and community nurses (FCNs) play a crucial role in delivering primary care to patients within their homes and communities. A key aspect of their role involves various health interventions, which are influenced by their unique competencies, such as health promotion, advanced clinical knowledge, and strong interpersonal skills. However, it is essential to understand which specific health outcomes these interventions impact to better understand the relationship between FCNs' skills and the health results. Objective: This study aims to outline the steps we will take to develop a set of core outcomes. These outcomes will be particularly sensitive to the health interventions carried out by FCNs, providing a clearer picture of their practice's impact. Methods: A Delphi survey will be used for this research, conducted from January to December 2024. The process will involve 5 steps and input from 3 stakeholder categories. These stakeholders will help identify a preliminary list of outcomes that will form the basis of our core outcome set (COS). Results: This guideline will be beneficial for a wide range of stakeholders involved in COS development, including COS developers, trialists, systematic reviewers, journal editors, policy makers, and patient groups. As of January 2024, we have successfully completed the first stage of the study, with the stakeholder group approving the reported outcomes and assigning participant lists for each stakeholder group. Conclusions: This study will provide a roadmap for identifying the key health outcomes influenced by the interventions of FCNs. The multistakeholder, multiphase approach will ensure a comprehensive and inclusive process. Ultimately, the findings will enhance our understanding of FCNs' impact on health outcomes, leading to more effective primary care strategies and policies. International Registered Report Identifier (IRRID): PRR1-10.2196/51084 ", doi="10.2196/51084", url="https://www.researchprotocols.org/2024/1/e51084", url="http://www.ncbi.nlm.nih.gov/pubmed/38551623" } @Article{info:doi/10.2196/46363, author="Ippolito, Christina and Canthiya, Lathushikka and Floreani, Amanda and Luckhart, Kathleen and Hoffman, Andrea and McAdam, Laura", title="Twice-Weekly Outpatient Rehabilitation Intervention for Young Children With Spinal Muscular Atrophy Treated With Genetic-Based Therapies: Protocol for a Feasibility Study", journal="JMIR Res Protoc", year="2023", month="Nov", day="2", volume="12", pages="e46363", keywords="active rehabilitation", keywords="atrophy", keywords="child", keywords="feasibility trial", keywords="feasibility", keywords="genetic-based", keywords="genetic-based therapy", keywords="infant", keywords="occupation therapy", keywords="pediatric", keywords="physical therapy", keywords="physiotherapy", keywords="pilot trial", keywords="rehabilitation", keywords="spinal muscular atrophy", abstract="Background: Spinal muscular atrophy (SMA) is a progressive neuromuscular disorder that causes muscle weakness and is the leading genetic cause of infant mortality worldwide. While no definitive cure exists, the approval of 3 genetic-based therapies in Canada since 2018 has led to significant improvements in muscle function for children with SMA. With that, there are no evidence-based rehabilitation interventions and minimal evidence on the combined effects of genetic-based therapies and rehabilitation. Objective: This protocol describes the methodology to assess the feasibility of a twice-weekly outpatient rehabilitation intervention focusing on gross and fine motor function to inform the methodology and sample size of a definitive clinical trial. Methods: We will conduct a single-center nonrandomized pilot and feasibility trial to explore an outpatient rehabilitation intervention for children aged 6 months to 3 years with SMA treated with genetic-based therapies. Participation in the study will occur over a 25-week period, with a baseline assessment visit followed by a 12-week intervention period and a 12-week nonintervention period. The rehabilitation intervention comprises weekly physical and occupational therapy for 11 weeks. Assessments will occur at baseline (week 0), end of intervention or early withdrawal (week 12), and follow-up (week 24). Predetermined feasibility indicators will evaluate study feasibility across process (recruitment rates, eligibility criteria, adherence rates, retention rates, questionnaire suitability, and acceptability), resource (time, implementation, and execution), management (materials and data), and scientific (safety, tolerability, and preliminary efficacy) domains. Results: This project was funded in March 2022, and data will be collected between March 2023 and December 2023. Data analysis will occur between January 2024 and March 2024, with publication expected in the fall of 2024. The protocol for the feasibility trial will be considered successful if it meets the success criteria set out for the feasibility indicators. Indicators of specific interest include all process indicators, as well as time. Exploratory indicators will be reported. Pragmatically, the results of the feasibility trial will inform changes to the protocol and the start-up of a definitive multisite trial. Conclusions: This novel twice-weekly outpatient rehabilitation intervention will be the first step toward filling the need for an evidence-based rehabilitation intervention for children with SMA treated with genetic-based therapies. It is expected that consistent and intensive rehabilitation therapy will augment functional gains being observed in this population. In the future, a definitive trial will measure the efficacy of the intervention. Trial Registration: ClinicalTrials.gov NCT05638750; https://clinicaltrials.gov/study/NCT05638750 International Registered Report Identifier (IRRID): DERR1-10.2196/46363 ", doi="10.2196/46363", url="https://www.researchprotocols.org/2023/1/e46363", url="http://www.ncbi.nlm.nih.gov/pubmed/37917140" } @Article{info:doi/10.2196/47109, author="Rennick-Egglestone, Stefan and Subhani, Mohsan and Knight, Holly and Jones, A. Katy and Hutton, Clare and Jackson, Tracey and Hutton, Matthew and Wragg, Andrew and Morling, R. Joanne and Sprange, Kirsty and Ryder, D. Stephen", title="Transient Elastography and Video Recovery Narrative Access to Support Recovery From Alcohol Misuse: Development of a Novel Intervention for Use in Community Alcohol Treatment Services", journal="JMIR Form Res", year="2023", month="Oct", day="4", volume="7", pages="e47109", keywords="recovery narrative", keywords="recovery story", keywords="alcohol misuse", keywords="alcohol use disorder", keywords="feasibility trial", keywords="complex intervention", keywords="KLIFAD intervention", abstract="Background: Mortality from alcohol-related liver disease has risen significantly for 3 decades. Transient elastography (TE) is a noninvasive test providing a numerical marker of liver disease. Preliminary evidence suggests that TE can reduce alcohol consumption. The KLIFAD (does knowledge of liver fibrosis affect high-risk drinking behavior?) study has developed a complex intervention wherein people receiving alcohol treatment are provided with access to TE, accompanied by scripted feedback tailored to their disease state, and access to video narratives describing alcohol misuse recovery after receiving TE. Recovery narratives are included due to preliminary evidence from mental health studies which suggest that access to digital narratives describing recovery from mental health problems can help people affected by mental health problems, including through mechanisms with the potential to be transferable to an alcohol treatment setting, for example, by increasing hope for the future, enabling learning from the experience of others, or promoting help-seeking behaviors. Objective: We aimed to develop the KLIFAD intervention to the point that it could be delivered in a feasibility trial and to produce knowledge relevant to clinicians and researchers developing interventions making use of biomarkers of disease. Methods: In research activity 1, standardized scripted feedback was developed by this study, and then iterated through focus groups with people who had experienced alcohol misuse and TE, and key alcohol workers with experience in delivering TE. We report critical design considerations identified through focus groups, in the form of sensitizing concepts. In research activity 2, a video production guide was coproduced to help produce impactful video-based recovery narratives, and a patient and public involvement (PPI) panel was consulted for recommendations on how best to integrate recovery narratives into an alcohol treatment setting. We report PPI recommendations and an overview of video form and content. Results: Through research activity 1, we learnt that patient feedback has not been standardized in prior use of TE, that receiving a numeric marker can provide an objective target that motivates and rewards recovery, and that key alcohol workers regularly tailor information to their clients. Through research activity 2, we developed a video production guide asking narrators what recovery means to them, what helped their recovery, and what they have learned about recovery. We produced 10 recovery narratives and collected PPI recommendations on maximizing impact and safety. These led to the production of unplanned videos presenting caregiver and clinician perspectives, and a choice to limit narrative availability to alcohol treatment settings, where support is available around distressing content. These choices have been evaluated through a feasibility randomized controlled trial [ISRCTN16922410]. Conclusions: Providing an objective target that motivates and rewards recovery is a candidate change mechanism for complex interventions integrating biomarkers of disease. Recovery narratives can contain distressing content; intervention developers should attend to safe usage. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-054954 ", doi="10.2196/47109", url="https://formative.jmir.org/2023/1/e47109", url="http://www.ncbi.nlm.nih.gov/pubmed/37792440" } @Article{info:doi/10.2196/48829, author="Etowa, B. Egbe and Boakye, N. Priscilla and Antabe, Roger and Wong, Pui-Hing Josephine", title="HIV-Response Intergenerational Participation Intervention Among Black Men in Ontario, Canada: Protocol for a Pilot Intervention Study", journal="JMIR Res Protoc", year="2023", month="Jul", day="11", volume="12", pages="e48829", keywords="community-based participatory project", keywords="heterosexual Black men", keywords="HIV response", keywords="intergenerational participation", keywords="intervention", abstract="Background: Black men and their communities are more affected by HIV. Although they constitute less than 5\% of the Ontarian population, they accounted for 26\% of new HIV diagnoses in 2015, nearly half of which (48.6\%) were attributed to heterosexual contact. HIV stigma and discrimination reinforce African, Caribbean, and Black men's HIV vulnerability by creating unsafe environments that deter them from testing and disclosure, resulting in isolation, depression, delayed diagnosis and linkage to treatment and care, and poor health outcomes. In response to these challenges, intergenerational strategies were identified from previous community-based participatory studies as best practices to reduce HIV vulnerabilities and promote resilience among heterosexual Black men and communities. The proposed intervention is premised on this recommendation of intergenerational intervention. Objective: The overarching objective is to engage heterosexual Black men and communities in cocreating a community centered, culturally safe intergenerational intervention to reduce HIV vulnerabilities and related health disparities. Methods: We will engage 12 diverse community stakeholders in Ontario, inclusive of heterosexual Black men, in 8 weekly sessions to evaluate existing evidence of effective HIV health literacy interventions, identify essential and relevant aspects, and work collaboratively to co-design the HIV-Response Intergenerational Participation (HIP) intervention for use with Black men and communities. Next, we will recruit 24 self-identified heterosexual Black men aged 18-29, 29-49, and ?50 years. We will pilot and evaluate the HIP intervention with 24 heterosexual Black men from these 3 age groups (split as 2 events: a total of 12 participants in person in Toronto and 12 participants on the web in Windsor, London, and Ottawa). We will use the data obtained along with questionnaires from validated scales and focus groups to evaluate the effectiveness of HIP. The data will include HIV knowledge, perceived stigma toward people living with HIV, acceptance and uptake of HIV testing, preexposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and condom use. We will also collect data related to perceptions about system-level factors such as discrimination, socially misconstrued masculine identity, etc. Quantitative analysis will essentially be a univariate descriptive analysis. We will use thematic analysis to highlight the results of the focus group discussions. Finally, we will disseminate the evaluation results and engage researchers, leaders, Black men, and communities to expand the project team and scale up the intervention in Ontario and across Canada. Results: Implementation commences by May 2023, and by September 2023, we should have produced, among others, an evidence-informed HIP intervention that can be adapted for use by heterosexual Black men and communities beyond Ontario. Conclusions: The pilot intervention will strengthen critical health literacy and build resilience against HIV through intergenerational dialogue among heterosexual Black men of all ages. International Registered Report Identifier (IRRID): PRR1-10.2196/48829 ", doi="10.2196/48829", url="https://www.researchprotocols.org/2023/1/e48829", url="http://www.ncbi.nlm.nih.gov/pubmed/37432719" } @Article{info:doi/10.2196/42769, author="Lu, Chenmiao and Al-Juaid, Rawan and Al-Amri, Mohammad", title="Gait Stability Characteristics in Able-Bodied Individuals During Self-paced Inclined Treadmill Walking: Within-Subject Repeated-Measures Study", journal="JMIR Form Res", year="2023", month="Jun", day="5", volume="7", pages="e42769", keywords="healthy individuals", keywords="muscle activation", keywords="self-paced walking", keywords="slope walking", keywords="stability", keywords="treadmill-based gait analysis", keywords="virtual reality", abstract="Background: Inclined walking is a challenging task that requires active neuromuscular control to maintain stability. However, the adaptive strategies that preserve stability during inclined walking are not well understood. Investigating the effects of self-paced inclined treadmill walking on gait stability characteristics and the activation patterns of key lower limb muscles can provide insights into these strategies. Objective: The aim of this study was to investigate the effects of self-paced inclined treadmill walking on gait stability characteristics and the activation of key lower limb muscles. Methods: Twenty-eight able-bodied individuals (mean age 25.02, SD 2.06 years) walked on an augmented instrumented treadmill for 3 minutes at 3 inclination angles (?8{\textdegree}, 0{\textdegree}, and 8{\textdegree}) at their preferred walking speed. Changes in gait characteristics (ie, stability, walking speed, spatial-temporal, kinematic, and muscle forces) across inclination angles were assessed using a repeated measures ANOVA and the Friedman test. Results: The study revealed that inclined treadmill walking has a significant impact on gait characteristics (P<.001). Changes were observed in spatial-temporal parameters, joint angles, and muscle activations depending on the treadmill inclination. Specifically, stability and walking speed decreased significantly during uphill walking, indicating that it was the most challenging walking condition. Uphill walking also led to a decrease in spatial parameters by at least 13.53\% and a 5.26\% to 10.96\% increase in temporal parameters. Furthermore, joint kinematics and peak activation of several muscles, including the hamstrings (biceps femoris, long head=109.5\%, biceps femoris, short head=53.3\%, semimembranosus=98.9\%, semitendinosus=90.9\%), gastrocnemius (medial gastrocnemius=40.6\%, lateral gastrocnemius=35.3\%), and vastii muscles (vastus intermedius=12.8\%, vastus lateralis=16.7\%) increased significantly during uphill walking. In contrast, downhill walking resulted in bilateral reductions in spatial-temporal gait parameters, with knee flexion increasing and hip flexion and ankle dorsiflexion decreasing. The peak activation of antagonist muscles, such as the quadriceps, tibialis anterior, and tibialis posterior, significantly increased during downhill walking (rectus femoris=97.7\%, vastus lateralis =70.6\%, vastus intermedius=68.7\%, tibialis anterior=72\%, tibialis posterior=107.1\%). Conclusions: Our findings demonstrate that able-bodied individuals adopt specific walking patterns during inclined treadmill walking to maintain a comfortable and safe walking performance. The results suggest that inclined treadmill walking has the potential to serve as a functional assessment and rehabilitation tool for gait stability by targeting muscle training. Future research should investigate the effects of inclined treadmill walking on individuals with gait impairments and the potential benefits of targeted muscle training. A better understanding of the adaptive strategies used during inclined walking may lead to the development of more effective rehabilitation interventions for individuals with lower limb injuries. ", doi="10.2196/42769", url="https://formative.jmir.org/2023/1/e42769", url="http://www.ncbi.nlm.nih.gov/pubmed/37276010" } @Article{info:doi/10.2196/42666, author="Shan, Yi and Ji, Meng and Xing, Zhaoquan and Dong, Zhaogang", title="Factors Associated With Limited Cancer Health Literacy Among Chinese People: Cross-sectional Survey Study", journal="JMIR Form Res", year="2023", month="May", day="24", volume="7", pages="e42666", keywords="factor", keywords="limited cancer health literacy", keywords="Chinese people", keywords="logistic regression", abstract="Background: Limited cancer health literacy may be attributed to various factors. Although these factors play decisive roles in identifying individuals with limited cancer health literacy, they have not been sufficiently investigated, especially in China. There is a pressing need to ascertain the factors that effectively identify Chinese people with poor cancer health literacy. Objective: This study aimed to identify the factor associated with limited cancer health literacy among Chinese people based on the 6-Item Cancer Health Literacy Test (CHLT-6). Methods: We first categorized Chinese study participants according to the answers provided for cancer health literacy as follows: people who provided ?3 correct answers were labeled as having limited cancer health literacy, whereas those who provided between 4 and 6 correct answers were labeled as having adequate cancer health literacy. We then adopted logistic regression to analyze the factors that were closely related to limited cancer health literacy among at-risk study participants. Results: The logistic regression analysis identified the following factors that effectively predicted limited cancer health literacy: (1) male gender, (2) low education attainment, (3) age, (4) high levels of self-assessed general disease knowledge, (5) low levels of digital health literacy, (6) limited communicative health literacy, (7) low general health numeracy, and (8) high levels of mistrust in health authorities. Conclusions: Using regression analysis, we successfully identified 8 factors that could be used as predictors of limited cancer health literacy among Chinese populations. These findings have important clinical implications for supporting Chinese people with limited cancer health literacy through the development of more targeted health educational programs and resources that better align with their actual skill levels. ", doi="10.2196/42666", url="https://formative.jmir.org/2023/1/e42666", url="http://www.ncbi.nlm.nih.gov/pubmed/37223982" } @Article{info:doi/10.2196/41925, author="Oyeyemi, Oluwafemi Sunday and Fagbemi, Stephen and Busari, Iyanda Ismaila and Wynn, Rolf", title="Belief in COVID-19 Conspiracy Theories, Level of Trust in Government Information, and Willingness to Take COVID-19 Vaccines Among Health Care Workers in Nigeria: Survey Study", journal="JMIR Form Res", year="2023", month="May", day="2", volume="7", pages="e41925", keywords="COVID-19", keywords="vaccination", keywords="misinformation", keywords="conspiracy theories", keywords="health workers", keywords="Nigeria", keywords="government", keywords="information", keywords="threat", keywords="vaccine", keywords="willingness", keywords="genetic", abstract="Background: The World Health Organization recently declared vaccine hesitancy or refusal as a threat to global health. COVID-19 vaccines have been proven efficacious and are central to combatting the pandemic. However, many---including skilled health care workers (HCWs)---have been hesitant in taking the vaccines. Conspiracy theories spread on social media may play a central role in fueling vaccine hesitancy. Objective: The objective of this study was to investigate HCWs' belief in COVID-19 vaccine conspiracy theories (ie, that the vaccines can alter one's DNA or genetic information and that the vaccines contain microchips) and trust in government information on COVID-19 vaccines. Methods: Health care workers in Ondo State, Nigeria, representing different health care professions were asked to participate anonymously in an online survey. The participants were asked about their beliefs in 2 viral conspiracy theories and their trust in government information on COVID-19 vaccines. We used multivariable logistic regressions to investigate the relationships between trust in government information on COVID-19 vaccines and (1) belief in DNA alteration, (2) belief in microchip implantation through the vaccine, and (3) willingness to accept the vaccine. Results: A total of 557 HCWs (n=156, 28\% men and n=395, 70.9\% women) were included in the study. A total of 26.4\% (n=147) of the sampled HCWs believed COVID-19 vaccines contained digital microchips, while 30\% (n=167) believed the vaccines could alter one's DNA or genetic information. The beliefs varied according to professional group, with 45.8\% (55/120) and 50\% (5/10) of nurses and pharmacists, respectively, believing in the DNA alteration theory and 33.3\% (40/120) and 37.5\% (6/16) of the nurses and laboratory scientists, respectively, believing in the microchip theory. Social media was an important source of COVID-19 information for 45.4\% (253/557) of HCWs. A total of 76.2\% (419/550) of the participants expressed a willingness to take the vaccine. The odds of HCWs believing that COVID-19 vaccines contained digital microchips increased significantly with decreasing level of trust in government information on COVID-19 vaccines (odds ratio [OR] 4.6, 95\% CI 2.6-8.0). We made a similar finding in those who believed COVID-19 vaccines could alter DNA and genetic information (OR 5.2, 95\% CI 3.1-8.8). Conclusions: Misinformation regarding COVID-19 vaccines reaches and influences HCWs. A high proportion of the sampled HCWs believed that COVID-19 vaccines contained microchips or that the vaccines could alter recipients' DNA and genetic information. This might have negative consequences in terms of the HCWs' own COVID-19 vaccination and their influence on other people. Lack of trust in government and its institutions might explain the belief in both conspiracy theories and vaccine hesitancy. There is a need for health care stakeholders in Nigeria and around the world to actively counteract misinformation, especially on social media, and give HCWs necessary scientifically sound information. ", doi="10.2196/41925", url="https://formative.jmir.org/2023/1/e41925", url="http://www.ncbi.nlm.nih.gov/pubmed/37068055" } @Article{info:doi/10.2196/40660, author="Rho, Jung Mi and Park, Jihwan", title="An Investigation of Factors Influencing the Postponement of the Use of Distributed Research Networks in South Korea: Web-Based Users' Survey Study", journal="JMIR Form Res", year="2023", month="Apr", day="12", volume="7", pages="e40660", keywords="distributed research networks", keywords="postponement", keywords="performance risk", keywords="workload", abstract="Background: Distributed research networks (DRNs) offer researchers the advantage of using various big data sets that are difficult to access and use. In addition, since the data are not physically exposed to the outside, it is possible to conduct research using medical data safely without data exposure. However, researchers still have difficulties and are concerned about using DRNs. Few studies involving DRNs have been conducted from the user's viewpoint. Therefore, it is necessary to look at DRNs from the researcher's point of view and find ways to facilitate the active use of DRNs. Objective: This study aimed to identify the factors that made researchers hesitate to use DRNs and to derive a method to facilitate active DRN use. Methods: We conducted a web-based survey of people working in the medical fields, such as hospitals and universities. We used 131 respondents' data from a survey from December 6 to 17, 2021. We conducted multiple regression analyses to determine the factors affecting the postponement of using DRNs. In addition, 2 independent sample t tests were conducted to analyze the difference between the 2 groups according to the following factors: organization, gender, experience with DRNs, length of the research career, position, and age. Results: Performance risk (t5=2.725, P=.007) and workload from DRNs (t5=3.543, P=.001) were significantly associated with users' postponement of DRN use. Researchers working at hospitals were found to feel more burdened by DRN use than researchers working at universities (t129=1.975, P=.05). It was also found that women perceived a higher privacy risk of DRNs than men (t129=--2.303, P=.02) and that those who had experience using DRNs delayed their use less than those without experience (t129=--4.215, P<.001). Conclusions: It is necessary to simplify the research and approval processes to reduce the performance risk and workload of research using DRNs. To optimize the process, DRN providers should develop a way to improve users' experiences. More user-friendly functionalities should be developed from the researcher's point of view. It is necessary to continuously promote effective functionalities for DRNs to reduce concerns about privacy risks. This study identified the concerns of DRN users in terms of DRN use and suggested ways to actively use DRNs. The derived results can be reflected in planning and developing DRNs. Our research will be helpful to prepare an activation plan for DRNs. ", doi="10.2196/40660", url="https://formative.jmir.org/2023/1/e40660", url="http://www.ncbi.nlm.nih.gov/pubmed/37043286" } @Article{info:doi/10.2196/39891, author="Van Heel, Lou Kasi and Nelson, Anna and Handysides, Daniel and Shah, Huma", title="The Factors Associated With Confidence in Using the Internet to Access Health Information: Cross-sectional Data Analysis", journal="JMIR Form Res", year="2023", month="Apr", day="11", volume="7", pages="e39891", keywords="confidence", keywords="health information access", keywords="health information seeking", keywords="health information sources", keywords="internet", keywords="health information", abstract="Background: Confidence in health information access is a measure of the perceived ability to obtain health information. One's beliefs or perceived ability to access health information is particularly important in understanding trends in health care access. Previous literature has found that access to health information is lowest among society's most vulnerable population groups. These groups include older, less educated, and low-income populations. While health confidence has previously been used as a scale to measure health outcomes, additional research is needed describing the demographic factors associated with users' confidence in health information access. This may be a key component of health information seeking that affects beneficial health outcomes such as prevention and treatment. Objective: This study examines the demographic factors associated with the levels of confidence in using the internet to access health information for adults 18 years and older in the United States. Methods: Using a cross-sectional design, secondary data from the Health Information National Trends Survey (HINTS) 5, Cycle 3 (2019) were analyzed (N=5374). An ordinal regression stratified by internet use was used to determine the association between demographic characteristics and level of confidence in health information access. Results: When the internet is the primary source for health information, high school graduates (adjusted odds ratio [AOR] 0.58, 95\% CI 0.37-0.89) compared to those with a college degree or more had significantly lower odds of being confident in obtaining health information. In addition, non-Hispanic Asian participants (AOR 0.44, 95\% CI 0.24-0.82) compared to non-Hispanic White participants, male participants (AOR 0.72, 95\% CI 0.54-0.97) compared to female participants, and those who made between US \$20,000-\$35,000 annually (AOR 0.55, 95\% CI 0.31-0.98) compared to those who made US \$75,000 or more annually had significantly lower odds of being confident in obtaining health information via the internet. Moreover, when the internet is the primary source for health information, those with health insurance had significantly higher odds of being confident in obtaining health information (AOR 2.91, 95\% CI 1.58-5.34) compared to those who do not have health insurance. Lastly, a significant association was observed between confidence in health information access and primary health information source and frequency of visiting a health care provider. Conclusions: Confidence in accessing health information can differ by individual demographics. Accessing health-related information from the internet has become increasingly more common and can provide insight into health information-seeking behaviors. Further exploration of these factors can inform the science of health education by providing deeper insight into improving access to health information for vulnerable populations. ", doi="10.2196/39891", url="https://formative.jmir.org/2023/1/e39891", url="http://www.ncbi.nlm.nih.gov/pubmed/37040161" } @Article{info:doi/10.2196/43494, author="Memon, Ali Zahid and Mian, Abeer and Reale, Sophie and Spencer, Rachael and Bhutta, Zulfiqar and Soltani, Hora", title="Community and Health Care Provider Perspectives on Barriers to and Enablers of Family Planning Use in Rural Sindh, Pakistan: Qualitative Exploratory Study", journal="JMIR Form Res", year="2023", month="Mar", day="10", volume="7", pages="e43494", keywords="gender", keywords="sexual and reproductive health", keywords="modern contraception", keywords="family planning", abstract="Background: Unmet need for family planning in Pakistan is high, with 17\% of all married women wanting to avoid or delay pregnancy. However, they cannot owing to a lack of access to modern contraception and sociocultural hindrances. With the modern contraceptive prevalence rate stagnant at approximately 25\% over the last 5 years, it is important to explore barriers and enablers to modern contraception uptake to reduce maternal and child mortality and improve reproductive health outcomes for young girls and women. Objective: A formative research approach was taken to explore community member and health care provider perspectives on access to and use of family planning methods in 2 rural districts of Sindh, Pakistan. The broader goal of this study was to provide evidence to design and implement a socioculturally appropriate family planning intervention within the existing service delivery platforms to increase modern contraceptive uptake in the context of rural Sindh. Methods: A qualitative exploratory design was used. Between October 2020 and December 2020, 11 focus group discussions and 11 in-depth interviews were conducted. Focus group discussions were held with men and women from the community, including adolescents, to build an understanding of community beliefs and concepts regarding modern contraceptive methods. In-depth interviews were conducted with health care workers and explored intersections between family planning and reproductive health service delivery at the facility and outreach levels. Results: The findings revealed that limited financial autonomy, restricted women's mobility, discriminatory gender norms, and cultural practices left women with little opportunity for independent decision-making on the use of modern contraceptive methods. Furthermore, facility-level and supply-side barriers, including frequent stock-outs of modern contraceptives combined with a lack of capacity of health workers to provide quality family planning services and counseling, played an important role in demotivating women from seeking services. In addition, a lack of integration of family planning with maternal and child health service delivery at the health system level was emphasized as a major missed opportunity for contraceptive uptake. Several demand-side barriers to family planning uptake were also highlighted. These included husbands' or in-laws' disapproval, social stigma, and perceived fear of side effects regarding modern family planning method use. More importantly, a lack of adolescent-friendly reproductive health services and spaces for counseling was identified as a critical intervention area. Conclusions: This study provides qualitative evidence on issues related to the effectiveness of family planning interventions, specifically in the context of rural Sindh. The findings emphasize the need to design socioculturally appropriate and health system--relevant family planning interventions---the effectiveness of which can be improved through their integration with maternal and child health service delivery mechanisms, consistent service provision, and opportunities for the capacity building of the health care workforce. International Registered Report Identifier (IRRID): RR2-10.2196/35291 ", doi="10.2196/43494", url="https://formative.jmir.org/2023/1/e43494", url="http://www.ncbi.nlm.nih.gov/pubmed/36897626" } TY - JOUR AU - Nwoke, Nmanma Chinenye AU - Awosoga, A. Oluwagbohunmi AU - McDonald, Sheila AU - Bonifacio, T. Glenda AU - Leung, Y. Brenda M. PY - 2023/2/20 TI - Prevalence and Associated Factors of Maternal Depression and Anxiety Among African Immigrant Women in Alberta, Canada: Quantitative Cross-sectional Survey Study JO - JMIR Form Res SP - e43800 VL - 7 KW - African women KW - immigrant women KW - mental health KW - pregnancy KW - postpartum health KW - depression KW - anxiety N2 - Background: Although there is a significant body of evidence on maternal mental health, an inadequate focus has been placed on African immigrant women. This is a significant limitation given the rapidly changing demographics in Canada. The prevalence of maternal depression and anxiety among African immigrant women in Alberta and Canada, as well as the associated risk factors, are not well understood and remain largely unknown. Objective: The purpose of this study was to investigate the prevalence and associated factors of maternal depression and anxiety among African immigrant women living in Alberta, Canada up to 2 years postpartum. Methods: This cross-sectional study surveyed 120 African immigrant women within 2 years of delivery in Alberta, Canada from January 2020 to December 2020. The English version of the Edinburgh Postnatal Depression Scale-10 (EPDS-10), the Generalized Anxiety Disorder-7 (GAD-7) scale, and a structured questionnaire regarding associated factors were administered to all participants. A cutoff score of 13 on the EPDS-10 was indicative of depression, while a cutoff score of 10 on the GAD-7 scale was indicative of anxiety. Multivariable logistic regression was used to determine the factors significantly associated with maternal depression and anxiety. Results: Among the 120 African immigrant women, 27.5% (33/120) met the EPDS-10 cutoff score for depression and 12.1% (14/116) met the GAD-7 cutoff score for anxiety. The majority of respondents with maternal depression were younger (18/33, 56%), had a total household income of CAD $60,000 or more (US $45,000 or more; 21/32, 66%), rented their homes (24/33, 73%), had an advanced degree (19/33, 58%), were married (26/31, 84%), were recent immigrants (19/30, 63%), had friends in the city (21/31, 68%), had a weak sense of belonging in the local community (26/31, 84%), were satisfied with their settlement process (17/28, 61%), and had access to a regular medical doctor (20/29, 69%). In addition, the majority of respondents with maternal anxiety were nonrecent immigrants (9/14, 64%), had friends in the city (8/13, 62%), had a weak sense of belonging in the local community (12/13, 92%), and had access to a regular medical doctor (7/12, 58%). The multivariable logistic regression model identified demographic and social factors significantly associated with maternal depression (maternal age, working status, presence of friends in the city, and access to a regular medical doctor) and maternal anxiety (access to a regular medical doctor and sense of belonging in the local community). Conclusions: Social support and community belonging initiatives may improve the maternal mental health outcomes of African immigrant women. Given the complexities immigrant women face, more research is needed on a comprehensive approach for public health and preventive strategies regarding maternal mental health after migration, including increasing access to family doctors. UR - https://formative.jmir.org/2023/1/e43800 UR - http://dx.doi.org/10.2196/43800 UR - http://www.ncbi.nlm.nih.gov/pubmed/36808093 ID - info:doi/10.2196/43800 ER - /2023/1/e43800", url="http://www.ncbi.nlm.nih.gov/pubmed/36808093" } @Article{info:doi/10.2196/41193, author="Holtz, Bree and Mitchell, Katharine", title="Supporting Parents of Children With Type 1 Diabetes: Experiment Comparing Message and Delivery Types", journal="JMIR Form Res", year="2023", month="Feb", day="3", volume="7", pages="e41193", keywords="caregiving", keywords="children", keywords="development", keywords="diabetes", keywords="diagnosis", keywords="effectiveness", keywords="email", keywords="intervention", keywords="management", keywords="social support", keywords="stress", keywords="support", keywords="type 1 diabetes", abstract="Background: Type 1 diabetes (T1D) is a chronic condition that typically affects young age group people and is estimated to afflict approximately 154,000 people younger than 20 years in the United States. Since T1D typically impacts children, parents must play an active role in helping their child manage the condition. This creates a substantial burden and responsibility for the parents. Objective: This pilot study sought to find ways to help parents with children with T1D in coping with stresses related to managing and monitoring their child's disease by providing informational support, either about parenting a child with T1D or general parenting messages through different channels. Methods: Parents (N=120) of children with T1D were recruited through an email listserv through local T1D Facebook groups. A total of 102 participants were included in the analysis. We conducted a 2{\texttimes}2 experimental study over an 8-week period to test 2 types of messages (diabetes specific vs general parenting) and the medium in which the messages were delivered (Facebook vs SMS text message). Diabetes behavior, informational support, emotional support, and quality of life were the main outcomes of interest. Results: The results suggested that the participants in the diabetes message groups showed improvement in diabetes behaviors (F1,99=3.69; P=.05) and were more satisfied with the intervention (F3,98=4.59; P=.005). There were no differences between message and medium groups on informational support, emotional support, or quality of life. Conclusions: The results of this study demonstrate that the medium---Facebook or SMS text messaging---does not matter for parents' perceptions of social support or quality of life. The diabetes message group reported higher levels of disease management. Finally, the groups with the diabetes support messages were more satisfied than those who received general parenting messages. The findings provide starting guidance for the development of social support interventions for this population. ", doi="10.2196/41193", url="https://formative.jmir.org/2023/1/e41193", url="http://www.ncbi.nlm.nih.gov/pubmed/36735338" } @Article{info:doi/10.2196/39226, author="Luetke Lanfer, Hanna and Brew-Sam, Nicola and Rossmann, Constanze", title="An Analysis of Power Dynamics Affecting Handwashing Interventions in Sierra Leone: Findings From a Qualitative Participatory Study", journal="JMIR Form Res", year="2023", month="Jan", day="27", volume="7", pages="e39226", keywords="participatory approaches", keywords="health promotion", keywords="handwashing", keywords="power dynamics", keywords="Sierra Leone", abstract="Background: Handwashing is an effective and cost-efficient health behavior for preventing infectious diseases; however, its practice is shaped by multiple contextual factors and inequalities between different social groups in Sierra Leone. To address these inequalities, participatory approaches that allow a more equitable distribution of resources and the development of locally tailored interventions are increasingly used. However, social power dynamics have not been well integrated into the concept of participation, despite their known impact. Objective: We sought to investigate the role of power dynamics in participatory approaches to handwashing in Sierra Leone. Methods: From a socio-ecological perspective, this qualitative, formative interview study aimed to identify relevant actors and their power relationships before designing a participatory handwashing project in rural Sierra Leone. A field experiment with focus groups and a research diary compared the development of power dynamics in a participatory, community-driven approach with that in a nonparticipatory top-down approach. Results: According to our formative study, in community-based projects, multiple groups and actors interact directly or indirectly with each other, located within a macro level (eg, political institutions), meso level (eg, community leaders and groups), and micro level (eg, families) of a socio-ecological model. Although distinct leadership structures were noticeable and affected intervention attendance and processes of change in nonparticipatory approaches, community-led activities and handwashing increased in the participatory approach, irrespective of the leadership structure. Despite their ambivalence, the strategic inclusion of different community leaders appeared essential to enhance the value of the project, mobilize creative action, and empower lower-ranking individuals to practice handwashing. A similar ambivalent role could be observed in relation to external researchers, especially if they come from a different cultural background than the research participants, for example, from a Western country in a non-Western project setting. Although external researchers can initiate a project or provide certain resources, distinct expectations regarding their roles and resources can impact participatory efforts and power relations. Conclusions: The results highlight the advantages of participatory approaches for health promotion. Power dynamics should be a core component of continuous reflection and analysis in participatory projects. ", doi="10.2196/39226", url="https://formative.jmir.org/2023/1/e39226", url="http://www.ncbi.nlm.nih.gov/pubmed/36705952" } @Article{info:doi/10.2196/41820, author="Shu, Chang and Chen, Yueyue and Yang, Huiyuan and Tao, Ran and Chen, Xiaoping and Yu, Jingjing", title="Investigation and Countermeasures Research of Hospital Information Construction of Tertiary Class-A Public Hospitals in China: Questionnaire Study", journal="JMIR Form Res", year="2023", month="Jan", day="20", volume="7", pages="e41820", keywords="public hospital", keywords="hospital information construction", keywords="current situation", keywords="development", keywords="countermeasures", abstract="Background: Medical informatization has initially demonstrated its advantages in improving the medical service industry. Over the past decade, the Chinese government have made a lot of effort to complete infrastructural information construction in the medical and health domain, and smart hospitals will be the next priority according to policies released by Chinese government in recent years. Objective: To provide strategic support for further development of medical information construction in China, this study aimed to investigate the current situation of medical information construction in tertiary class-A public hospitals and analyze the existing problems and countermeasures. Methods: This study surveyed 23 tertiary class-A public hospitals in China who voluntarily responded to a self-designed questionnaire distributed in April 2020 to investigate the current medical information construction status. Descriptive statistics were used to summarize the current configurations of hospital information department, hospital information systems, hospital internet service and its application, and the satisfaction of hospital information construction. Interviews were also conducted with the respondents in this study for requirement analysis. Results: The results show that hospital information construction has become one of the priorities of the hospitals' daily work, and the medical information infrastructural construction and internet service application of the hospitals are good; however, a remarkable gap among the different level of hospitals can be observed. Although most hospitals had built their own IT team to undertake information construction work, the actual utilization rate of big data collected and stored in the hospital information system was not satisfactory. Conclusions: Support for the construction of information technology in primary care institutions should be increased to balance the level of development of medical informatization in medical institutions at all levels. The training of complex talents with both IT and medical backgrounds should be emphasized, and specialized disease information standards should be developed to lay a solid data foundation for data utilization and improve the utilization of medical big data. ", doi="10.2196/41820", url="https://formative.jmir.org/2023/1/e41820", url="http://www.ncbi.nlm.nih.gov/pubmed/36662565" } @Article{info:doi/10.2196/37344, author="Song, Liping and Yu, Xiangyuan and Su, Bing and Geng, Kui Wen and Lan, Guanghua and Zhang, Xiangjun", title="HIV Prevalence and Risk Factors Among Young Men Who Have Sex With Men in Southwest China: Cross-sectional Questionnaire Study", journal="JMIR Form Res", year="2023", month="Jan", day="11", volume="7", pages="e37344", keywords="HIV", keywords="young men who have sex with men", keywords="syphilis", keywords="sexually transmitted infection", keywords="ethnic minority", abstract="Background: Previous studies showed an increase in HIV prevalence among young men who have sex with men aged 25 years or younger in China. Objective: This study aimed to assess HIV prevalence and associated factors among young men who have sex with men in the Guangxi Zhuang Autonomous Region. Methods: This study was conducted in 4 cities (Guilin, Liuzhou, Beihai, and Nanning) in the Guangxi Zhuang Autonomous Region between June 2014 and May 2016. Participants were reached through web-based and site recruitment approaches. Laboratory tests were performed to detect HIV and syphilis infections. A self-administered questionnaire was used to collect data from 632 eligible young men who have sex with men. Results: The prevalence of HIV and syphilis was 9.3\% (59/632) and 11.4\% (72/632), respectively. Multivariable logistic analysis showed that ethnic minority (adjusted odds ratio [AOR] for Han Chinese vs other minorities 0.28, 95\% CI 0.11-0.71, P=.007), receptive sexual positioning in the past 6 months (AOR 2.94, 95\% CI 1.32-6.53, P=.008), current syphilis infection (AOR for individuals without vs those with infection 0.38, 95\% CI 0.19-0.75, P=.005), inconsistent condom use in the past 6 months (AOR 1.91, 95\% CI 1.06-3.45, P=.03), and psychotropic drug use before last anal intercourse (AOR 16.70, 95\% CI 2.34-119.18, P=.005) were independently associated with HIV infection. Conclusions: There is an urgent need to scale up HIV and syphilis interventions in young men who have sex with men. Some subgroups might need specific attention for HIV prevention, including ethnic minority men, individuals with a history of sexually transmitted infections, and individuals who have been engaging in receptive anal sex. ", doi="10.2196/37344", url="https://formative.jmir.org/2023/1/e37344", url="http://www.ncbi.nlm.nih.gov/pubmed/36630166" } @Article{info:doi/10.2196/39947, author="Xu, Jie and Lu, Lu and Xing, Kaichen and Shi, Huwei and Chen, Ruiyao and Yao, Yujun and Liu, Sichen and Xiao, Zhongzhou and Peng, Xinwei and Luo, Shuqing and Zhong, Yun", title="Theoretical Approach and Scale Construction of Patient Privacy Protection Behavior of Doctors in Public Medical Institutions in China: Pilot Development Study", journal="JMIR Form Res", year="2022", month="Dec", day="14", volume="6", number="12", pages="e39947", keywords="scale", keywords="Chinese public medical institutions", keywords="doctors' protection behavior of patients' privacy", abstract="Background: Considering the high incidence of medical privacy disclosure, it is of vital importance to study doctors' privacy protection behavior and its influencing factors. Objective: We aim to develop a scale for doctors' protection of patients' privacy in Chinese public medical institutions, following construction of a theoretical model framework through grounded theory, and subsequently to validate the scale to measure this protection behavior. Methods: Combined with the theoretical paradigm of protection motivation theory (PMT) and semistructured interview data, the grounded theory research method, followed by the Delphi expert and group discussion methods, a theoretical framework and initial scale for doctors in Chinese public medical institutions to protect patients' privacy was formed. The adjusted scale was collected online using a WeChat electronic survey measured using a 5-point Likert scale. Exploratory and confirmatory factor analysis (EFA and CFA) and tests to analyze reliability and validity were performed on the sample data. SPSS 19.0 and Amos 26.0 statistical analysis software were used for EFA and CFA of the sample data, respectively. Results: According to the internal logic of PMT, we developed a novel theoretical framework of a ``storyline,'' which was a process from being unaware of patients' privacy to having privacy protection behavior, that affected doctors' cognitive intermediary and changed the development of doctors' awareness, finally affecting actual privacy protection behavior in Chinese public medical institutions. Ultimately, we created a scale to measure 18 variables in the theoretical model, comprising 63 measurement items, with a total of 208 doctors participating in the scaling survey, who were predominantly educated to the master's degree level (n=151, 72.6\%). The department distribution was relatively balanced. Prior to EFA, the Kaiser-Meyer-Olkin (KMO) value was 0.702, indicating that the study was suitable for factor analysis. The minimum value of Cronbach $\alpha$ for each study variable was .754, which met the internal consistency requirements of the scale. The standard factor loading value of each potential measurement item in CFA had scores greater than 0.5, which signified that all the items in the scale could effectively converge to the corresponding potential variables. Conclusions: The theoretical framework and scale to assess doctors' patient protection behavior in public medical institutions in China ?lls a significant gap in the literature and can be used to further the current knowledge of physicians' thought processes and adoption decisions. ", doi="10.2196/39947", url="https://formative.jmir.org/2022/12/e39947", url="http://www.ncbi.nlm.nih.gov/pubmed/36515996" } @Article{info:doi/10.2196/37101, author="Huang, Heyin and Wang, Yichen and Zhang, Lanzhi and Zhang, Qinxiu and Wu, Xiaojuan and He, Hengsheng", title="Psychological Disorders of Patients With Allergic Rhinitis in Chengdu, China: Exploratory Research", journal="JMIR Form Res", year="2022", month="Nov", day="10", volume="6", number="11", pages="e37101", keywords="psychological disorders", keywords="allergic rhinitis", keywords="Chengdu", keywords="China", abstract="Background: The number of patients with allergic rhinitis (AR) has exceeded 500 million worldwide due to the unstable curative effect that can easily produce mental and psychological disorders. However, most of the relevant existing literature is one-on-one retrospective analyses or targeted meta-analyses of AR with psychological disorders like irritability, depression, and anxiety, while ``multi-hospital + interdisciplinary'' multiple regression analyses are scarce. Objective: This study aims to precisely identify the psychological disorders of patients with AR who were diagnosed and treated in the five most renowned hospitals in Chengdu, China over the past 5 years using 10 classification methods so as to attract attention and care from otolaryngologists. Methods: The Symptom Checklist 90 (SCL-90) was used to group and score the mental state of 827 strictly screened patients with AR according to 9 classification criteria. The scores were then compared within groups. Intergroup comparisons were made between the study group and the Chinese norm, and the positive factors for psychological disorders were extracted. Four symptoms in the study group, that is, nasal itching, sneezing, clear discharge, and nasal congestion, were scored on a visual analog scale. Partial correlation analysis was performed between the extracted positive factors for psychological disorders and the symptom scores by the multiple regression statistical method. Results: Among 827 patients, 124 (15\%) had no mental health impairments, 176 (21.3\%) had mild impairments, 474 (57.3\%) had mild to moderate impairments, 41 (5\%) had moderate to severe impairments, and 12 (1.4\%) had severe impairments. The average score of the SCL-90 for all 827 patients was 2.64 (SD 0.25), which corresponded to mild to moderate mental health impairments. The 827 patients scored significantly higher for the 4 positive factors: depression, anxiety, psychosis, and other (sleep, diet). Depression was positively correlated with sneezing and clear discharge, anxiety was positively correlated with nasal itching and congestion, psychosis was positively correlated with nasal itching and sneezing, and other (sleep, diet) was positively correlated with clear discharge and nasal congestion. Conclusions: Patients with AR have mild to moderate mental health impairments, with women and those with abnormal BMI, aged ?45 years, with a monthly salary <{\textyen}5110 (US \$700), with a disease duration <13 years, residing in urban areas, with a high school or above education, or who are indoor laborers being at high risk and requiring more care, follow-up, and comprehensive therapy from otolaryngologists. ", doi="10.2196/37101", url="https://formative.jmir.org/2022/11/e37101", url="http://www.ncbi.nlm.nih.gov/pubmed/36355407" } @Article{info:doi/10.2196/34268, author="Kuroki, Makoto and Yamamoto, Kiyoshi and Goldfinch, Shaun", title="Factors Influencing the Adoption of Voluntary Nonpharmaceutical Interventions to Control COVID-19 in Japan: Cross-sectional Study", journal="JMIR Form Res", year="2022", month="Aug", day="2", volume="6", number="8", pages="e34268", keywords="COVID-19", keywords="nonpharmaceutical interventions", keywords="social distancing", keywords="phone tracing", keywords="trust in government", keywords="confidence in scientists", abstract="Background: Trust in government is seen to facilitate crisis management and policy instrument adoption across numerous studies. However, in Japan, public support for government handling of the COVID-19 pandemic and trust in the government is low, yet the adoption of voluntary nondigital nonpharmaceutical interventions (NPIs) is high. This is an important tension this study seeks to unravel. Objective: The aim of this study is to understand the antecedents of nondigital NPI and tracking app adoption in the COVID-19 pandemic in Japan. Methods: A commercial company was contracted to deliver an online survey of 1248 Japanese citizens in December 2020. A quota technique was used to deliver a sample representative in terms of gender, age, residence, income, and education. Results: The adoption of voluntary nondigital NPIs is predicted by confidence in public health scientists and a favoring of infection control over reducing economic and social costs. A novel and unexpected finding is that trust in government does not predict nondigital NPI use. Perceived risk and knowledge of infection did not increase the use of nondigital NPIs. Education and income were not significant factors, although female and older respondents demonstrated greater compliance. For the adoption of a phone tracking app, trust in government is important, as is urban residence, albeit with a lower use of the app compared to nondigital NPIs. Conclusions: Voluntary compliance in the adoption of nondigital NPIs---if skillfully led by trusted scientific experts and in accord with societal norms---can be effectively achieved. We provide evidence that trust in government is effective in encouraging the use of the Japanese tracking app. Moreover, the technical efficacy of digital initiatives and perceptions of such will unsurprisingly affect citizen support and use of digital tools. ", doi="10.2196/34268", url="https://formative.jmir.org/2022/8/e34268", url="http://www.ncbi.nlm.nih.gov/pubmed/35916697" } @Article{info:doi/10.2196/34044, author="Williams, A. Kofoworola D. and Dougherty, A. Sharyn and Lattie, G. Emily and Guidry, D. Jeanine P. and Carlyle, E. Kellie", title="Examining Hashtag Use of \#blackboyjoy and \#theblackmancan and Related Content on Instagram: Descriptive Content Analysis", journal="JMIR Form Res", year="2022", month="Aug", day="1", volume="6", number="8", pages="e34044", keywords="Black/African American men", keywords="mental health prevention", keywords="social media", keywords="Instagram", keywords="hashtags", keywords="content analysis", keywords="Black masculinity", abstract="Background: Social media is widely accessible and increasingly utilized. Social media users develop hashtags and visual, text-based imagery to challenge misrepresentations, garner social support, and discuss a variety of mental health issues. Understanding how Black men are represented on social media and are using social media may be an avenue for promoting their engagement with and uptake of digital mental health interventions. Objective: The aim of this study was to conduct a content analysis of posts containing visual and text-based components related to representations of Black men's race, gender, and behaviors. Methods: An exploratory, descriptive content analysis was conducted for 500 Instagram posts to examine characteristics, content, and public engagement of posts containing the hashtags \#theblackmancan and \#blackboyjoy. Posts were selected randomly and extracted from Instagram using a social network mining tool during Fall 2018 and Spring 2019. A codebook was developed, and all posts were analyzed by 2 independent coders. Analyses included frequency counts and descriptive analysis to determine content and characteristics of posts. Mann-Whitney U tests and Kruskal-Wallis H tests were conducted to assess engagement associated with posts via likes, comments, and video views. Results: Of the 500 posts extracted, most were image based (368/500, 73.6\%), 272/500 (54.4\%) were posted by an individual and 135/500 (27.0\%) by a community organization, 269/500 (53.8\%) were posted by individuals from Black populations, and 177/500 (35.4\%) posts contained images of only males. Posts depicted images of Black men as fathers (100/500, 20.0\%), Black men being celebrated (101/500, 20.2\%), and Black men expressing joy (217/500, 43.4\%). Posts (127/500, 25.4\%) also depicted Black men in relation to gender atypical behavior, such as caring for children or styling their children's hair. Variables related to education and restrictive affection did not show up often in posts. Engagement via likes (median 1671, P<.001), comments (P<.001), and views (P<.001) for posts containing \#theblackmancan was significantly higher compared with posts containing \#blackboyjoy (median 140). Posts containing elements of celebrating Black men (P=.02) and gender atypical behavior (P<.001) also had significantly higher engagement. Conclusions: This is one of the first studies to look at hashtag use of \#blackboyjoy and \#theblackmancan. Posts containing \#blackboyjoy and \#theblackmancan promoted positive user-generated visual and text-based content on Instagram and promoted positive interactions among Black and diverse communities. With the popularity of social media and hashtag use increasing, researchers and future interventional research should investigate the potential for such imagery to serve as culturally relevant design components for digital mental health prevention efforts geared towards Black men and the communities they exist and engage with. ", doi="10.2196/34044", url="https://formative.jmir.org/2022/8/e34044", url="http://www.ncbi.nlm.nih.gov/pubmed/35916699" } @Article{info:doi/10.2196/37189, author="Reszel, Jessica and van den Hoek, Joan and Nguyen, Tram and Aravind, Gayatri and Bayley, T. Mark and Bird, Marie-Louise and Edwards, Kate and Eng, J. Janice and Moore, L. Jennifer and Nelson, A. Michelle L. and Ploughman, Michelle and Richardson, Julie and Salbach, M. Nancy and Tang, Ada and Graham, D. Ian", title="The Stroke Recovery in Motion Implementation Planner: Mixed Methods User Evaluation", journal="JMIR Form Res", year="2022", month="Jul", day="29", volume="6", number="7", pages="e37189", keywords="stroke", keywords="rehabilitation", keywords="community-based exercise programs", keywords="knowledge translation", keywords="knowledge mobilization", keywords="implementation science", abstract="Background: As more people are surviving stroke, there is a growing need for services and programs that support the long-term needs of people living with the effects of stroke. Exercise has many benefits; however, most people with stroke do not have access to specialized exercise programs that meet their needs in their communities. To catalyze the implementation of these programs, our team developed the Stroke Recovery in Motion Implementation Planner, an evidence-informed implementation guide for teams planning a community-based exercise program for people with stroke. Objective: This study aimed to conduct a user evaluation to elicit user perceptions of the usefulness and acceptability of the Planner to inform revisions. Methods: This mixed methods study used a concurrent triangulation design. We used purposive sampling to enroll a diverse sample of end users (program managers and coordinators, rehabilitation health partners, and fitness professionals) from three main groups: those who are currently planning a program, those who intend to plan a program in the future, and those who had previously planned a program. Participants reviewed the Planner and completed a questionnaire and interviews to identify positive features, areas of improvement, value, and feasibility. We used descriptive statistics for quantitative data and content analysis for qualitative data. We triangulated the data sources to identify Planner modifications. Results: A total of 39 people participated in this study. Overall, the feedback was positive, highlighting the value of the Planner's comprehensiveness, tools and templates, and real-world examples. The identified areas for improvement included clarifying the need for specific steps, refining navigation, and creating more action-oriented content. Most participants reported an increase in knowledge and confidence after reading the Planner and reported that using the resource would improve their planning approach. Conclusions: We used a rigorous and user-centered process to develop and evaluate the Planner. End users indicated that it is a valuable resource and identified specific changes for improvement. The Planner was subsequently updated and is now publicly available for community planning teams to use in the planning and delivery of evidence-informed, sustainable, community-based exercise programs for people with stroke. ", doi="10.2196/37189", url="https://formative.jmir.org/2022/7/e37189", url="http://www.ncbi.nlm.nih.gov/pubmed/35904870" } @Article{info:doi/10.2196/32892, author="Powell, C. Adam and Long, W. James and Deshmukh, U. Uday and Simmons, D. Jeffrey", title="The Association Between the Use of Low-Slice Computed Tomography Machines and Downstream Care: Comparative Study of 16-Slice and 64-Slice Computed Tomography Angiography", journal="JMIR Form Res", year="2022", month="Jun", day="30", volume="6", number="6", pages="e32892", keywords="computed tomography", keywords="tomography", keywords="diagnostic imaging", keywords="outpatient", keywords="angiography", keywords="obsolescence", keywords="computed tomography angiography of the neck", keywords="neck", keywords="low-slice computed tomography", keywords="cervicocerebral angiography", keywords="downstream testing", keywords="computed tomography machine", keywords="invasive testing", keywords="machine", keywords="testing", keywords="invasive", abstract="Background: Although computed tomography (CT) studies on machines with more slices have reported higher positive and negative predictive values, the impact of using low-slice (16-slice) CT machines on downstream testing has not been well studied. In community outpatient settings, low-slice CT machines remain in use, although many hospitals have adopted higher-slice machines. Objective: This study examines the association between the use of low-slice CT machines and downstream invasive testing in the context of the CT angiography of the neck. Methods: Included health insurance claims pertained to adults with commercial or Medicare Advantage health plans who underwent the CT angiography of the neck. Site certification data were used to assign counts of slices to claims. Claims that were made in the 60 days after CT were examined for cervicocerebral angiography. The association between the number of slices and cervicocerebral angiography was evaluated by using a chi-square test and multivariate logistic regression. Results: Claims for 16-slice CT had a 5.1\% (33/641) downstream cervicocerebral angiography rate, while claims for 64-slice CT had a 3.1\% (35/1125) rate, and a significant difference (P=.03) was observed. An analysis that was adjusted for patient demographics also found a significant relationship (odds ratio 1.64, 95\% CI 1.00-2.69; P=.047). Conclusions: The use of low-slice CT machines in the community may impact the quality of care and result in more downstream testing. ", doi="10.2196/32892", url="https://formative.jmir.org/2022/6/e32892", url="http://www.ncbi.nlm.nih.gov/pubmed/35771601" } @Article{info:doi/10.2196/36354, author="Elliott, A. Sarah and Wright, S. Kelsey and Scott, D. Shannon and Mohamed, Muna and Farah, Asha and Hartling, Lisa", title="Adapting Child Health Knowledge Translation Tools for Somali Parents: Qualitative Study Exploring Process Considerations and Stakeholder Engagement", journal="JMIR Form Res", year="2022", month="Apr", day="4", volume="6", number="4", pages="e36354", keywords="knowledge translation", keywords="cultural adaptation", keywords="trust", keywords="linguistics", keywords="parents", keywords="child health", abstract="Background: We have developed a series of knowledge translation (KT) tools that integrate parental experiences to communicate evidence-based information about acute childhood health conditions to parents and caregivers. While we created these tools with parent input, it is unclear if they are useful for diverse parent groups, including specific immigrant and refugee groups in Canada. Objective: This study aims to explore the usefulness of our preexisting KT tools within our local Somali community, and understand what cultural and linguistic adaptations could improve their usability. Methods: After viewing 4 KT tools (differing in design and format) about various acute child health conditions, health care providers (HCPs) and knowledge brokers (KBs) who work with Somali families were interviewed about the usability of these tools and discussed considerations for adapting KT tools for use within the Somali community. Results: A total of 13 HCPs and KBs participated and indicated that the Somali community values accessibility, representation, and the role of trusted others in delivering effective KT products. Understanding accessibility barriers, the power of adequate representation, and engaging meaningfully with prominent community leaders were key suggestions for ensuring relevance of KT products and uptake by community members. Conclusions: This study represents an essential piece of understanding processes for adapting or developing KT products for culturally and linguistically diverse communities. ", doi="10.2196/36354", url="https://formative.jmir.org/2022/4/e36354", url="http://www.ncbi.nlm.nih.gov/pubmed/35377330" } @Article{info:doi/10.2196/34258, author="Raptis, Aristotle Dimitri and Raptis, Aristotle and Tinguely, Pascale and ", title="A Platform (Authorships.org) for the Objective Qualification and Order of Academic Authorship in Medical and Science Journals: Development and Evaluation Study Using the Design Science Research Methodology", journal="JMIR Form Res", year="2022", month="Mar", day="17", volume="6", number="3", pages="e34258", keywords="authorship", keywords="writing", keywords="dissent and disputes", keywords="research ethics", keywords="software design", abstract="Background: The qualification and order of authorship in scientific manuscripts are the main disputes in collaborative research work. Objective: The aim of this project was to develop an open-access web-based platform for objective decision-making of authorship qualification and order in medical and science journals. Methods: The design science process methodology was used to develop suitable software for authorship qualification and order. The first part of the software was designed to differentiate between qualification for authorship versus acknowledgment, using items of the recommendations of the International Committee of Medical Journal Editors. The second part addressed the order of authorship, using the analytical hierarchy process for objective multiple criteria decision-making and ranking. The platform was evaluated qualitatively (n=30) and quantitatively (n=18) using a dedicated questionnaire, by an international panel of medical and biomedical professionals and research collaborators worldwide. Results: Authorships.org represents an open-access software compatible with all major platforms and web browsers. Software usability and output were evaluated and presented for 3 existing clinical and biomedical research studies. All 18 international evaluators felt that the Authorships.org platform was easy to use or remained neutral. Moreover, 59\% (n=10) were satisfied with the software output results while the rest were unsure, 59\% (n=10) would definitely use it for future projects while 41\% (n=7) would consider it, 94\% (n=16) felt it may prove useful to eliminate disputes regarding authorship, 82\% (n=14) felt that it should become mandatory for manuscript submission to journals, and 53\% (n=9) raised concerns regarding the potential unethical use of the software as a tool. Conclusions: Authorships.org allows transparent evaluation of authorship qualification and order in academic medical and science journals. Objectified proof of authorship contributions may become mandatory during manuscript submission in high-quality academic journals. ", doi="10.2196/34258", url="https://formative.jmir.org/2022/3/e34258", url="http://www.ncbi.nlm.nih.gov/pubmed/35298392" } @Article{info:doi/10.2196/34029, author="Ozieh, N. Mukoso and Egede, E. Leonard", title="A Lifestyle Intervention to Delay Early Chronic Kidney Disease in African Americans With Diabetic Kidney Disease: Pre-Post Pilot Study", journal="JMIR Form Res", year="2022", month="Mar", day="15", volume="6", number="3", pages="e34029", keywords="type 2 diabetes mellitus", keywords="chronic kidney insufficiency", keywords="healthy lifestyle", keywords="outcomes research", keywords="African Americans", keywords="quasiexperimental study", abstract="Background: Behavioral factors, such as lifestyle, have been shown to explain approximately 24\% of the excess risk of chronic kidney disease (CKD) among African Americans. However, there are limited intervention studies culturally tailored to African Americans with type 2 diabetes mellitus and CKD. Objective: The main objective of this study was to examine the feasibility and preliminary efficacy of a culturally tailored lifestyle intervention among African Americans with type 2 diabetes mellitus and CKD. Methods: A pre-post design was used to test the feasibility of a lifestyle intervention in 30 African American adults recruited from the Medical University of South Carolina between January 2017 and February 2017. A research nurse delivered the manualized study intervention weekly for 6 weeks. Clinical outcomes (hemoglobin A1c, blood pressure, and estimated glomerular filtration rate [eGFR]) were measured at baseline and postintervention. Disease knowledge, self-care, and behavior outcomes were also measured using validated structured questionnaires at baseline and postintervention. Descriptive statistics and effect sizes were calculated to determine clinically important changes from baseline. Results: Significant pre-post mean differences and decreases were observed for hemoglobin A1c (mean 0.75\%, 95\% CI 0.16-1.34; P=.01), total cholesterol (mean 16.38 mg/dL, 95\% CI 5.82-26.94; P=.004), low-density lipoprotein (mean 13.73 mg/dL, 95\% CI 3.91-23.54; P=.008), and eGFR (mean 6.73 mL/min/1.73m2, 95\% CI 0.97-12.48; P=.02). Significant pre-post mean differences and increases were observed for CKD self-efficacy (mean ?11.15, 95\% CI ?21.55 to ?0.75; P=.03), CKD knowledge (mean ?2.62, 95\% CI ?3.98 to ?1.25; P<.001), exercise behavior (mean ?1.21, 95\% CI ?1.96 to ?0.46; P=.003), and blood sugar testing (mean ?2.15, 95\% CI ?3.47 to ?0.83; P=.003). Conclusions: This study provides preliminary data for a large-scale appropriately powered randomized controlled trial to examine a culturally tailored lifestyle intervention in African Americans with type 2 diabetes mellitus and CKD in order to improve clinical, knowledge, self-care, and behavior outcomes in this population. ", doi="10.2196/34029", url="https://formative.jmir.org/2022/3/e34029", url="http://www.ncbi.nlm.nih.gov/pubmed/35289751" } @Article{info:doi/10.2196/27286, author="Joseph, Gili and Schori, Hadas", title="The Beneficial Effect of the First COVID-19 Lockdown on Undergraduate Students of Education: Prospective Cohort Study", journal="JMIR Form Res", year="2022", month="Feb", day="23", volume="6", number="2", pages="e27286", keywords="sleep quality", keywords="exercise", keywords="well-being", keywords="undergraduate students", keywords="COVID-19 lockdown", keywords="COVID-19", abstract="Background: The COVID-19 pandemic has been spreading consistently since the beginning of 2020. On February 27, 2020, the first patient with coronavirus was diagnosed in Israel. On March 14, 2020, the Israeli government declared a general lockdown that lasted about a month, which altered the lives of the entire population. Objective: The objective of this paper is to evaluate the change in the well-being, physical activity, and sleep quality of undergraduate students of education at 2 time points: before (November 2019) and during (April 2020) the first COVID-19 lockdown. Methods: In total, 533 undergraduate students of education submitted an online questionnaire before the lockdown and at its end. The questionnaire comprised 4 parts: a (1) sociodemographic and (2) weekly exercise questionnaire taken from the International Physical Activity Questionnaire--Short Form; (3) sleep quality, rated using the Mini Sleep Questionnaire; and (4) well-being, rated using the short version of the Mental Health Inventory. This was a pre-post prospective cohort questionnaire study. Results: It was predicted that there would be a decrease in the aforementioned parameters. Contrary to all expectations, an increase was observed in all 3. Results showed that during the lockdown, there was an increase in the level of exercise students engaged in. Overall, 102 (61.4\%) of 166 students engaged in a greater amount of physical activity during the COVID-19 lockdown compared to 150 (40.9\%) of 367 students who engaged in a greater amount of physical activity before COVID-19. Levels of sleep quality (mean 5.34 [SD 0.92] vs mean 5.12 [SD 0.46], P=.02) and well-being (mean 3.79 [SD 0.62] vs mean 3.67 [SD 0.59], P=.02) were also higher during the COVID-19 lockdown. Conclusions: These findings indicate that undergraduate students seem to have taken advantage of the change in lifestyle due to the lockdown, directing the free time toward improving health by engaging in more physical activity, thus improving sleep quality and well-being. ", doi="10.2196/27286", url="https://formative.jmir.org/2022/2/e27286", url="http://www.ncbi.nlm.nih.gov/pubmed/35072635" } @Article{info:doi/10.2196/34966, author="Nakayama, Kazuhiro and Yonekura, Yuki and Danya, Hitomi and Hagiwara, Kanako", title="COVID-19 Preventive Behaviors and Health Literacy, Information Evaluation, and Decision-making Skills in Japanese Adults: Cross-sectional Survey Study", journal="JMIR Form Res", year="2022", month="Jan", day="24", volume="6", number="1", pages="e34966", keywords="coronavirus", keywords="COVID-19", keywords="health literacy", keywords="health information", keywords="decision-making", keywords="health promotion", keywords="prevention", keywords="behavior", keywords="survey", keywords="evaluation", abstract="Background: Health literacy is important for the prevention of COVID-19 transmission. Research in Japan shows that health literacy is related to skills in evaluating information and decision-making (skills that are not necessarily limited to information about health). Such basic skills are important, particularly when individuals encounter new health issues for which there is insufficient evidence. Objective: We aimed to determine the extent to which COVID-19 preventive behaviors were associated with health literacy and skills in evaluating information and making decisions. Methods: A web-based questionnaire survey was conducted using a Japanese internet research company. The measures comprised 8 items on COVID-19 preventive behaviors, health literacy items (European Health Literacy Survey Questionnaire), 5 items on information evaluation, and 4 items on decision-making process. Pearson correlations between these variables were calculated. Multivariable analyses were also conducted using the COVID-19 preventive behavior score as a dependent variable. Results: A total of 3914 valid responses were received.COVID-19 preventive behaviors were significantly correlated with health literacy (r=0.23), information evaluation (r=0.24), and decision-making process (r=0.30). Standardized regression coefficients (health literacy: $\beta$=.11; information evaluation: $\beta$=.13; decision-making: $\beta$=.18) showed that decision-making process contributed the most. Conclusions: Although comprehensive health literacy is necessary for COVID-19 preventive behaviors, the skills to evaluate a wide range of information and to make appropriate decisions are no less important. Opportunities for people to acquire these skills should be available at all times. ", doi="10.2196/34966", url="https://formative.jmir.org/2022/1/e34966", url="http://www.ncbi.nlm.nih.gov/pubmed/34982036" } @Article{info:doi/10.2196/33322, author="Grimes, Amanda and Lightner, S. Joseph and Pina, Kimberly and Donis de Miranda, S. Evelyn and Meissen-Sebelius, Emily and Shook, P. Robin and Hurley, A. Emily", title="Designing an Adaptive Adolescent Physical Activity and Nutrition Intervention for COVID-19--Related Health Challenges: Formative Research Study", journal="JMIR Form Res", year="2022", month="Jan", day="21", volume="6", number="1", pages="e33322", keywords="intervention", keywords="physical activity", keywords="nutrition", keywords="adolescents", keywords="formative research", keywords="COVID-19", keywords="exercise", keywords="young adult", keywords="teenager", keywords="focus group", keywords="qualitative", keywords="interview", keywords="urban", keywords="barrier", abstract="Background: With rates of childhood obesity continually increasing, effective physical activity and nutrition interventions are needed. Formative research is used to tailor interventions to different cultural and geographic contexts and can be vital in adapting intervention strategies in the face of significant disruptive circumstances (like COVID-19). Objective: We conducted formative research via in-person and web-based focus groups among middle schoolers and parents to better understand the facilitators and barriers to physical activity and fruit and vegetable consumption and to inform the design of a large intervention for a low-income, urban setting in the US Midwest. Methods: We conducted 2 phases of qualitative focus groups with parents (n=20) and 6th-9th grade middle schoolers (n=23). Phase 1 was conducted prior to the COVID-19 pandemic in late 2019, and phase 2 was conducted during the COVID-19 pandemic in the summer of 2020. Focus groups were transcribed and thematically coded using the Dedoose software. Results: The main facilitators of physical activity prior to the pandemic included the opportunity to have fun, peer influence, competition (for some), and incentives, while the main barriers to physical activity were time constraints and social discomfort. The main facilitators of eating fruits and vegetables included parental influence, preparation technique, and convenience, while barriers included dislike of vegetables, time constraints, and preparation or freshness. During the pandemic, facilitators of physical activity remained the same, while additional barriers to physical activity such as lack of motivation and limited time spent outside of the home were reported. For fruit and vegetable consumption, both facilitators and barriers remained the same for both time periods. Additionally, for some participants, the pandemic offered an opportunity to offer more fruits and vegetables to middle schoolers throughout the day. Conclusions: Some themes identified were common to those reported in previous studies, such as peer influence on physical activity and parental influence on fruit and vegetable consumption. Novel themes such as lack of motivation to be active and limited time outside the home helped improve intervention adaptation, specifically during the COVID-19 pandemic. The continuity of formative research after a major unexpected change in the intervention context can be essential in targeting areas of an intervention that can be retained and those that need to be adjusted. ", doi="10.2196/33322", url="https://formative.jmir.org/2022/1/e33322", url="http://www.ncbi.nlm.nih.gov/pubmed/34932499" } @Article{info:doi/10.2196/19750, author="Flippo, Brittany and Stone, Bradley and Stahr, Shelbie and Khalil, Mahmoud and Davis, Rodney and Kamel, Mohamed and Singh, Manisha", title="Short-Term and Long-Term Renal Outcomes in Patients With Obesity After Minimally Invasive Versus Open Partial Nephrectomy for the Treatment of Renal Cancer: Retrospective Study", journal="JMIR Form Res", year="2022", month="Jan", day="10", volume="6", number="1", pages="e19750", keywords="renal outcomes", keywords="renal cell carcinoma", keywords="minimally invasive vs open partial nephrectomy", keywords="obesity", keywords="kidney", keywords="cancer", keywords="surgery", keywords="retrospective", keywords="outcome", keywords="short-term", keywords="long-term", abstract="Background: Obesity is significantly associated with renal cell carcinoma. Surgery is the preferred treatment for demarcated lesions of renal cell carcinoma; however, obesity increases the complexity of surgical outcomes. Minimally invasive surgical techniques are preferred over open partial nephrectomy (OPN), but controversy remains regarding the most efficacious technique in patients with obesity. Objective: This study aims to determine whether minimally invasive partial nephrectomy (MIPN) or OPN better preserves renal function and investigate short- and long-term renal outcomes in patients with obesity undergoing a partial nephrectomy. Methods: We conducted a retrospective chart review of 242 adult patients aged ?18 years who underwent MIPN or OPN between January 1, 2005, and December 31, 2016, at the University of Arkansas for Medical Sciences. Using creatinine as a measure of kidney function, patients' preoperative levels were compared with their postoperative levels in 2-time frames: short (3-6 months postsurgery) or long (>6 months). The primary outcome was the change in creatinine values from preoperative to >6 months postoperatively in patients with obesity. Secondary outcomes included the change in creatinine values from preoperative to 3 to 6 months postoperatively in patients with obesity who underwent MIPN versus OPN. We also analyzed the creatinine values of nonobese patients (BMI <30) who underwent partial nephrectomy using the same time frames. Unconditional logistic regression was used to estimate crude and multivariable-adjusted odds ratios (ORs) and 95\% CI to observe associations between surgery type and changes in creatinine values from while stratifying for obesity. Results: A total of 140 patients were included in the study, of whom 75 were obese and 65 were nonobese. At >6 months after MIPN (n=20), the odds of patients with obesity having a decrease or no change in creatinine values was 1.24 times higher than those who had OPN (n=13; OR 1.24, 95\% CI 0.299-6.729; P=.80). At 3 to 6 months after MIPN (n=27), the odds were 0.62 times lower than those after OPN (n=17; OR 0.62, 95\% CI 0.140-2.753; P=.56). In the nonobese group, at 3 to 6 months after undergoing minimally invasive surgery (n=18), the odds of having a decrease or no change in creatinine values was 4.86 times higher than those who had open surgery (n=21; OR 4.86, 95\% CI 1.085-21.809; P=.04). At more than 6 months after MIPN (n=14), the odds were 4.13 times higher than those after OPN (n=11; OR 4.13, 95\% CI 0.579-29.485; P=.16). Conclusions: We observed a nonstatistically significant preservation of renal function in patients with obesity who underwent OPN at 3 to 6 months postoperatively. Conversely, after 6 months, the same was true for MIPN, indicating the long-term benefit of MIPN. In the nonobese group, MIPN was favored over OPN.? ", doi="10.2196/19750", url="https://formative.jmir.org/2022/1/e19750", url="http://www.ncbi.nlm.nih.gov/pubmed/35006078" } @Article{info:doi/10.2196/32422, author="Sutherland, Stephanie and Jeong, Dahn and Cheng, Michael and St-Jean, Mireille and Jalali, Alireza", title="Perceptions of Educational Needs in an Era of Shifting Mental Health Care to Primary Care: Exploratory Pilot Study", journal="JMIR Form Res", year="2022", month="Jan", day="7", volume="6", number="1", pages="e32422", keywords="mental health", keywords="Canada", keywords="qualitative research", keywords="caregiver", keywords="family physician", keywords="mentorship", abstract="Background: There is an unmet need for mental health care in Canada. Primary care providers such as general practitioners and family physicians are the essential part of mental health care services; however, mental health is often underestimated and underprioritized by family physicians. It is currently not known what is required to increase care providers' willingness, comfort, and skills to adequately provide care to patients who present with mental health issues. Objective: The aim of this study was to understand the need of caregivers (family members overseeing care of an individual with a mental health diagnosis) and family physicians regarding the care and medical management of individuals with mental health conditions. Methods: A needs assessment was designed to understand the educational needs of caregivers and family physicians regarding the provision of mental health care, specifically to seek advice on the format and delivery mode for an educational curriculum to be accessed by both stakeholder groups. Exploratory qualitative interviews were conducted, and data were collected and analyzed iteratively until thematic saturation was achieved. Results: Caregivers of individuals with mental health conditions (n=24) and family physicians (n=10) were interviewed. Both the caregivers and the family physicians expressed dissatisfaction with the status quo regarding the provision of mental health care at the family physician's office. They stated that there was a need for more educational materials as well as additional support. The caregivers expressed a general lack of confidence in family physicians to manage their son's or daughter's mental health condition, while family physicians sought more networking opportunities to improve and facilitate the provision of mental health care. Conclusions: Robust qualitative studies are necessary to identify the educational and medical management needs of caregivers and family physicians. Understanding each other's perspectives is an essential first step to collaboratively designing, implementing, and subsequently evaluating community-based mental health care. Fortunately, there are initiatives underway to address these need areas (eg, websites such as the eMentalHealth, as well as the mentorship and collaborative care network), and information from this study can help inform the gaps in those existing initiatives. ", doi="10.2196/32422", url="https://formative.jmir.org/2022/1/e32422", url="http://www.ncbi.nlm.nih.gov/pubmed/34994704" } @Article{info:doi/10.2196/22809, author="Iacobelli, Francisco and Dragon, Ginger and Mazur, Giselle and Guitelman, Judith", title="Web-Based Information Seeking Behaviors of Low-Literacy Hispanic Survivors of Breast Cancer: Observational Pilot Study", journal="JMIR Form Res", year="2021", month="Oct", day="27", volume="5", number="10", pages="e22809", keywords="low literacy", keywords="health literacy", keywords="online searches", keywords="Hispanic breast cancer survivors", abstract="Background: Internet searching is a useful tool for seeking health information and one that can benefit low-literacy populations. However, low-literacy Hispanic survivors of breast cancer do not normally search for health information on the web. For them, the process of searching can be frustrating, as frequent mistakes while typing can result in misleading search results lists. Searches using voice (dictation) are preferred by this population; however, even if an appropriate result list is displayed, low-literacy Hispanic women may be challenged in their ability to fully understand any individual article from that list because of the complexity of the writing. Objective: This observational study aims to explore and describe web-based search behaviors of Hispanic survivors of breast cancer by themselves and with their caregivers, as well as to describe the challenges they face when processing health information on the web. Methods: We recruited 7 Hispanic female survivors of breast cancer. They had the option to bring a caregiver. Of the 7 women, 3 (43\%) did, totaling 10 women. We administered the Health LiTT health literacy test, a demographic survey, and a breast cancer knowledge assessment. Next, we trained the participants to search on the web with either a keyboard or via voice. Then, they had to find information about 3 guided queries and 1 free-form query related to breast cancer. Participants were allowed to search in English or in Spanish. We video and audio recorded the computer activity of all participants and analyzed it. Results: We found web articles to be written for a grade level of 11.33 in English and 7.15 in Spanish. We also found that most participants preferred searching using voice but struggled with this modality. Pausing while searching via voice resulted in incomplete search queries, as it confused the search engine. At other times, background noises were detected and included in the search. We also found that participants formulated overly general queries to broaden the results list hoping to find more specific information. In addition, several participants considered their queries satisfied based on information from the snippets on the result lists alone. Finally, participants who spent more time reviewing articles scored higher on the health literacy test. Conclusions: Despite the problems of searching using speech, we found a preference for this modality, which suggests a need to avoid potential errors that could appear in written queries. We also found the use of general questions to increase the chances of answers to more specific concerns. Understanding search behaviors and information evaluation strategies for low-literacy Hispanic women survivors of breast cancer is fundamental to designing useful search interfaces that yield relevant and reliable information on the web. ", doi="10.2196/22809", url="https://formative.jmir.org/2021/10/e22809", url="http://www.ncbi.nlm.nih.gov/pubmed/34704952" } @Article{info:doi/10.2196/26314, author="Tong, Yao and Liao, C. Zachary and Tarczy-Hornoch, Peter and Luo, Gang", title="Using a Constraint-Based Method to Identify Chronic Disease Patients Who Are Apt to Obtain Care Mostly Within a Given Health Care System: Retrospective Cohort Study", journal="JMIR Form Res", year="2021", month="Oct", day="7", volume="5", number="10", pages="e26314", keywords="asthma", keywords="chronic kidney disease", keywords="chronic obstructive pulmonary disease", keywords="data analysis", keywords="diabetes mellitus", keywords="emergency department", keywords="health care system", keywords="inpatients", keywords="patient care management", abstract="Background: For several major chronic diseases including asthma, chronic obstructive pulmonary disease, chronic kidney disease, and diabetes, a state-of-the-art method to avert poor outcomes is to use predictive models to identify future high-cost patients for preemptive care management interventions. Frequently, an American patient obtains care from multiple health care systems, each managed by a distinct institution. As the patient's medical data are spread across these health care systems, none has complete medical data for the patient. The task of building models to predict an individual patient's cost is currently thought to be impractical with incomplete data, which limits the use of care management to improve outcomes. Recently, we developed a constraint-based method to identify patients who are apt to obtain care mostly within a given health care system. Our method was shown to work well for the cohort of all adult patients at the University of Washington Medicine for a 6-month follow-up period. It is unknown how well our method works for patients with various chronic diseases and over follow-up periods of different lengths, and subsequently, whether it is reasonable to perform this predictive modeling task on the subset of patients pinpointed by our method. Objective: To understand our method's potential to enable this predictive modeling task on incomplete medical data, this study assesses our method's performance at the University of Washington Medicine on 5 subgroups of adult patients with major chronic diseases and over follow-up periods of 2 different lengths. Methods: We used University of Washington Medicine data for all adult patients who obtained care at the University of Washington Medicine in 2018 and PreManage data containing usage information from all hospitals in Washington state in 2019. We evaluated our method's performance over the follow-up periods of 6 months and 12 months on 5 patient subgroups separately---asthma, chronic kidney disease, type 1 diabetes, type 2 diabetes, and chronic obstructive pulmonary disease. Results: Our method identified 21.81\% (3194/14,644) of University of Washington Medicine adult patients with asthma. Around 66.75\% (797/1194) and 67.13\% (1997/2975) of their emergency department visits and inpatient stays took place within the University of Washington Medicine system in the subsequent 6 months and in the subsequent 12 months, respectively, approximately double the corresponding percentage for all University of Washington Medicine adult patients with asthma. The performance for adult patients with chronic kidney disease, adult patients with chronic obstructive pulmonary disease, adult patients with type 1 diabetes, and adult patients with type 2 diabetes was reasonably similar to that for adult patients with asthma. Conclusions: For each of the 5 chronic diseases most relevant to care management, our method can pinpoint a reasonably large subset of patients who are apt to obtain care mostly within the University of Washington Medicine system. This opens the door to building models to predict an individual patient's cost on incomplete data, which was formerly deemed impractical. International Registered Report Identifier (IRRID): RR2-10.2196/13783 ", doi="10.2196/26314", url="https://formative.jmir.org/2021/10/e26314", url="http://www.ncbi.nlm.nih.gov/pubmed/34617906" } @Article{info:doi/10.2196/26980, author="Farah, Mohamed Alinoor and Nour, Yousuf Tahir and Obsiye, Muse and Aden, Akil Mowlid and Ali, Moeline Omar and Hussein, Arab Muktar and Budul, Bedel Abdullahi and Omer, Muktar and Getnet, Fentabil", title="Knowledge, Attitudes, and Practices Regarding COVID-19 Among Health Care Workers in Public Health Facilities in Eastern Ethiopia: Cross-sectional Survey Study", journal="JMIR Form Res", year="2021", month="Oct", day="1", volume="5", number="10", pages="e26980", keywords="COVID-19", keywords="knowledge", keywords="attitude", keywords="practice", keywords="health care workers", keywords="Eastern Ethiopia", abstract="Background: On March 13, 2020, Ethiopia reported the first confirmed case of COVID-19 in Addis Ababa. COVID-19 is likely to overwhelm an already-fragile health care delivery system and reduce the availability of essential health services. This analysis of data from the Somali Region of Eastern Ethiopia on health care workers' (HCWs) knowledge, attitudes, and practices regarding the prevention and control of COVID-19 may be used in planning health education programs about the emerging viral disease. Objective: This study aimed to investigate the knowledge, attitudes, and practices of HCWs regarding COVID-19 infection. Methods: This cross-sectional study was conducted among HCWs in three public health facilities in the Somali Region, Eastern Ethiopia. A self-administered questionnaire was shared with all HCWs working at the public health facilities. A total of 15 knowledge questions were scored as 1 or 0 for correct or incorrect responses, respectively. A total of 14 practice questions were scored on a 3-point scale from 1 (``always'') to 3 (``never''). A total of six attitude questions were rated on a 5-point Likert scale, in a negative dimension, as follows: 1 (``strongly agree''), 2 (``agree''), 3 (``neutral''), 4 (``disagree''), and 5 (``strongly disagree''). Mean scores were calculated and used as a cut point to dichotomize the outcome variables (>13.7 indicated good knowledge, <18.8 indicated good practices, and ?10.5 indicated favorable attitudes). We used t tests and analyses of variance (ie, F tests) to analyze the mean score differences of knowledge, attitudes, and practices between the independent variables. Spearman correlation was used to assess the relationship between mean knowledge and attitude scores. Results: Of the 686 HCWs approached, a total of 434 HCWs responded (63.3\% response rate). The mean age of the participants was 27.6 (SD 5.3) years, and the majority of the participants were male (293/434, 67.5\%). The mean knowledge score was 13.7 (SD 2.6), and 73.3\% (318/434) of participants had sufficient knowledge. The mean attitude score was 10.5 (SD 4.1), and 54.8\% (238/434) of the participants had a good attitude toward COVID-19. The mean practice score was 18.8 (SD 5.8), and 61.5\% (267/434) of the participants practiced precautionary measures to prevent COVID-19. There was a negative correlation between knowledge and attitude scores (r=--0.295, P<.001) and between knowledge and practice scores (r=--0.298, P<.001). Conclusions: The overall levels of knowledge and practice were relatively better than the attitude level. This highlights the need to implement strategies that enhance the positive attitudes and safe practices of the HCWs for better containment of the pandemic and supporting of essential health care services. ", doi="10.2196/26980", url="https://formative.jmir.org/2021/10/e26980", url="http://www.ncbi.nlm.nih.gov/pubmed/34477559" } @Article{info:doi/10.2196/27062, author="Laursen, Hjorth Ditte and Rom, Gitte and Bangh{\o}j, Margareta Anne and Tarnow, Lise and Schou, Lone", title="Improving Diabetes Self-management by Providing Continuous Positive Airway Pressure Treatment to Patients With Obstructive Sleep Apnea and Type 2 Diabetes: Qualitative Exploratory Interview Study", journal="JMIR Form Res", year="2021", month="Jul", day="20", volume="5", number="7", pages="e27062", keywords="diabetes", keywords="diabetes self-management", keywords="obstructive sleep apnea", keywords="continued positive airway pressure", keywords="sleep patterns", keywords="sleepiness in daily life", keywords="sleep apnea", keywords="elderly", keywords="sleep", abstract="Background: There is a high prevalence of unexplained and unexplored obstructive sleep apnea (OSA) among patients with type 2 diabetes. The daytime symptoms of OSA include severe fatigue, cognitive problems, a decreased quality of life, and the reduced motivation to perform self-care. These symptoms impair the management of both diabetes and daily life. OSA may therefore have negative implications for diabetes self-management. Continuous positive airway pressure (CPAP) therapy is used to treat OSA. This treatment improves sleep quality, insulin resistance, and glycemic control. Although the benefits of using CPAP as a treatment for OSA are clear, the noncompliance rate is high, and the evidence for the perceived effect that CPAP treatment has on patients with type 2 diabetes and OSA is poor. Objective: The purpose of this study was to analyze the impacts that comorbid diabetes and OSA have on the daily lives of older adults and to investigate the perceived effect that CPAP treatment for OSA has on patients' diabetes self-management. Methods: A qualitative follow-up study that involved in-depth, semistructured dyad interviews with couples before and after CPAP treatment (N=22) was conducted. Patients were recruited from the Hilleroed Hospital in Denmark and were all diagnosed with type 2 diabetes, aged >18 years, and had an apnea-hypopnea index of ?15. All interviews were coded and analyzed via thematic analysis. Results: The results showed that patients and their partners did not consider OSA to be a serious disorder, as they believed that OSA symptoms were similar to those of the process of aging. Patients experienced poor nocturnal sleep, took frequent daytime naps, exhibited reduced cognitive function, and had low levels of physical activity and a high-calorie diet. These factors negatively influenced their diabetes self-management. Despite the immediate benefit of CPAP treatment, most patients (11/12, 92\%) faced technical challenges when using the CPAP device. Only the patients with severe OSA symptoms that affected their daily lives overcame the challenges of using the CPAP device and thereby improved their diabetes self-management. Patients with less severe symptoms rated CPAP-related challenges as more burdensome than their symptoms. Conclusions: If used correctly, CPAP has the potential to significantly improve OSA, resulting in better sleep quality; improved physical activity; improved diet; and, in the end, better diabetes self-management. However, there are many barriers to undergoing CPAP treatment, and only few patients manage to overcome these barriers and comply with correct treatment. ", doi="10.2196/27062", url="https://formative.jmir.org/2021/7/e27062", url="http://www.ncbi.nlm.nih.gov/pubmed/34283032" } @Article{info:doi/10.2196/25043, author="van der Haar, Sandra and Hoevenaars, M. Femke P. and van den Brink, J. Willem and van den Broek, Tim and Timmer, Mari{\"e}lle and Boorsma, Andr{\'e} and Doets, L. Esm{\'e}e", title="Exploring the Potential of Personalized Dietary Advice for Health Improvement in Motivated Individuals With Premetabolic Syndrome: Pretest-Posttest Study", journal="JMIR Form Res", year="2021", month="Jun", day="24", volume="5", number="6", pages="e25043", keywords="personalized nutrition", keywords="metabolic syndrome", keywords="dietary behavior", keywords="diet", keywords="metabolic", keywords="metabolic health", keywords="dietary advice", keywords="dietary feedback", keywords="digital health", abstract="Background: Dietary quality plays an essential role in the prevention and management of metabolic syndrome (MetS). Objective: The aim of this pilot study is to organize personalized dietary advice in a real-life setting and to explore the effects on dietary intake, metabolic health, and perceived health. Methods: We followed a one-group pretest-posttest design and included 37 individuals at risk of MetS, who indicated motivation to change dietary behavior. For a period of 16 weeks, participants received personalized advice (t=0 and t=8) and feedback (t=0, t=4, t=8, t=12 and t=16) on dietary quality and metabolic health (ie, waist circumference, BMI, blood pressure, lipid profile, fasting glucose levels, and C-peptide). Personalized advice was generated in a two-stage process. In stage 1, an automated algorithm generated advice per food group, integrating data on individual dietary quality (Dutch Healthy Diet Index; total score 8-80) and metabolic health parameters. Stage 2 included a telephone consultation with a trained dietitian to define a personal dietary behavior change strategy and to discuss individual preferences. Dietary quality and metabolic health markers were assessed at t=0, t=8, and t=16. Self-perceived health was evaluated on 7-point Likert scales at t=0 and t=16. Results: At the end of the study period, dietary quality was significantly improved compared with the baseline (Dutch Healthy Diet Index +4.3; P<.001). In addition, lipid profile (triglycerides, P=.02; total cholesterol, P=.01; high-density lipoprotein, P<.001; and low-density lipoprotein, P<.001), BMI (P<.001), waist circumference (P=.01), and C-peptide (P=.01) were all significantly improved, whereas plasma glucose increased by 0.23 nmol/L (P=.04). In line with these results, self-perceived health scores were higher at t=16 weeks than at baseline (+0.67; P=.005). Conclusions: This exploratory study showed that personalized dietary advice resulted in positive effects on dietary behavior, metabolic health, and self-perceived health in motivated pre-MetS adults. The study was performed in a do-it-yourself setting, highlighting the potential of at-home health improvement through dietary changes. Trial Registration: ClinicalTrials.gov NCT04595669; https://clinicaltrials.gov/ct2/show/NCT04595669 ", doi="10.2196/25043", url="https://formative.jmir.org/2021/6/e25043/", url="http://www.ncbi.nlm.nih.gov/pubmed/34185002" } @Article{info:doi/10.2196/29365, author="Costanza, Alessandra and Chytas, Vasileios and Piguet, Val{\'e}rie and Luthy, Christophe and Mazzola, Viridiana and Bondolfi, Guido and Cedraschi, Christine", title="Meaning in Life Among Patients With Chronic Pain and Suicidal Ideation: Mixed Methods Study", journal="JMIR Form Res", year="2021", month="Jun", day="4", volume="5", number="6", pages="e29365", keywords="suicide", keywords="suicidal behavior", keywords="suicidal ideation", keywords="suicide attempt", keywords="chronic pain", keywords="meaning in life", keywords="protective factors", keywords="risk factors", keywords="mental health", abstract="Background: Patients with chronic pain have elevated risk of suicidal ideation and behavior, including suicide attempts and completed suicides. In most studies, associations between chronic pain and suicidal ideation/suicidal behavior are robust even after adjusting for the effect of sociodemographics and psychiatric comorbidity. However, to refine the risk profile of these patients, further exploration of other possible risk and protective factors is necessary. Objective: There is a common clinical observation that experiencing chronic pain often requires a revision of life goals and expectations, and hence, it impacts the existential domain including one's perception of the meaning in life (MiL). This study aimed to characterize the main domains that constitute the personal MiL, including the ``presence of'' and ``search for'' constructs, in a group of patients with chronic pain and suicidal ideation. Methods: Seventy participants were enlisted by ongoing recruitment through a larger project anchored in daily clinical practice at the Multidisciplinary Pain Center of the Geneva University Hospitals. It was an observational mixed method study. Data were recorded through both validated quantitative questionnaires and qualitative open-ended questions. Results: The total sample consisted of 70 patients. Responses to questionnaires showed a depressive episode in 68 (97\%) patients and anxious disorders in 25 (36\%) patients. With a score threshold for positive MiL of 24, the mean score for the ``presence of'' construct was 20.13 (SD 8.23), and 63\% (44/70) of respondents had a score <24. The mean score for the ``search for'' construct was lower at 18.14 (SD 8.64), and 70\% (49/70) of respondents had a score <24. The ``presence of'' and ``search for'' constructs were significantly positively correlated (R=0.402; P=.001). An open question addressed the ``presence of'' construct by inviting the respondents to cite domains they consider as providing meaning in their life at the present time. All patients responded to this question, citing one or more domains. The three main dimensions that emerged from content analysis of this qualitative section were as follows: the domain of relationships, the domain of personal activities, and pain and its consequences on MiL. Conclusions: The study results provide insights into patients with chronic pain and suicidal ideation, including the domains that provide them with meaning in their lives and the impact of pain on these domains with regard to suicidal ideation. The main clinical implications concern both prevention and supportive/psychotherapeutic interventions. They are based on a narrative approach aiming to explore with the patients the content of their suffering and the MiL domains that they could identify to mitigate it, in order to restructure/reinforce these domains and thus possibly reduce suicidal ideation. Specifically, a focus on maintaining the domains of interpersonal relationships and personal activities can allow patients to ultimately escape the biopsychosocial vicious cycle of chronic pain--induced deep moral suffering. ", doi="10.2196/29365", url="https://formative.jmir.org/2021/6/e29365", url="http://www.ncbi.nlm.nih.gov/pubmed/34003136" } @Article{info:doi/10.2196/25663, author="Joseph, P. Rodney and Vega-L{\'o}pez, Sonia and Han, SeungYong", title="Physical Activity Patterns and Neighborhood Characteristics of First-Generation Latina Immigrants Living in Arizona: Cross-sectional Study", journal="JMIR Form Res", year="2021", month="May", day="17", volume="5", number="5", pages="e25663", keywords="emigrants and immigrants", keywords="physical activity", keywords="exercise", keywords="residence characteristics", keywords="female", keywords="metabolic disease", keywords="Latina", keywords="immigrants", keywords="emigrants", keywords="health outcomes", abstract="Background: Metabolic diseases, including obesity and type 2 diabetes, are a major health concern for Latina immigrants. Performing regular aerobic physical activity (PA) is a lifestyle behavior associated with the prevention and control of these conditions. However, PA levels of most Latina immigrants are below national guidelines. Neighborhood environmental factors may influence the PA levels of adults, but limited research has explored associations between the neighborhood environment and PA levels among Latina immigrants. Objective: The objective of this study was to explore the PA patterns of first-generation US Latina immigrants and how neighborhood environmental factors are related to those PA patterns. Methods: Using a cross-sectional study design, 50 first-generation Latina immigrants completed the International Physical Activity Questionnaire (IPAQ) and the Neighborhood Scales Questionnaire, which assessed 6 perceived neighborhood factors: (1) walking environment, (2) aesthetic quality, (3) safety, (4) violence, (5) social cohesion, and (6) activities with neighbors. Median self-reported metabolic equivalent (MET)-minutes/week of PA were used to summarize domain-specific (ie, work, domestic/household, leisure, and transportation) and intensity-specific (ie, walking, moderate, vigorous, moderate to vigorous) PA patterns. Logistic regression examined associations between neighborhood factors and engaging in leisure-time PA (ie, dichotomous outcome of some versus no leisure-time PA), transportation PA (ie, dichotomous outcome of some versus no transportation PA), and meeting national PA guidelines (ie, dichotomous outcome of meeting versus not meeting guidelines). Results: Preliminary analyses showed that 10 participants reported excessively high PA levels and 1 participant had incomplete PA data; these women were excluded from analyses based on IPAQ scoring guidelines. The remaining 39 participants (mean age 40.5 years; mean length of US residency 4.6 years) reported a median of 4512 MET-minutes/week of total PA. The majority of PA was acquired through domestic activities (median 2160 MET-minutes/week), followed by leisure-time PA (median 396 MET-minutes/week), transportation PA (median 198 MET-minutes/week), and work PA (0 MET-minutes/week). Intensity-specific PA patterns showed a median of 594 MET-minutes/week of walking activity and 3500 MET-minutes/week of moderate-to-vigorous PA. Logistic regression models indicated that the neighborhood factors of walking environment, aesthetic quality, and safety were positively associated with engaging in leisure-time PA (odds ratios of 5.95, 95\% CI 1.49-23.74; 2.45, 95\% CI 1.01-5.93; and 3.30, 95\% CI 1.26-8.67, respectively) and meeting national PA guidelines (odds ratios of 4.15, 95\% CI 1.13-15.18; 6.43, 95\% CI 1.45-28.39; and 2.53, 95\% CI 1.00-6.36, respectively). The neighborhood factors of violence, social cohesion, and activities with neighbors were not significantly associated with PA outcomes. Conclusions: Although most participants met national PA guidelines (ie, ?500 MET-minutes/week of moderate-to-vigorous PA), the majority of their PA was achieved through domestic activities, with limited leisure, transportation, and work PA. Given that leisure-time PA in particular plays a significant role in improving health outcomes, findings suggest that many Latina immigrants could benefit from a leisure-time PA intervention. Such interventions should consider neighborhood environmental influences, as these factors may serve as determinants of PA. ", doi="10.2196/25663", url="https://formative.jmir.org/2021/5/e25663", url="http://www.ncbi.nlm.nih.gov/pubmed/33999003" } @Article{info:doi/10.2196/25577, author="Remiker, Mark and Sabo, Samantha and Jim{\'e}nez, Dulce and Samarron Longorio, Alexandra and Chief, Carmenlita and Williamson, Heather and Teufel-Shone, Nicolette", title="Using a Multisectoral Approach to Advance Health Equity in Rural Arizona: Community-Engaged Survey Development and Implementation Study", journal="JMIR Form Res", year="2021", month="May", day="12", volume="5", number="5", pages="e25577", keywords="health equity", keywords="community-engaged", keywords="multisector", keywords="survey development", abstract="Background: Over the past decade, public health research and practice sectors have shifted their focus away from identifying health disparities and toward addressing the social, environmental, and economic determinants of health equity. Given the complex and interrelated nature of these determinants, developing policies that will advance health equity requires collaboration across sectors outside of health. However, engaging various stakeholder groups, tapping into their unique knowledge systems, and identifying common objectives across sectors is difficult and time consuming and can impede collaborative efforts. Objective: The Southwest Health Equity Research Collaborative at Northern Arizona University, in partnership with an 11-member community advisory council, is addressing this need with a joint community-campus effort to develop and implement a Regional Health Equity Survey (RHES) designed to generate an interdisciplinary body of knowledge, which will be used to guide future multisectoral action for improving community health and well-being. Methods: Researchers and community partners used facilitated discussions and free listing techniques to generate survey items. The community partners pilot tested the survey instrument to evaluate its feasibility and duration before survey administration. Respondent-driven sampling was used to ensure that participants included leadership from across all sectors and regions of northern Arizona. Results: Over the course of 6 months, 206 participants representing 13 sectors across the 5 counties of northern Arizona were recruited to participate in an RHES. Survey response rates, completion percentage, and sector representation were used to assess the effectiveness and feasibility of using a community-engaged apporach for survey development and participant recruitment. The findings describe the current capacity to impact health equity by using a multisectoral approach in northern Arizona. Conclusions: The Southwest Health Equity Research Collaborative effectively engaged community members to assist with the development and implementation of an RHES aimed at understanding and promoting multisectoral action on the root causes of health inequity. The results will help to build research and evaluation capacity to address the social, economic, and environmental conditions of health inequity in the region. ", doi="10.2196/25577", url="https://formative.jmir.org/2021/5/e25577", url="http://www.ncbi.nlm.nih.gov/pubmed/33978596" } @Article{info:doi/10.2196/21481, author="Nagawa, S. Catherine and Faro, M. Jamie and Menon, J. Anitha and Ito Fukunaga, Mayuko and Williams, H. Jessica and Mourao, Dalton and Emidio, M. Oluwabunmi and Davis, Maryann and Pbert, Lori and Cutrona, L. Sarah and Houston, K. Thomas and Sadasivam, S. Rajani", title="Written Advice Given by African American Smokers to Their Peers: Qualitative Study of Motivational Messages", journal="JMIR Form Res", year="2021", month="Apr", day="30", volume="5", number="4", pages="e21481", keywords="tobacco disparities", keywords="peer-to-peer", keywords="communication", keywords="smoking", keywords="cessation", keywords="thematic analysis", keywords="intervention", keywords="African American", abstract="Background: Although African Americans have the lowest rates of smoking onset and progression to daily smoking, they are less likely to achieve long-term cessation. Interventions tailored to promote use of cessation resources in African American individuals who smoke are needed. In our past work, we demonstrated the effectiveness of a technology-assisted peer-written message intervention for increasing smoking cessation in non-Hispanic White smokers. In this formative study, we have adapted this intervention to be specific for African American smokers. Objective: We aimed to report on the qualitative analysis of messages written by African American current and former smokers for their peers in response to hypothetical scenarios of smokers facing cessation challenges. Methods: We recruited African American adult current and former smokers (n=41) via ResearchMatch between April 2017 and November 2017. We asked participants to write motivational messages for their peers in response to smoking-related hypothetical scenarios. We also collected data on sociodemographic factors and smoking characteristics. Thematic analysis was conducted to identify cessation strategies suggested by the study participants. Results: Among the study participants, 60\% (25/41) were female. Additionally, more than half (23/41, 56\%) were thinking about quitting, 29\% (12/41) had set a quit date, and 27\% (11/41) had used electronic cigarettes in the past 30 days. Themes derived from the qualitative analysis of peer-written messages were (1) behavioral strategies, (2) seeking help, (3) improvements in quality of life, (4) attitudes and expectations, and (5) mindfulness/religious or spiritual practices. Under the behavioral strategies theme, distraction strategies were the most frequently suggested strategies (referenced 84 times in the 318 messages), followed by use of evidence-based treatments/cessation strategies. Within the seeking help theme, subthemes included seeking help or support from family/friends or close social networks (referenced 56 times) and health care professionals (referenced 22 times). The most frequent subthemes that emerged from improvements in the quality of life theme included improving one's health (referenced 22 times) and quality of life (referenced 21 times). Subthemes that emerged from the attitude and expectations theme included practicing positive self-talk (referenced 27 times), autonomy/independence from the smoking habit (referenced six times), and financial cost of smoking (referenced five times). The two subthemes that emerged from the mindfulness/religious or spiritual practices theme were use of self-awareness techniques (referenced 36 times) and religious or spiritual practices to cope (referenced 13 times). Conclusions: Our approach to adapt a prior peer-message intervention to African American smokers yielded a set of evidence-based messages that may be suitable for smokers at all phases of motivation to quit (ready to quit or not ready to quit). In future research, we plan to assess the impact of texting these messages to African American smokers in a smoking cessation trial. ", doi="10.2196/21481", url="https://formative.jmir.org/2021/4/e21481", url="http://www.ncbi.nlm.nih.gov/pubmed/33929332" } @Article{info:doi/10.2196/25438, author="Althumiri, A. Nora and Basyouni, H. Mada and BinDhim, F. Nasser", title="Exploring the Association Between Physical Activity and Risk of Mental Health Disorders in Saudi Arabian Adults: Cross-sectional Study", journal="JMIR Public Health Surveill", year="2021", month="Apr", day="14", volume="7", number="4", pages="e25438", keywords="Saudi Arabia", keywords="physical activity", keywords="mental health", keywords="depression", keywords="anxiety", keywords="risk", keywords="symptoms", keywords="cross-sectional", keywords="survey", abstract="Background: The relationship between physical activity and mental health, especially the symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD), has received increasing attention in recent years. Objective: The aim of this study was to explore the association between fulfilling the World Health Organization (WHO) global recommendations on physical activity and the risk and symptoms of MDD and GAD in the Saudi population. Methods: This study was a secondary analysis of data from a large nationwide cross-sectional survey conducted via phone interviews in June and July 2020. In this study, a proportional quota sampling technique was used to obtain an equal distribution of participants, stratified by age and gender, across the 13 regions of Saudi Arabia. The main mental health screening tool used for the risk of MDD was the Patient Health Questionnaire-9 (PHQ-9). Risk of GAD was measured using the Generalized Anxiety Disorder-7 (GAD-7) scale. Participants self-reported whether they fulfill the WHO global recommendations on (1) moderate-intensity aerobic physical activity (MIPA) and (2) vigorous-intensity aerobic physical activity (VIPA). The results were then analyzed based on the following two categories: fulfilling the WHO global recommendations or not. Results: The data analysis included 8333 participants recruited in the main study between June and July 2020. The response rate was 81.45\% (8333/10,231). Of them, 50.3\% (4192/8333) were female, and the mean age was 36.5 years, with a median age of 36 years and a range from 18 to 90 years. The average total PHQ-9 score was 5.61, and the average total GAD-7 score was 4.18. For men, the average total PHQ-9 and GAD-7 scores were associated with fulfilling recommendations for MIPA; however, there were no associations for VIPA in both sexes. Fulfilling the WHO's recommendations for MIPA was associated with considerably fewer depressive symptoms in six of the nine items in the PHQ-9. Moreover, fulfilling recommendations for MIPA was associated with considerably fewer anxiety symptoms in six of the seven items in the GAD-7. However, fulfilling recommendations for VIPA was significantly associated with more depressive symptoms in one of the PHQ-9 items (``Thoughts that you would be better off dead or thoughts of hurting yourself in some way;'' P<.001). Conclusions: This study has shown that fulfilling guidelines on MIPA is associated with less overall risk of MDD and GAD in males and fewer depressive and anxiety symptoms generally in a nonclinical population. In the general population, an increase in MIPA may improve well-being and general mental health. ", doi="10.2196/25438", url="https://publichealth.jmir.org/2021/4/e25438", url="http://www.ncbi.nlm.nih.gov/pubmed/33851932" } @Article{info:doi/10.2196/27107, author="Mira, Joaquin Jose and Cobos, Angel and Mart{\'i}nez Garc{\'i}a, Olga and Bueno Dom{\'i}nguez, Jos{\'e} Mar{\'i}a and Astier-Pe{\~n}a, Pilar Mar{\'i}a and P{\'e}rez P{\'e}rez, Pastora and Carrillo, Irene and Guilabert, Mercedes and Perez-Jover, Virtudes and Fernandez, Cesar and Vicente, Asuncion Mar{\'i}a and Lahera-Martin, Matilde and Silvestre Busto, Carmen and Lorenzo Mart{\'i}nez, Susana and Sanchez Martinez, Ascension and Martin-Delgado, Jimmy and Mula, Aurora and Marco-Gomez, Barbara and Abad Bouzan, Cristina and Aibar-Remon, Carlos and Aranaz-Andres, Jesus and ", title="An Acute Stress Scale for Health Care Professionals Caring for Patients With COVID-19: Validation Study", journal="JMIR Form Res", year="2021", month="Mar", day="9", volume="5", number="3", pages="e27107", keywords="SARS-CoV-2 virus", keywords="COVID-19 outbreak", keywords="medical staff", keywords="acute stress", keywords="moral injury", keywords="posttraumatic stress", keywords="COVID-19", abstract="Background: The COVID-19 pandemic has affected the response capacity of the health care workforce, and health care professionals have been experiencing acute stress reactions since the beginning of the pandemic. In Spain, the first wave was particularly severe among the population and health care professionals, many of whom were infected. These professionals required initial psychological supports that were gradual and in line with their conditions. Objective: In the early days of the pandemic in Spain (March 2020), this study aimed to design and validate a scale to measure acute stress experienced by the health care workforce during the care of patients with COVID-19: the Self-applied Acute Stress Scale (EASE). Methods: Item development, scale development, and scale evaluation were considered. Qualitative research was conducted to produce the initial pool of items, assure their legibility, and assess the validity of the content. Internal consistency was calculated using Cronbach $\alpha$ and McDonald $\omega$. Confirmatory factor analysis and the Mann-Whitney-Wilcoxon test were used to assess construct validity. Linear regression was applied to assess criterion validity. Back-translation methodology was used to translate the scale into Portuguese and English. Results: A total of 228 health professionals from the Spanish public health system responded to the 10 items of the EASE scale. Internal consistency was .87 (McDonald $\omega$). Goodness-of-fit indices confirmed a two-factor structure, explaining 55\% of the variance. As expected, the highest level of stress was found among professionals working in health services where a higher number of deaths from COVID-19 occurred (P<.05). Conclusions: The EASE scale was shown to have adequate metric properties regarding consistency and construct validity. The EASE scale could be used to determine the levels of acute stress among the health care workforce in order to give them proportional support according to their needs during emergency conditions, such as the COVID-19 pandemic. ", doi="10.2196/27107", url="https://formative.jmir.org/2021/3/e27107", url="http://www.ncbi.nlm.nih.gov/pubmed/33687343" } @Article{info:doi/10.2196/24302, author="Godfrey, M. Emily and Kazmerski, M. Traci and Brown, Georgia and Thayer, K. Erin and Mentch, Laura and Pam, Molly and Al Achkar, Morhaf", title="Educational Needs and Preferences for Patient-Centered Outcomes Research in the Cystic Fibrosis Community: Mixed Methods Study", journal="JMIR Form Res", year="2021", month="Mar", day="4", volume="5", number="3", pages="e24302", keywords="cystic fibrosis", keywords="needs assessment", keywords="patient-centered outcomes research", keywords="training", keywords="education", keywords="team building", keywords="patient engagement", abstract="Background: Cystic fibrosis (CF) is a rare, life-shortening, multiorgan disease, the treatment of which has seen significant increases in the life expectancy of those with CF. Many advances in CF care are thanks to the dedicated and active participation of people with CF as research participants. Unfortunately, most CF research teams still do not fully partner with people with CF or their caregivers. Objective: The aim of this study was to determine the interest, knowledge gaps, and desired format for patient-centered outcomes research (PCOR) training in the CF community. Methods: We surveyed patients, caregivers, researchers, research staff, and diverse health care providers via list servers and social media outreach about their knowledge of, experience with, and preferences for PCOR training components. We followed the survey with 3 small-group discussion sessions with 22 participants who completed the survey to establish consensus and prioritize key learning components of a PCOR training program. We summarized results using descriptive statistics. Results: A total of 170 participants completed the survey (patients/caregivers: 96/170, 56.5\%; researchers/health care providers: 74/170, 43.5\%). Among providers, 26\% (19/74) were physicians/advanced practice providers, 20\% (15/74) were nurses, and 54\% (40/74) were from other disciplines. Among all participants, 86.5\% (147/170) expressed interest in learning about PCOR, although training topics and training format differed between the patient/caregiver and researcher/health care provider groups. Before participating in PCOR, patients/caregivers wanted to understand more about expectations of them as partners on PCOR research teams (82/96, 85\%). Meanwhile, researchers/health care providers desired information on how to include outcomes important to patients/caregivers (55/74, 74\%) and the quality and impact of PCOR research (52/74, 70\% and 51/74, 69\%, respectively). Patients/caregivers were most interested in learning about the time commitment as a PCOR team member (75/96, 78\%). Researchers/health care providers wanted to receive training about how to establish trust (47/74, 64\%) and maintain confidentiality (47/74, 64\%) when including patient or caregiver partners on the PCOR team. During follow-up discussions, participants emphasized the importance of addressing the traditional patient/caregiver and researchers/health care provider hierarchy by teaching about transparency, appreciation, creating a common language between the groups, and providing specific training on ``how'' to do PCOR. Conclusions: Our findings suggest CF community members are interested in PCOR. A high-quality training program would fill a current deficit in methodological research. This assessment identified the topics and formats desired and can be used to develop targeted training to enhance meaningful PCOR in CF. ", doi="10.2196/24302", url="https://formative.jmir.org/2021/3/e24302", url="http://www.ncbi.nlm.nih.gov/pubmed/33661127" } @Article{info:doi/10.2196/26406, author="Niemczak, Christopher and Fellows, Abigail and Lichtenstein, Jonathan and White-Schwoch, Travis and Magohe, Albert and Gui, Jiang and Wilbur, Jed and Clavier, Odile and Massawe, Enica and Moshi, Ndeserua and Boivin, Michael and Kraus, Nina and Buckey, Jay", title="Central Auditory Tests to Track Cognitive Function in People With HIV: Longitudinal Cohort Study", journal="JMIR Form Res", year="2021", month="Feb", day="9", volume="5", number="2", pages="e26406", keywords="HIV", keywords="central auditory function", keywords="auditory perception", keywords="cognitive dysfunction", keywords="testing", keywords="cognition", keywords="cognitive function", keywords="neurocognitive deficit", keywords="longitudinal", keywords="auditory", keywords="nervous system", keywords="screening", keywords="monitoring", keywords="surveillance", abstract="Background: The development of neurocognitive deficits in people infected with HIV is a significant public health problem. Previous cross-sectional studies have shown that performance on central auditory tests (CATs) correlates with cognitive test results in those with HIV, but no longitudinal data exist for confirmation. We have been performing longitudinal assessments of central auditory and cognitive function on a cohort of HIV-positive and HIV-negative individuals in Dar es Salaam, Tanzania to understand how the central auditory system could be used to study and track the progress of central nervous system dysfunction. Objective: The goal of the project was to determine if CATs can track the trajectory of cognitive function over time in people diagnosed with HIV. Methods: Tests of peripheral and central auditory function as well as cognitive performance were performed on 382 individuals over the course of 3.5 years. Visits were scheduled every 6 months. CATs included tests of auditory temporal processing (gap detection) and speech perception in noise (Hearing in Noise Test and Triple Digit Test). Cognitive tests included the Montreal Cognitive Assessment (MoCA), Test of Variables of Attention (TOVA), and subtests from the Cogstate battery. HIV-positive subjects were divided into groups based on their CAT results at their final visit (bottom 20\%, top 20\%, middle 60\%). Primary analyses focused on the comparison between HIV-positive individuals that performed worse on CATs (bottom 20\%) and the overall HIV-positive group (middle 60\%). Data were analyzed using linear mixed-effect models with time as the main fixed effect. Results: The group with the worst (bottom 20\%) CAT performance showed a difference in trajectory for the MoCA (P=.003), TOVA (P<.048), and Cogstate (P<.046) over the course of the study period compared to the overall HIV-positive group. A battery of three CATs showed a significant difference in cognitive trajectory over a relatively short study period of 3.5 years independent of age (bottom 20\% vs HIV-positive group). Conclusions: The results of this study support the ability for CATs to track cognitive function over time, suggesting that central auditory processing can provide a window into central nervous system performance. CATs can be simple to perform, and are relatively insensitive to education and socioeconomic status because they only require repeating sentences, numbers, or detecting gaps in noise. These tests could potentially provide a time-efficient, low-cost method to screen for and monitor cognitive decline in patients with HIV, making them a useful surveillance tool for this major public health problem. ", doi="10.2196/26406", url="http://formative.jmir.org/2021/2/e26406/", url="http://www.ncbi.nlm.nih.gov/pubmed/33470933" } @Article{info:doi/10.2196/18732, author="Khan, Zaman Danyal and Fitzpatrick, Mairead Siobhan and Hilton, Bryn and McNair, GK Angus and Sarewitz, Ellen and Davies, Marshall Benjamin and Kotter, RN Mark and ", title="Prevailing Outcome Themes Reported by People With Degenerative Cervical Myelopathy: Focus Group Study", journal="JMIR Form Res", year="2021", month="Feb", day="3", volume="5", number="2", pages="e18732", keywords="cervical", keywords="myelopathy", keywords="spondylosis", keywords="spondylotic", keywords="stenosis", keywords="disc herniation", keywords="ossification posterior longitudinal ligament", keywords="qualitative", keywords="thematic analysis", keywords="core outcomes set", keywords="consensus", keywords="Delphi", keywords="patient perspectives", abstract="Background: Degenerative cervical myelopathy (DCM) arises when arthritic changes of the cervical spine cause compression and a progressive injury to the spinal cord. It is common and potentially disabling. People with DCM have among the lowest quality of life scores (Short Form Health Survey--36 item [SF-36]) of chronic disease, although the drivers of the imapact of DCM are not entirely understood. DCM research faces a number of challenges, including the heterogeneous reporting of study data. The AO Spine Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy (RECODE-DCM) project is an international consensus process that aims to improve research efficiency through formation of a core outcome set (COS). A key part of COS development process is organizing outcomes into domains that represent key aspects of the disease. To facilitate this, we sought to qualitatively explore the context and impact of patient-reported outcomes in DCM on study participants. Objective: The goal of the research was to qualitatively explore the patient-reported outcomes in DCM to improve understanding of patient perspective and assist the organization of outcomes into domains for the consensus process. Methods: Focus group sessions were hosted in collaboration with Myelopathy.org, a charity and support group for people with DCM. A 40-minute session was audiorecorded and transcribed verbatim. Two authors familiarized themselves with the data and then performed data coding independently. Codes were grouped into themes and a thematic analysis was performed guided by Braun and Clarke's 6-phase approach. The themes were subsequently reviewed with an independent stakeholder with DCM, assisting in the process of capturing the true context and importance of themes. Results: Five people with DCM (3 men and 2 women) participated in the focus group session. The median age was 53 years, and the median score on the modified Japanese Orthopaedic Association scale was 11 (interquartile range 9.5-11.5), indicating the participants had moderate to severe DCM. A total of 54 codes were reviewed and grouped into 10 potential themes that captured the impact of the disability on people with DCM: acceptance of symptoms, anticipatory anxiety, coping mechanisms/resilience, feelings of helplessness, financial consequences, lack of recognition, mental health impact, loss of life control, social reclusiveness and isolation, and social stigma. Conclusions: This qualitative analysis of the perspectives of people with DCM has highlighted a number of prevailing themes currently unmeasured in clinical research or care. The determinants of low quality of life in DCM are currently unknown, and these findings provide a novel and so far, unique perspective. Continued inclusion of online communities and use of targeted digital software will be important in establishing a consensus-based COS for patients with DCM that is inclusive of all relevant stakeholders including people with DCM. ", doi="10.2196/18732", url="https://formative.jmir.org/2021/2/e18732", url="http://www.ncbi.nlm.nih.gov/pubmed/33533719" } @Article{info:doi/10.2196/15007, author="Halliday, A. Jennifer and Speight, Jane and Bennet, Andrea and Beeney, J. Linda and Hendrieckx, Christel", title="The Diabetes and Emotional Health Handbook and Toolkit for Health Professionals Supporting Adults With Type 1 and Type 2 Diabetes: Formative Evaluation", journal="JMIR Form Res", year="2020", month="Feb", day="21", volume="4", number="2", pages="e15007", keywords="diabetes mellitus", keywords="mental health", keywords="medical reference books", keywords="needs assessment", keywords="evaluation studies", keywords="qualitative research", abstract="Background: Health professionals have expressed unmet needs, including lacking the skills, confidence, training, and resources needed to properly attend to the psychological needs of people with diabetes. Objective: Informed by needs assessments, this study aimed to develop practical, evidence-based resources to support health professionals to address the emotional needs of adults with type 1 or type 2 diabetes. Methods: We developed a new handbook and toolkit informed by formative evaluation, including literature reviews, stakeholder consultation and review, and a qualitative study. In the qualitative study, health professionals participated in interviews after reading sections of the handbook and toolkit. Results: The literature review uncovered that psychological problems are common among adults with diabetes, but health professionals lack resources to provide related support. We planned and drafted resources to fill this unmet need, guided by stakeholder consultation and an Expert Reference Group (ERG). Before finalizing the resources, we implemented feedback received from stakeholders (ERG, health professionals, academics, and people with diabetes). The resulting resources were the practical, evidence-based Diabetes and Emotional Health handbook and toolkit. A total of 19 health professionals took part in the qualitative study about the handbook and toolkit. They viewed the resources favorably, felt empowered to support people with diabetes experiencing psychological problems, and felt motivated to share the resources with others. Some gave examples of how they had used the handbook in clinical practice. A perceived highlight was the inclusion of a process model outlining 7 steps for identifying and supporting people with emotional problems: the 7 A's model. With funding from the National Diabetes Services Scheme (NDSS), more than 2400 copies of Diabetes and Emotional Health have been distributed. It is freely available on the Web. The NDSS is an initiative of the Australian Government administered with the assistance of Diabetes Australia. Conclusions: The new evidence-based resources are perceived by stakeholders as effective aids to assist health professionals in providing emotional support to adults with diabetes. The 7 A's model may have clinical utility for routine monitoring of other psychological and health-related problems, as part of person-centered clinical care. ", doi="10.2196/15007", url="https://formative.jmir.org/2020/2/e15007", url="http://www.ncbi.nlm.nih.gov/pubmed/32130112" } @Article{info:doi/10.2196/15017, author="Salvador Verg{\'e}s, {\`A}ngels and Yildirim, Meltem and Salvador, Bertran and Garcia Cuyas, Francesc", title="Trends in Scientific Reports on Cartilage Bioprinting: Scoping Review", journal="JMIR Form Res", year="2019", month="Aug", day="28", volume="3", number="3", pages="e15017", keywords="cartilage 3D printing", keywords="knowledge", keywords="tissue engineering", keywords="surgery", keywords="cartilage repair", keywords="chondrogenesis", keywords="cartilage biomaterials", abstract="Background: Satisfactory therapeutic strategies for cartilaginous lesion repair do not yet exist. This creates a challenge for surgeons and biomedical engineers and leads them to investigate the role of bioprinting and tissue engineering as viable treatments through orthopedic surgery, plastic surgery, and otorhinolaryngology. Recent increases in related scientific literature suggest that bioprinted cartilage may develop into a viable solution. Objective: The objectives of this review were to (1) synthesize the scientific advances published to date, (2) identify unresolved technical problems regarding human application, and (3) identify more effective ways for the scientific community to transfer their findings to clinicians. Methods: This scoping review considered articles published between 2009 and 2019 that were identified through searching PubMed, Scopus, Web of Science, and Google Scholar. Arksey and O'Malley's five-step framework was used to delimit and direct the initial search results, from which we established the following research questions: (1) What do authors of current research say about human application? (2) What necessary technical improvements are identified in the research? (3) On which issues do the authors agree? and (4) What future research priorities emerge in the studies? We used the Cohen kappa statistic to validate the interrater reliability. Results: The 13 articles included in the review demonstrated the feasibility of cartilage bioprinting in live animal studies. Some investigators are already considering short-term human experimentation, although technical limitations still need to be resolved. Both the use and manufacturing process of stem cells need to be standardized, and a consensus is needed regarding the composition of hydrogels. Using on-site printing strategies and predesigned implants may allow techniques to adapt to multiple situations. In addition, the predictive capacity of implant behavior may lead to optimal results. Conclusions: Cartilage bioprinting for surgical applications is nearing its initial use in humans. Current research suggests that surgeons will soon be able to replace damaged tissue with bioprinted material. ", doi="10.2196/15017", url="http://formative.jmir.org/2019/3/e15017/", url="http://www.ncbi.nlm.nih.gov/pubmed/31464195" } @Article{info:doi/10.2196/13643, author="Hall, Cougar and Hoj, H. Taylor and Julian, Clark and Wright, Geoff and Chaney, A. Robert and Crookston, Benjamin and West, Joshua", title="Pedal-Assist Mountain Bikes: A Pilot Study Comparison of the Exercise Response, Perceptions, and Beliefs of Experienced Mountain Bikers", journal="JMIR Form Res", year="2019", month="Aug", day="13", volume="3", number="3", pages="e13643", keywords="public health", keywords="physical activity", keywords="heart rate", abstract="Background: Mountain biking is an aerobic physical activity that has experienced rapid growth. The emergence of the electric pedal-assist mountain bike (eMTB), while not without its critics, presents the potential for an even larger segment of the population to enjoy the health benefits of mountain biking. Although the research focused on the use of e-bikes generally is growing, there is limited research specifically targeting eMTB use. Research is needed exploring the potential exercise response of riding an eMTB, together with the beliefs and perceptions of mountain bikers who have and have not experienced eMTB riding. Objective: This study aimed to compare conventional mountain bike and eMTB use. This was done by investigating 2 questions: (1) What proportion of exercise response is retained for an experienced mountain biker while using an eMTB when compared with a conventional mountain bike? and (2) What are the perceptions and beliefs of experienced mountain bikers toward eMTBs both before and after riding an eMTB? Methods: A convergent mixed methods data collection approach was used in the study. Participants completed both a pre- and postride questionnaire, and data regarding heart rate were collected. Heart rates from each ride were compared against each other. Results: The average heart rate during eMTB use was 94\% (31/33) of the average heart rate during conventional mountain bike use. Therefore, eMTB use in this study achieved a majority of the exercise response and exceeded established biometric thresholds for cardiovascular fitness. Paired t test statistics were calculated to compare beliefs of conventional mountain bikes and eMTBs and to compare mean heart rate and speed between conventional mountain bike and eMTB use on the study loop. Participants overwhelmingly perceived the potential impact of eMTB use to be positive on both pre- and post-eMTB ride questionnaires. Conclusions: Despite the measured benefit, participants' perceived exertion while riding the eMTB was low. ", doi="10.2196/13643", url="http://formative.jmir.org/2019/3/e13643/", url="http://www.ncbi.nlm.nih.gov/pubmed/31411139" } TY - JOUR AU - Kalokhe, Shivdas Ameeta AU - Iyer, Sandhya AU - Katendra, Tuman AU - Gadhe, Keshav AU - Kolhe, R. Ambika AU - Paranjape, Anuradha AU - del Rio, Carlos AU - Stephenson, Rob AU - Sahay, Seema PY - 2019/01/18 TI - Primary Prevention of Intimate Partner Violence Among Recently Married Dyads Residing in the Slums of Pune, India: Development and Rationale for a Dyadic Intervention JO - JMIR Res Protoc SP - e11533 VL - 8 IS - 1 KW - intimate partner violence KW - prevention KW - gender-based violence KW - domestic violence KW - intervention N2 - Background: Intimate partner violence (IPV) is frequently experienced by women of low socioeconomic status in India. It is a human rights violation and associated with negative effects on physical and mental well-being, underscoring the need for effective prevention strategies. Objective: This study aimed to develop a dyadic intervention for the primary prevention of IPV among newly married couples residing in slum communities in India. Methods: The intervention was developed using a community-based, mixed-methods design rooted in couple-interdependence theory and guided by the intervention mapping (IM) framework. It used the six critical IM steps to inform the content and delivery of the intervention: (1) needs assessment, (2) preparation of matrices of change objectives, (3) selection of theory-based methods and practical applications, (4) production of intervention components and materials, (5) intervention adoption and implementation, and (6) evaluation planning. Results: The resulting Ghya Bharari Ekatra (Take a Flight Together) intervention is intended to be delivered in 6 weekly sessions by a trained pair of male and female lay community educators to groups of 3 to 5 newly married couples in the community in which they reside. It uses games, discussions, self-reflections, and skill-building exercises to cover the following topics: enhancing relationship quality time, self-esteem and resilience, communication and conflict management, goal setting and implementation, sexual communication and sexual health and reproductive health knowledge, and redefining and challenging norms surrounding IPV occurrence. The formative work guided the protocol, including module duration and timing (2-hour sessions of convenience to participants), ordering of modules (based on potential level of interest and sensitivity of the topics), content (ie, informed scripts of role plays and films), intervention delivery methods (ie, interactive activities), and selection of the interventionists (based on capacity to connect with participants) and venue (community-based, convenient, and safe spaces). Ghya Bharari Ekatra was piloted between January and May 2018, and evaluation is presently underway. Conclusions: Ghya Bharari Ekatra is evidence-based, grounded in intervention-mapping, and developed and iteratively refined using a community-based participatory research approach, suggesting it has great potential to be an acceptable and effective solution to preventing IPV among newly married couples. Trial Registration: ClinicalTrials.gov NCT03332134; https://clinicaltrials.gov/ct2/show/NCT03332134 UR - http://www.researchprotocols.org/2019/1/e11533/ UR - http://dx.doi.org/10.2196/11533 UR - http://www.ncbi.nlm.nih.gov/pubmed/30664483 ID - info:doi/10.2196/11533 ER - bi.nlm.nih.gov/pubmed/30664483" } @Article{info:doi/10.2196/11189, author="McCreery, L. Jessica and Mackintosh, A. Kelly and Cox, S. Narelle and McNarry, A. Melitta", title="Assessing the Perceptions of Inspiratory Muscle Training in Children With Cystic Fibrosis and Their Multidisciplinary Team: Mixed-Methods Study", journal="JMIR Pediatr Parent", year="2018", month="Oct", day="25", volume="1", number="2", pages="e11189", keywords="cystic fibrosis", keywords="health perceptions", keywords="inspiratory muscle training", keywords="mobile phone", keywords="pediatrics", keywords="qualitative", abstract="Background: Little is known about the opinions or perceived benefits of an inspiratory muscle training intervention in patients with cystic fibrosis and their multidisciplinary team. Objective: The aim of this qualitative study was to examine patients' and multidisciplinary teams' views on inspiratory muscle training to inform and tailor future interventions. Methods: Individual, semistructured interviews were conducted to evaluate participants' perspectives of a 4-week inspiratory muscle training intervention. In this study, 8 of 13 individuals involved in the inspiratory muscle training program (5 children aged 11-14 years; 2 physiotherapists; and 1 respiratory physician) participated. Interviews were transcribed verbatim, analyzed using thematic analyses, and then coded into relevant themes. Results: Four key themes emerged: acceptability, facilitators, barriers, and recommendations. While fun, enjoyment, and improved perceived physical ability were reported by children and their multidisciplinary team following the inspiratory muscle training program, the multidisciplinary team identified factors such as time and cost as key barriers. Conclusions: A short inspiratory muscle training program was perceived to have positive effects on the physical ability and psychosocial health of children with cystic fibrosis. These findings highlight the importance of obtaining participants' and multidisciplinary teams' perceptions and recommendations to ensure the efficacy and optimal design of future inspiratory muscle training protocols. ", doi="10.2196/11189", url="http://pediatrics.jmir.org/2018/2/e11189/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518290" } TY - JOUR AU - Saberi, Parya AU - Berrean, Beth AU - Thomas, Sean AU - Gandhi, Monica AU - Scott, Hyman PY - 2018/01/16 TI - A Simple Pre-Exposure Prophylaxis (PrEP) Optimization Intervention for Health Care Providers Prescribing PrEP: Pilot Study JO - JMIR Formativ Res SP - e2 VL - 2 IS - 1 KW - pre-exposure prophylaxis KW - PrEP KW - health care providers KW - HIV KW - technology KW - panel management N2 - Background: Pre-exposure prophylaxis (PrEP) has been shown to be highly effective for the prevention of HIV in clinical trials and demonstration projects, but PrEP uptake and adherence outside of these settings in the United States has been limited. Lack of knowledge and willingness of health care providers (HCPs) to prescribe PrEP is an important barrier to implementation. Objective: The objective of this study was to describe and examine the feasibility and acceptability of a PrEP Optimization Intervention (PrEP-OI) targeted at HCPs. The ultimate purpose of this intervention was to increase PrEP uptake, adherence, and persistence among those at risk for HIV acquisition. Methods: This intervention included the following: (1) a Web-based panel management tool called PrEP-Rx, which provides comprehensive HIV risk assessment, automates reminders for follow-up, and reports patients? history of PrEP use; and (2) centralized PrEP coordination by a clinical support staff member (ie, the PrEP coordinator) who can identify individuals at risk for HIV, provide medical insurance navigation, and support multiple HCPs. Feasibility was evaluated based on HCPs? ability to log in to PrEP-Rx and use it as needed. Acceptability was assessed via individual formative qualitative interviews with HCPs after 1 month of the intervention. Results: The intervention was feasible and acceptable among HCPs (N=6). HCPs identified system-level barriers to PrEP provision, many of which can be addressed by this intervention. HCPs noted that the intervention improved their PrEP knowledge; increased ease of PrEP prescription; and was likely to improve patient engagement and retention in care, enhance communication with patients, and improve patient monitoring and follow-up. Conclusions: Given the critical role HCPs serve in disseminating PrEP, we created an easy-to-use PrEP optimization intervention deemed feasible and acceptable to providers. Further research on this tool and its ability to impact the PrEP continuum of care is needed. UR - http://formative.jmir.org/2018/1/e2/ UR - http://dx.doi.org/10.2196/formative.8623 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/formative.8623 ER - /" }